When a calcium deposit forms on the heel bone (the calcaneus), it forms a bone-like growth that is known as a heel spur. Heel spurs are usually only visible on xrays, and cannot normally be detected with the naked eye. Heel spurs can be underneath the heel or at the back of the heel, and they may be present on one or both heels of an affected patient. They are commonly associated with the inflammatory conditions: plantar fasciitis and Achilles tendonitis.
What causes heel spurs to develop?
Heel spurs develop when calcium builds up in a ‘stressed’ location. This happens as a result of constant and excessive pressure placed on the attachment points of the ligaments or tendons in the foot that attach at the heel. In patients with heel spurs associated with plantar fasciitis, the growth is underneath the heel, where the plantar fascia ligament attaches to the calcaneus; and in patients with Achilles tendonitis, the associated heel spur is usually at the back of the heel bone, where the Achilles tendon attaches. Repeated strain from walking, running, or jumping barefoot, especially on hard surfaces, is a common cause of heel spurs. Heel spurs can also be a common issue in people with problematic foot biomechanics (less than ideal gait/walking pattern in the foot due to malalignment of the muscles and soft tissue structures in the lower leg and foot). Some other causes of heel spurs may include wearing unsupportive footwear and overweight / obesity.
What are the symptoms of heel spurs?
It was previously though that heel spurs are the direct cause of heel pain. It is now widely accepted that the spurs themselves do not cause the pain, but rather, the pain is caused by the inflammation of the surrounding tissues. This inflammation may be due to inflammatory conditions such as plantar fasciitis or Achilles tendonitis, or the physical pressure on structures such as the heel fat pad, where the heel spur ‘digs in’ to the tissue.
The pain associated with heel spurs is usually described in ways ranging from intermittent to constant and chronic. The pain is normally localized and can be pin-pointed, and it is usually worst first thing in the morning. It may be sharp initially, but often subsides to a dull ache. Patients usually experience more severe pain when walking or running barefoot, especially on hard surfaces.
How are heel spurs diagnosed?
You will need to see your specialist sports podiatrist for a proper diagnosis, as the symptoms of heel spurs are very similar to many other ankle and foot complaints that will need to be excluded. In the majority of cases, heel spurs can only be diagnosed on xray. Before requesting you have an xray though, your sports podiatrist will ask you a number of questions about your pain, and they will conduct a series of tests. Some of these may include palpating (physically feeling) the areas of the foot to locate the source of the pain.
As part of their examination, your sports podiatrist may wish to conduct a biomechanical assessment and motion analysis of your lower leg and foot on their treadmill. This can be a fantastic diagnostic tool, as it will allow your podiatrist to determine the alignment of your foot and visualize any imbalances in your gait (walking pattern), therefore providing valuable information about where the areas of greatest pressure in your foot are.
What treatments are available for heel spurs?
Treatment for heel spurs is usually based around reducing inflammation to relieve pain. Your sports podiatrist may recommend some of the following treatments:
Rest, to take the pressure off your feet, reduce inflammation and help to relieve pain
Use a cold compress or ice pack for 15-20 minutes a few times a day to reduce inflammation
Stretching and strengthening exercises, to assist you in managing the pain long-term. Your sports podiatrist can recommend which types of exercises are most appropriate for your condition, to ensure that you are only undertaking beneficial exercise and not exacerbating your condition
Shoe inserts such as heel pads or orthotics may be recommended for you to provide arch and heel support to reduce pain and allow healing to take place more permanently.
Over-the-counter anti-inflammatories may be advised for short-term use in patients with severe and debilitating pain, however these have side-affects and are therefore not a solution in the longer term.
In some severe cases, if the heel spurs are very painful and ongoing, surgery may be recommended, though this is uncommon. Of the patients that do have surgery to remove their heel spurs, most are also suffering with plantar fasciitis or Achilles tendonitis, and the surgery indicated is corrective for these conditions as well.
Are heel spurs preventable?
Preventing heel spurs from developing is largely a case of paying attention to the overall health of your feet and arches. Simple things like managing your weight and ensuring that you are wearing correctly fitted and appropriate shoes for your foot and type of activity are key. Always ensure that you are taking time to warm up appropriately with functional stretches for the type of exercise you are engaging in, so that you reduce the risk of over-stretching or straining the ligaments and tendons in your ankle and foot, or developing tight calf muscles that will pull on the heel. Avoid running and jumping on hard surfaces.
Most importantly, never continue to push through any heel pain. Heel spurs develop from prolonged and repeated stress, and with that in mind, you should not continue to exercise or wear shoes, that cause you pain. If you experience heel pain, ice the sore foot, elevate and rest it, and make an appointment with your sports podiatrist as soon as is practical for a thorough medical assessment.
The information regarding heel spurs provided above should not be taken as general advice and is for educational purposes only. If you have heel pain and suspect you may have a heel spur, you should consult with a suitably qualified sports podiatrist to discuss your condition. You can make an appointment with one of our specialist podiatrists by emailing email@example.com or by calling 82110600.
For many years Heel spurs have been misdiagnosed as the cause of the severe pain in the heel. Upon x-ray, practitioners observed a spur-like growth of bone at the point where the plantar fascial ligament, or Achilles Tendon inserts at the heel – this can be clearly seen in the x-ray below. It was therefore wrongfully concluded that such an obvious growth must be the cause of the pain.
Heel spurs can occur under the heel in association with plantar fasciitis and at the back of the heel in patients with Achilles Tendon problems / tight calf muscles. Unfortunately, this misdiagnosis resulted in many years of ineffective treatment (and this still occurs today) with patients unable to find a cure that offered any long-term relief. Spurs are nature’s way of making a connection to tight tissue that pulls on an attachment. They are created by pulling, but are not a part of the pain.
The actual pain is the pulling and tearing of the micro fibres of the soft tissue at its insertion point at the heel. The ensuing growth of bone or “heel spur” is merely a by-product.
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