It is caused by excessive pulling of the plantar fascia on the periosteum at the attachment of the heel bone. Excessive pulling causes pain at the inner edge of the plantar fascia (plantar fasciitis). Lesions that cause tension in the plantar fascia include flatfoot and Achilles tendon contracture. Rheumatoid arthritis and gout are other causes of heel pain. These arthralgias are often associated with moderate to severe fever and swelling, which can be distinguished from local causes of heel spur syndrome. Compression of the vascular nerves by the proliferating spur can lead to severe pain in the foot, difficulty walking and even paralysis. Osteomalacia has become one of the most difficult diseases affecting the quality of life of the elderly. This disease is best treated with small acupuncture and is usually cured in one visit.