By JUDY SIEGEL-ITZKOVICHheel 521(photo credit: Wikimedia Commons)I am an active 80-year-old woman.I suffer from terrible pain from heel spurs. My doctor gave me an injection and sent me for silicone inserts in my shoes. Nothing helps! Is there anything else that can be done?D.W., JerusalemYoel Greenwald, a veteran health fund and private podiatrist, replies: A heel spur is a deposit of calcium on the bottom of the heel bone. It is a very common condition and occurs more often in women than in men.Sometimes they can be harmless, but they are frequently painful in the long term and sometimes excruciating.They are often connected with plantar fasciitis, a painful inflammation of the connective tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the ball of the foot. The condition is not necessarily connected to age.Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Many people describe the pain of heel spurs and plantar fasciitis like a nail or knife stuck in the bottom of the foot. The bone itself is usually not the problem; rather, it is usually when the tendon attached to bone is inflamed. Sufferers usually have a high-arch foot type – the opposite of flat feet – tight fascia and tight musculature in the calf.I advise sufferers to wear shoes with a small heel, not a completely flat one and not high heels, which causes the muscles to become shorter. Wearing small heels alleviates tension that causes inflammation.In addition, special five-centimeter- wide straps or tape can be bound to the foot, from the arch to the heel.This reduces tension on the fascia. I prefer them to insoles for this purpose.I also recommend warm baths of the affected foot to get the blood flowing at the end of the day, and then following that with cold baths to calm down the foot and prevent inflammation. A simple anti-inflammatory pill such as ibuprofen can be given for two weeks; this is preferable to cortisone injections, which can however be given for more serious cases.There is also extra-corporeal shock wave therapy (ESWT), or lithotripsy, which used to be given for kidney stones. The soft tissue and bone in the boot can be exposed to pulses of high pressure. This can cause the calcium deposits to disintegrate, and the tissue can often heal nicely. Some patients feel better after a few treatments.Another possibility, which is much more drastic, is surgery to cut the tendon from the bone, but few patients need this. Generally, only one foot at a time is affected by heel spurs.My daughter is considering growth hormone for my granddaughter, who is below average height for her age. She has just turned 11, and an X-ray of her hand shows bone development to be that of age 10. A blood test showed nothing out of the ordinary.The thought of playing around with a child’s hormone levels appalls me, but I appreciate that my granddaughter would feel better about herself if she were taller. How safe is the therapy? How long has the treatment been available, and have there been any adverse effects from it? P.C., BinyaminaProf. Moshe Philip, chief of endocrinology at Schneider Children’s Medical Center for Israel in Petah Tikva, replies: The use of growth hormone for treating children with short stature was approved by the US Food and Drug Administration in 2003. The conditions for use were very strict – that boys be under 1.6 meters and girls under 1.5 meters, and that they be under the 1.25 percentile in height. This is assessed in the middle and end of puberty, at 13 years in girls and 14 or 15 in boys. As a result, a paper that won international consensus was published in 2008 in a prominent journal that explained the reasons for and against the use of growth hormones and the risk.There are rare, short-term complications, such as intracranial pressure; we don’t know enough about longterm ones. So we are careful about deciding to give growth hormone to children. I give it sometimes myself, but it is not a cosmetic solution for all short children; their problem must be extreme.Growth hormone therapy is not in the basket of health services; partial coverage is available in supplementary health insurance policies. Only pediatric endocrinologists can give it.Companies that make the hormone have to keep a registry listing cases with complications.Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting.Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com, giving your initials, age and place of residence.
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