The old man and the heel spur

Rereading Ernest Hemingway’s novella ‘The Old Man and the Sea,  I was intrigued by the references  to Joe DiMaggio and in particular to his diagnosis of heel spur. Things were getting tough in the boat at the time, with Santiago the old man saying:

“But I must have confidence and I must be worthy of the great DiMaggio who does all things perfectly even with the pain of the bone spur in his heel. What is a bone spur? he asked himself. Un espuela de hueso. We do not have them. Can it be as painful as the spur of a fighting cock in one’s heel? I do not think I could endure that or the loss of the eye and of both eyes and continue to fight as the fighting cocks do”

Hemingway makes it sound painful. Interestingly, heel spur is a metaphorical diagnosis and metaphors are rare in ‘The Old Man and the Sea’.

Donald Trump has/had heel spurs too. He was diagnosed with heel spurs in 1968 resulting in a deferment for military service in the Vietnam war. He called it a temporary malady, was no longer bothered by it, avoided surgery  and “over a period of time it  healed up” (New York Times NYT Aug 1 2016). It doesn’t seem to affect his golf.

Three clinical Trump and DiMaggio heel spur thoughts

  1. Trump is right – the symptoms related to heel spur labels are nearly always temporary and the processes behind it will usually heal up. DiMaggio had surgery (removal of spur and fat pad in his case) and was never the same again.
  2. ‘Heel Spur’ is a metaphorical diagnosis just like ‘whiplash’, ‘total knee replacement’ and ‘frozen shoulder’ are. And being a metaphor, it will surely mean different things to different people. It’s already a scary label with its evoked imagery of cowboy spurs, blood, rooster spurs and a sharp point to step on that may perhaps even break. The embodiment of the heel spur label itself may be as important in any other variable in the pain experience. Perhaps Hemingway have been partly responsible for increasing the pain in generations of people labelled as having ‘heel spur’.

From Moseley GL, Butler DS 2017 Explain Pain Supercharged, Noigroup

  1. Remember, bony outgrowths from the calcaneum  occur in around 25% of the population and are increasingly common with aging. They are rarely in the plantar fascia too. Reasoning clinicians should consider other processes including inflammation in any structure, neurogenic inflammation via calcaneal nerves (test SLR with ankle dorsiflexion and eversion), calcaneal nerve ectopia, nerve root referral and upregulated foot representations in the cord and brain after reading about Donald Trump and especially Joe DiMaggio’s heels. Start any treatments by removing the name ‘heel spur’ and remembering that a bone can’t hurt by itself.

– David Butler

 

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