Get the facts about heel spurs, and learn how to safely service clients with this condition.
Heel spurs aren’t well understood, which is why clients who tell you they have them are likely wrong—and clients who do have them might not even know it. Also called calcaneal spurs (calcaneus is the medical term for heel bone), heel spurs are caused by a buildup of calcium that creates a protrusion, usually no more than an inch or so long, on the underside of the foot that might be pointy or, as often described, “shelflike.” Spurs can cause a dull ache throughout the day and often hurt when people get up in the morning or when they stand up quickly after sitting for a while.
Contributing to the confusion is that many people with heel spurs don’t have any symptoms at all. In addition, they’re rarely visible through the surface of the skin, nor can you typically feel them through the skin. A lot of people with heel pain assume that heel spurs are the cause, but an X-ray is the only way to know for sure, says Ami Sheth, DPM, a podiatrist in Los Gatos, California, and a spokesperson for the American Podiatric Association. “I’ve seen some people with pretty large spurs, but they don’t bother them,” says Sheth. “Most of the time when people say, ‘I have heel spurs,’ they mean they have plantar fasciitis.”
So, what causes heel spurs to develop, how are they treated and is it safe for nail techs to service clients with this condition? Here’s what you need to know.
Bone spurs develop in the foot as the body’s way of creating length when the plantar fascia, or band of tissue that connects the heel bone to the toes, is tight. Essentially, if the heel bone grows out a little more, it decreases the length the plantar fascia needs to stretch, stopping the tugging on it that can cause pain and discomfort. There are two different types of spurs, says Sheth: A spur going north, heading away from the ground at the back of the heel, can develop if your Achilles (the tendon that connects calf muscles to the heel) is too tight, and a spur along on bottom is related to plantar fasciitis (when the fascia is inflamed and irritated), the most common cause of heel pain. The two conditions are often related, but it’s more common for plantar fasciitis, not heel or bone spurs, to cause foot pain.
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One out of 10 people has heel spurs, but only one out of 20 people with heel spurs experiences foot pain, according to the American Academy of Orthopaedic Surgeons. “In terms of pain, the spur itself kind of doesn’t matter,” says Sheth. “The issue is the traction. It’s the pulling or tightening of the fascia that’s really the problem.”
Some oft-cited contributors to the development of heel spurs are obesity, age, being active in sports, wearing high heels, and having a high arch or no arch in the foot. But the biggest factor in risk for heel spurs is simply how a person’s body is put together, says Sheth. “The mobility of the foot as it hits the ground and the tightness of the plantar fascia are two of the biggest reasons you get it,” she says. “So, it’s not necessarily because you wear heels; it’s the biomechanical differences in all of us—how our heel hits the ground and how the muscles and tendons are all attached.”
In other words, heel spurs can develop if there’s a biomechanical mismatch in the way your plantar fascia is able to stretch and spring back, says Sheth. But even though it’s typically a biomechanical issue, lifestyle choices, such as wearing shoes that don’t provide good arch support, working on your feet all day or playing sports, play a role as well. “I usually see it with people who run or are really active in sports,” says Janet McCormick, MS, a licensed nail tech and cofounder of the Nailcare Academy in Fort Myers, Florida.
Treatment and Prevention
Although the development of heel spurs depends a lot on a person’s biology, it’s smart to be proactive about preventing them, says Sheth. The plantar fascia and calf muscles are all connected, so one of the best ways to keep them supple is to stretch them regularly. “You prevent spurring in a roundabout way, because it’s really heel pain you’re trying to prevent,” she says. “Stretch your calf muscles and wear supportive shoes if you start noticing a mismatch or heel pain.” In addition, icing the feet and anti- inflammatory medication can help many people combat heel pain, says Sheth.
If those measures prove ineffective, a podiatrist might prescribe cortisone injections, physical therapy, stem cell shots or orthotics (customized foot support). For some people, the divide between the heel bone and plantar fascia is so great that surgery is the only answer, says Sheth. Surgical intervention is rarely needed, however, and if it is, it’s a simpler procedure than in years past, when surgeons would cut the heel spur off, she says.
When it comes to servicing a client who potentially has heel spurs, keep in mind that some spurs are painful, but some aren’t and don’t require special attention, says Denise Baich, ANT, FNT, MNT, a licensed medical nail tech and owner of Pedicure Plus, a salon in the office of Premier Podiatry in St. Louis. Make sure to find out what you’re dealing with before going ahead with a service. “As part of the initial evaluation when a client arrives for an appointment, we discuss any pain or discomfort so that we can tailor the service accordingly,” says Baich.
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Before you start the service, you should check the feet for tenderness, says McCormick. “One of the problems is that many nail techs just look at the feet,” she says. “Instead, they need to gently press areas, such as on the heel where it turns and curves under, to see if they’re sensitive.” Treat clients with heel pain gently, she advises, by making sure to avoid pressing down on the top of the foot when its on the foot rest and filling footbaths with temperate water.
If a client tells you that she feels any sharp, sudden pains in her feet, however, it’s best to suggest that she go to a podiatrist to have it checked out. “As pedicurists, this diagnosis is beyond our scope, as is treatment,” says Baich. “Our area of expertise would be along the lines of providing a soothing massage or topical application that would provide some comfort or temporary relief.”
Heel Spur Facts
- One in 10 people in the United States has heel spurs.
- Around 20 percent of people with heel spurs don’t have any symptoms.
- Heel spurs are frequently associated with plantar fasciitis, the most common cause of heel pain.
- Middle-age men and women are more likely to develop heel spurs.
- Orthotic devices, shoe inserts and heel lifts can help relieve the pain associated with heel spurs.
Sources: Lancaster Orthopedic Group, lancasterortho.com; MedicineNet, medicinenet.com; American Podiatric Medical Association, apma.org; WebMD, webmd.com
–by Virginia Pelley
This story first appeared in the June issue of Nailpro magazine. To receive the magazine, click here to subscribe.
[Images: Getty Images]