Why are “Heel Spurs” Important When it Comes to Military Service?

The New York Times released an  article  today that claims President Trump was given the diagnosis of “heel spurs” so he would be exempt from military service.  Putting aside the ethical, moral and political components of this story; one might wonder why heel spurs would disqualify someone from service.

A heel spur is actually an abnormal outgrowth of bone of the calcaneus (heel bone).  They may occur on just one foot or both.  The tissue on the bottom of the foot called the plantar fascia attaches to the bottom of the heel bone and when stressed, can produce a spur of the bone due to the traction that is occurred with the stress of the fascia attachment.    It is the plantar fascia that actually causes the pain.

Heel pain is VERY common.  One estimate is that there are 5 million Americans that have heel pain at a given time.  Approximately 35-40% of patients at Family Podiatry Center present with the complaint of heel pain.

Plantar fasciitis developed as a diagnosis to more accurately define the source of the pain over time and it takes on definite course with consistent symptoms of pain in the morning and after periods of rest. More recently, some podiatric physicians that specialize in heel pain recognize that there are two forms of plantar fasciitis including a chronic version called plantar fasciosis.   The plantar fascia is much easier to treat before it becomes chronic and it’s important to seek treatment from a qualified podiatrist once the pain cycle changes.  Chronic plantar fascial damage will not respond to the traditional treatments and may require regenerative medical treatments.

So why did “heel spurs” exempt people from military service?  Aside from being very painful, heel pain was often associated with “flat feet” which tire easily.  Nowadays, both flat feet and heel pain are easily maintained using custom orthotic devices and no long pose a threat to our soldiers. 

Heel Pain - Why Some Shoes Help and Others Don't!

Millions of people suffer from heel pain - most of which (although not all) is due to plantar fasciitis/heel spurs/plantar fasciosis.  Some people swear by their Vionics/Birkenstocks/Oofos/Chaos sandals and most podiatrists will tell you to wear a closed heel shoe such as a running shoe for stability.  So which shoe is right for you and why??

First of all, let me tell  you that not only am I a podiatric physician, but I also suffer from plantar fasciitis (PF) on and off.  I have personal experience as well as professional experience and knowledge of the anatomy and biomechanics of the lower extremities.  The simple answer is:  What works for you may NOT work for someone else!

The more complicated answer comes down to foot type, foot structure and the reason for your plantar fasciitis and how long you have had it.  These individual factors become especially important in controlling re-occurrence which is common with PF.

First of all, it is so important to get rid of PF before it becomes chronic. Acute PF is thought to be inflammatory but chronic is not.  Chronic PF is a topic in of itself; but for now, know that steroid injections often fail because chronic PF progresses beyond inflammation producing scar tissue or tears within the fascia itself.

There are two important parts to controlling most acute PF - control of your rearfoot (heel and subtalar joint) and allowing the tight tissues to stretch.  Heel control is an integral part of treating acute PF because it helps control the motion of the heel causing inflammation.  Shoes with a stiff heel counter (the back of the heel) such as running shoes are a very important part of resolving heel pain.  I tell all my patients to wear them 24/7 "for now" to control the heel.  It's not necessary once the pain subsides, but until then it is a must!

Rearfoot control is also achieved with most types of custom orthotics. (This is how they differ from over the counter arch supports sold as "orthotics"). There are many factors if prescribing custom orthotics based on your shoe wear, foot type and associated anatomy.  Even if the orthotics prescribed by your podiatrist don't help the acute pain, they are important in controlling the heel to prevent re-occurrence!  Hopefully your podiatrist explained this to you, but if not,  don't be upset if they don't help get rid of the acute pain because they are still very important!

Both flat feet and high arch feet can develop PF due to tightness of the fascia, but also can develop from tightness of the Achilles tendon and even the hamstrings.  Vionics and Birkenstocks help people because they have a negative heel (where the heel sits lower than the toe box) which helps to stretch the Achilles tendon. While those sandals may help with the pain while wearing them, they often don't improve the condition overall because they don't provide heel control.   I think they are great once the pain has subsided and for those times that you absolutely can't wear sneakers, but sneakers with heel control are much better at getting the problem under control quicker.  Running shoes that have a negative heel are a great tool in allowing stretching of the Achilles as well as providing heel control.

