High impact exercise, excess weight, arthritis - even standing on concrete for long periods - all can lead to a heel spur. With every step, the foot absorbs tremendous force. The heel strikes the ground with 2,000 pounds of force per 100 pounds of body weight. Most of the shock is absorbed by a muscle called the plantar fascia, an elastic-like band that stretches along the bottom of the foot and protects it from the stress of day-to-day activities.

An athlete who fails to warm up or a sedentary person who undertakes punishing weekend exercise can cause excessive stress on the hamstring muscle or Achilles tendon. Because they are attached, stress on one of these pulls the plantar fascia muscle, sometimes causing it to overstretch, become inflamed - even tear.

When it is injured, the muscle reacts by contracting or shortening whenever the patient sits or lies down. This brings temporary relief, but when he or she stands or walks on the tight muscle, the pain returns. It is especially intense on arising from a night's rest.

In an attempt to strengthen the muscle, the body creates calcification in the injured area, much in the same way it heals a broken bone. The heel calcifies, building up an extra layer of bone - a spur.

Surgery for a painful heel spur may be avoided if the patient seeks treatment early. Your podiatrist may tape the injured muscle or order oral medication to quiet the inflammation and ease the pain. He or she may anesthetize your heel and inject it with cortisone, but these injections should be limited to one or two.

Shock absorbing inserts for your shoes, available at sporting goods stores, may help. Some shoes come already fitted with this material. If your foot turns in abnormally, making you "pigeon-toed" and prone to heel spurs, your podiatrist can prescribe corrective orthotics - custom-made inserts for your shoes.

If surgery is necessary to remedy a heel spur, it can be done in the podiatrist's office. An innovative procedure employs only a tiny puncture of the heel under local anesthetic. No stitches are needed and the patient does not have to wear a cast.

I use a foot-controlled, fluoroscopic camera to monitor the procedure. It allows me to pinpoint the spur's exact location and precisely navigate tiny surgical instruments to snip muscle fibers and remove calcified fragment.

The patient can walk after surgery and usually is free of pain in about a week, but on occasion, some discomfort can persist for up to six months. If the patient's job involves sitting down from time to time, he or she can return to work within a week. Others who stand all day or do heavy lifting may need up to eight weeks off the job. Heel spur surgery is covered by most private health insurance, Medicare and Medicaid.

Of course no two people are the same. We would be happy to discuss your unique foot condition. You can always reach us:

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4. Arrange for a free in-office consultation.