Heel Spur

Heel Spur

A heel spur is a hooked bony growth protruding from under the heel bone (calcaneus). It has identical symptoms to, and is often found to co-exist with plantar fasciitis.

Heel Spur Symptoms

Symptoms may be very similar to those of plantar fasciitis and include:

  • Pain and tenderness under the heel, especially when weight bearing.
  • Pain may be worse on standing first thing in the morning and ease off later as the foot warms up, only to return later.
  • Symptoms are usually worse with running or walking and improve with rest.
  • The main diagnosis of a heel spur is made by X-ray where a bony growth on the heel can be seen.

A heel spur can also occur without any symptoms at all and you would never know you have one unless it was spotted on an Xray.

What causes a heel spur?

Formation of a heel spur is thought to be due to repetitive trauma. This could be due to repetitive traction (pulling) on the plantar fascia insertion on the calcaneus (heel bone). Or repetitive trauma to the plantar fascia, or the small muscles of the foot which insert into the calcaneus.

Heel spur anatomy

In some people, this could be due to a genetic predisposition to develop new bone growth in response to repetitive trauma. Running, jumping and ballet have been found to be risk factors causing repetitive trauma leading to the heel spur formation.

In the younger population, females have been found to have a higher rate of incidents of heel spur formation.

A heel spur can also occur as a normal anatomical variation of the calcaneus bone in some cases. It can also occur as a normal process of ageing with calcification of ligaments.

Heel spur formation has also been found to be associated with:

  • A change in the gait pattern (how you walk).
  • Increasing weight. Therefore there is a greater pressure on your foot.
  • Overpronation and flat feet.
  • Rheumatoid and osteoarthritis.

Why are some heel spurs painful?

Pain from heel spurs can be due to decreased elasticity of the heel fat pad and sometimes it can also be due to compression of a small nerve in the foot which can lead to muscle atrophy.


Heel Spur Treatment

Rest – the most important part of treatment is rest. Do not undertake activities which hurt your foot or aggravate symptoms as this will only cause painful symptoms to persist.

Ice – apply a cold therapy wrap regularly for 10 minutes at a time every hour initially to reduce pain and inflammation of the surrounding tissues. As symptoms subside, the frequency of application can reduce to 2 or 3 times per day.

Arch support taping – is an excellent way of providing support and protection to the heel. A plantar fasciitis taping technique can often relieve symptoms instantly. All that is needed is a simple roll of 2.5cm zinc oxide tape.

Plantar fasciitis taping

Medication – anti-Inflammatory medicine (e.g. ibuprofen) may be prescribed by a doctor but always check with a medical professional first. Taking some medications such as ibuprofen should not be done if the patient has asthma.

Shoe inserts – can help to take the pressure off the heel spur and reduce pain. If these treatments do not significantly ease the symptoms then surgical excision of the extra bone may be an option, but recureence can occur.

Exercises – in particular stretches to keep your foot and ankle strong and mobile are important, if pain allows. Stretching the plantar fascia is particularly important, especially if symptoms are worse in the morning.

Plantar fasciitis night splint – is worn overnight if possible and is excellent for stretching and preventing the plantar fascia tightening up overnight.


Stretching Exercises

Plantar fascia stretching

Ultimately, getting rid of long-term pain means stretching the plantar fascia so it does not put additional strain on the insertion to the heel.

  • One way the plantar fascia can be stretched is by pulling up on the foot and toes with the hands.
  • Hold the stretch for about 30 seconds.
  • Repeat this stretch 5 times and aim to stretch 3 times a day.
  • Calf muscle stretches are also important.

Plantar Fasciitis Night Splint

Plantar fasciitis night splint
Plantar fasciitis night splint

The night splint is normally worn overnight, although it can be applied for shorter periods during the day. It works by preventing the tissues from tightening up overnight.

Some people may find them uncomfortable to wear, but if you can gradually increase the wearing time each night then the results can be worth it. Wearing a night splint is more effective then plantar fasciitis stretches alone.


References

  • Kirkpatrick, J. , Yassaie, O. and Mirjalili, S. A. (2017), The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations. J. Anat., 230: 743-751. doi:10.1111/joa.12607
  • American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. Schneider, Harry P. et al. The Journal of Foot and Ankle Surgery, Volume 57, Issue 2, 370 – 381
This article has been written with reference to the bibliography.