Finally, a few words about those sandals that I mentioned and others that are heavily marketed to the public for heel pain.   Whenever anyone talks about heel pain, recommendations for these sandals are given quickly but the success of specific sandals is based on individual foot type!  Oofos, for example, provide extra shock absorption so they may be great for a high arch foot type but not for those that need a negative heel.  Vionics (based on personal experience) seem to provide rearfoot control further back in the arch as opposed to the high mid-arch support found with  Chaos which is a different type of control.  I know for myself and my foot type, this makes a huge difference.  It is important to make sure you have a discussion with your podiatrist on which sandal might be best for YOU once you get the PF under control.

Controlling PF goes beyond the control of shoes and sandals; but with so many people making recommendations to their friends on which of these costly shoes to buy I felt compelled to write about the differences between them and why YOUR foot may need something different than your friends.  Please see a podiatrist well versed in PF if your heel pain persists for longer than 4-6 weeks to be properly evaluated for YOUR individual treatment and shoe recommendations!

IMPORTANT PEDICURE TIPS!!

We are in full swing of summer now and women everywhere are getting their weekly pedicures or bimonthly!  Best advice if you have callouses is to SEE A PODIATRIST FIRST!

(BTW - toe nails grow slower than fingernails so you do NOT need to have them done with every manicure).




I often have patients saying they "catch" fungus from a pedicure but I honestly think that is not always the case.  Direct infection to the skin of the feet and legs, however is another story.

While not common, there are certainly documented cases where infections occur as a result of transferring bacteria (or fungus) from one person to another.   CBS News just put out this article of a woman almost losing her leg because a contaminated callous shaver was used on her.

So here are my tips for pedicures!

1)  Pedicurists in most states are not allowed to use blades or other callous removers.  If you have callouses that are thick, painful or simply unsightly, SEE A PODIATRIST to have them removed before you have your pedicure!  The benefits to the skin from the pedicure will last much longer if you have the callouses removed properly from a podiatrist.

Pinch Callous

2) Understand that callouses are a result of a structural problem and will continue to develop unless those problems are corrected.  Your podiatrist (podiatric physician) will educate you on the whys, hows and whens that influence your callouses.  Sometimes simply wearing custom orthotics can get rid of that "pinch" callous on the joint of your big toe that many of us seem to have.

3) Go to a salon first thing in the morning when the tools and whirlpools have the least chance of being contaminated.

4) Make sure they are using freshly sterilized instruments, including the nail files!

5) Never shave just prior to going for a pedicure.  This will reduce the risk of bacteria entering your skin if there is a contamination.

Finally - enjoy your freshly painted pink/red/blue/gray toes!!

Stilettos and Cobblestone - do the two work together???

Okay,  I am a little obsessed right now with Meghan Markle but not as much as Google thinks because I keep getting Meghan Markle news links!  But this one was pertinent.  Meghan wears heels on cobblestone in Dublin explores the difficulty wearing heels while walking on cobblestone streets!

I could swear I already wrote an article on this, but can't seem to find it.  The short answer is NO - of course high heels and cobblestones don't mix!  Walking on any uneven surface is difficult but cobblestone surface is uneven, irregular and a mix of contours joined together with sand.   And if you have ever tried walking in sand with heels, you know what additional problems that brings!

So what risks did Meghan take when walking on cobblestone in her 3 inch Sarah Flint shoes (not really stilettos if they are only 3 inches People Magazine)?  She risks spraining her ankles, spraying her foot, sustaining a fracture if she slips and getting those skinny heels stuck in that sand!

What the People article didn't talk about is the problem more women experience while wearing heels in another inconvenient surface:  grass.  They did provide a photo showing the Duchess of Sussex standing in the grass and mentioned that she was able to walk across the park, but the take home message in this instance is simply having those skinny heels sink into the grass!  I KNOW you have experienced that at least once.  in your high heel wearing life time!  Unlike walking on cobblestone, walking on grass while in heels once is certainly enough to make sure you don't make that mistake again.  Seems that getting stuck in the grass is more embarrassing than falling and spraining your ankles!  And who want to clean the mud off the heels while you are out and about all dressed up!

