Heel Spur

Heel Spur

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

Treatment involves rest, reducing symptoms with ice or cold therapy, stretching and correcting foot biomechanics.

Heel Spur Symptoms

Symptoms may be very similar to those of plantar fasciitis and include pain and tenderness under the heel, pain on weight bearing and in severe cases, difficulty walking. Pain may be worse on standing first thing in the morning and ease off later as the foot warms up, only to return later with increased weight bearing, running or walking. Rest urually relieves pain.

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

The heel 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.

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 the athlete would never know they have one unless it was spotted on an Xray. Likewise, Plantar fasciitis can occur without a heel spur.

What causes a heel spur?

Formation of a heel spur is thought to be due to repetitive trauma. This could be due to repetitive longitudinal traction on the plantar fascia insertion on the calcaneum or repetitive mechanical trauma to the plantar fascia or the small muscles of the foot which insert into the calcaneum. In some, this could be due to a genetic predisposition to develop bone 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.

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

Heel spur formation has been found to be associated with increasing age possibly due to the change in the gait pattern, increasing weight due to the greater pressure on the foot, foot pronation and flat feet, rheumatoid and osteoarthritis.

Heel Spur Treatment

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

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.

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

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 and stretches to keep the foot and ankle strong and mobile are important as long as pain allows. Stretching the plantar fascia is important, especially if symptoms are worse in the morning. A plantar fasciitis night splint is excellent for stretching and preventing the plantar fascia tightening up overnight.

Stretching Exercises

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. Below we outline a few simple foot stretching exercises which can be done pain-free and in conjunction with other treatment methods.

Stretching the Plantar Fascia

plantar fascia stretch

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. It takes discipline to stretch regularly until the pain goes but it is important. Do this stretch as well as calf muscles stretching exercises with the leg straight.

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.

Arch Support Taping

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.