Bottom line - know where you will be walking BEFORE you venture out in those skinny heels!

It’s July 4th so we should all be thinking Red, White and Blue!! Even when we are thinking of our toes??

The color of each and every toe can indicate the health condition of that toe!

With the summer months of having exposed toes, it’s important to understand what each color might mean.

Red Toes.  Assuming we are not talking about active bleeding, having redness appear suddenly or even gradually may indicate inflammation.  Inflammation is your body’s reaction to something that is injuring or irritating your body.  Stubbing your toe, a cut in the skin or even an ingrown nail can all cause inflammation.   As inflammation increases, the area that appears red, or pink, may spread.  Infection is always a worry with redness as well.  It is often difficult to know if your redness is infection or inflammation so if it worsens, its important to see a podiatric physician as soon as possible.  At  Family Podiatry Center we always make room for same day appointments for injuries, ingrown nails or suspected infections.

White Toes.  If a toe turns white, it is likely related to your arterial (blood) supply to that toe.  People with heart disease or peripheral arterial disease may experience white toes, but even otherwise health people may have this problem.  Raynaud’s is a condition that causes spasm of the small arteries that give blood and oxygen to the toes.  Some people develop Raynaud’s by itself or it may be present with certain inflammatory or arthritic conditions.  It’s important to take protective measures of proper socks and shoe wear and not to smoke cigarettes which can increase the spasms of the arteries.  These spasms can occur in the cold of winter but also in damp climates regardless of temperature.  Speaking of cold weather…white toes in the winter may also be the result of frostbite!

Blue Toes.  Blue toes usually indicate that the veins leading the blood away from the toes are not working and the blood is pooling in the toes.  Veins function to bring blood from all areas of our body back to the heart.  With the toes having the smallest veins and being subject the most to gravity, venous congestion of the feet (and toes) can be a sign of vein disease.  It’s not uncommon for women and men n their 30’s and 40’s to begin having symptoms of vein issues.  A podiatric physician can identify if your veins are causing your swelling, pain or discoloration.

Resolutions for the New Year: Resolve to Walk!

New Year's Resolutions...................

Resolution #1:  Be more active on this Blog!!

So many people include exercise as a resolution for the new year.  So many people give it up because the exercise they have chosen becomes a hardship either because of cost or complicated new equipment.  In my mind, the best exercise is also the easiest:  Walking.

Walking requires no special equipment other than a pair of appropriate shoes.  Walking requires no cost of membership.  Walking requires no commitment or long term relationship with a gym.  Walking requires you to 1) put on your shoes and 2) Go!

I used to think the same about running.  I loved to run.  I loved the crisp fresh air and the energy I felt when I was out there engaging with the world outside.  And running was easy.  Just put on my shoes and go!  Running became a problem however, when I my knee scope showed significant arthritis.  So instead, walking became the new running.

There are a MILLION websites with info on running, especially with the new year just behind us.  This article is what inspired me to return to this blog after a much too long absence.  There is some great advice here on how to maximize your walking workout.  Walking is the simplest thing you can do to get in shape for the new year!

While I can't promise I will blog weekly, I will try to focus on walking more because I truly believe walking is the answer to many people's quest for fitness.

Today I want to talk about shoes.  While there used to be an entire category of "walking shoes" that I don't think were never intended for fitness walking.  The very best shoes for fitness walking are running shoes.  Running shoes, as opposed to tennis shoes, basketball shoes or even cross trainers allow you to propel in a forward motion from heel to toe.  Running shoes generally have more space in the toe box, provide more support, give padding at the ball of the foot and allow for shock absorption.  I am talking about traditional running shoes, not minimalist runners.

This post isn't intended to discuss the differences in the types of running shoes out there - that is an entirely different topic but the key elements are 1) making sure you have enough arch support if you are a pronator and 2) making sure you have enough shock absorption if you have a high arch foot and 3) its important to see a podiatric physician to determine your foot type and to be evaluated if you should be in custom orthotics before buying new running shoes.   For now, however, make the resolution to walk, find your running shoes and Go!