It is very common for our podiatrists to hear that when a person develops heel pain, they quicklysuspect that their pain is caused by a heel spur. While ‘heel spurs’ have become a common term to explain heel pain, thisisn’t technically accurate, and for over 95% of the patients we see with pain at the bottom of their heel, the true cause of painis actually a condition called plantar fasciitis.
Interestingly, heel spurs are present in about 15% of the general population, many of whom won’t ever know they have one, unless it iscoincidentally discovered on an x-ray while investigating something else. Of those with heel spurs, less than 5% actually have heelpain. To help solve the confusion, here’s a look into what heel spurs really are, and why they occur.
What Is A Heel Spur?
A heel spur, otherwise known as an osteophyte, is a bony outgrowth that starts at the heel bone. Looking at an x-ray, the spuroften looks like a small spike or hook which faces the inside of the arch - an appearance that leaves many automatically assuming that theymust be like a painful splinter. What an x-ray doesn’t show is that the spur sits in line with the tissue fibres that it is embeddedin, as opposed to piercing them, which is why most people don’t notice their heel spur.
A heel spur is made of calcium deposits that build gradually over many months or years. While here we’re using the example of a spurat the bottom of the heel that is often mistaken for plantar fasciitis, spurs can develop anywhere that tendons attach to bone - whetherthat be at the back of the heel bone at the Achilles tendon, or on other bones across the the body.
Heel Spur Symptoms
The symptoms of a heel spur can be tricky to describe because most heel spurs are asymptomatic, and most times when patients come to uslooking for answers to their heel spur pain, they are actually looking for answers to their plantar fasciitis pain, but have confused theterm due to the way it is commonly used.
When heel spurs are symptomatic, they can aggravate the tissue that they’re associated with, which in this case isthe plantar fascia, producing symptoms including:
- Pain or tenderness in the heel of the affected foot which can feel sharp, dull or may throb
- Inflammation at the bottom of the heel, or the location where the spur is present
- Pain when walking or exercising without supportive shoes, or in bare feet
- The feeling of a small, bony bump on the bottom or back of your heel
- Numbness, burning and tingling if the nerves are impacted by the spur
What Causes A Heel Spur?
Heel spurs have been shown to develop in response to damage and strain to the soft tissues that insert at the bottom of the heel - in thiscase, the insertional fibres of the plantar fascia tissue. When the plantar fascia, which connects to thebottom of the heel bone, repetitively pulls on and places stress on the heel during movement, this creates micro-trauma. The body respondsby trying to repair the area by creating more bone - this becomes the calcified protrusions that we know as heel spurs.
Anything that exacerbates the pulling and stress on the heel bone from the plantar fascia will contribute to the development of a heel spur,including:
- Overusing the fascia, often from overtraining
- Wearing unsupportive or worn down shoes, which places more stress on the fascia
- Muscle imbalances and dysfunction, which can lead to overuse
- Rigid feet with poor mobility and flexibility that are inadequate to absorb shock
- Excessive pronation of the ankle and feet, as well as other biomechanical issues
- Having a leg length difference
- Bowed or knocked knees
- Abnormal walking and running patterns that place extra stress on the heel bone and ligaments
Heel spurs may also be caused by inflammatory arthritis, and may beencouraged by other problems like the breakdown of the fat pad of the heel.
Risk Factors
Having plantar fasciitis (or any tendinopathy elsewhere in the body) that hasbeen present for over 8 weeks places you at a higher risk of developing heel spurs, as it demonstrates that there is excess tension andpulling at the tissues with the body trying to repair the condition. This places certain groups of people at a higher risk of heelspurs:
- Those who wear high heeled shoes, which adds more strain on the fascia and can shorten the Achilles tendon over time
- Older adults as, over time, the flexibility of the plantar fascia decreases and the heel's protective fat pad that helps to cushion andprotect the heel bone also thins
- Active runners, joggers and jumpers as more strain will be placed on the heel bone during training, especially if training on hard surfacesand for many years
- Those with gait abnormalities, which place excessive stress on the heel bone and the connecting tissues
- Those regularly wearing unsupportive or worn out shoes
Diagnosis
Due to the similarity in symptoms between a heel spur and other causes of heel pain like plantar fasciitis, confidently diagnosing a heelspur specifically includes taking your medical and injury history, a comprehensive clinical exam, and an x-ray.
Even when a heel spur is confirmed via x-ray, it can be difficult to confirm if your pain is actually related to the spur, or if it iscoincidentally present while it is your plantar fascia tissue that is producing the pain. Thankfully, the initial treatment for both plantarfasciitis and a heel spur is the same, and the assessments performed by our podiatrists are always comprehensive and designed to give youthe most information and answers to why your pain has developed.
Treating Heel Spurs
Treating a spur at the bottom of your heel follows the same treatment plan as plantar fasciitis, because of the unique way in which the twoare connected. This may include:
- Custom prescribed foot orthotics may be used to offload the damaged plantar fascia, andreduce the stress on the bone in the area of the spur
- ASA Laser, which radiates specific wavelengths of light to reduce inflammation, support faster cell repair, and offer faster pain relief
- A strengthening and stretching program focusing on the joints and muscles in your feet and ankles
- Adapting and modifying your training program to reduce the strain at the back of the heel
- Gait retraining to address any biomechanical issues that could be contributing to your pain
- Switching to supportive footwear with cushioning soles
- Foot and ankle strapping for temporary pain relief
- Foot mobilisation techniques to help restore optimal movement in the foot and ankle
- Shockwave therapy to accelerate and facilitate the healing process
- Dry needling of surrounding soft tissues structures to release tension in the muscles, bytargeting trigger points
For almost all of our patients that have heel spurs confirmed with an x-ray, following our proven treatment methods completely resolves allof the painful symptoms, meaning that the heel spur will not require direct treatment with surgery or other methods. If conservativetreatment methods fail, however, surgery may be considered as a last resort.
What Can Happen If I Ignore Heel Spur?
If you ignore heel pain, then there is a good chance that your pain will persist and may even worsen to limit what you cando on a daily basis, which is why we always recommend promptly treating any heel pain that develops. If your heel spur is detectedaccidentally without any pain or symptoms, however, or if treating plantar fasciitis resolves your symptoms, then treatment is not indicatedfor the spur itself, and it is fine to ignore. In these cases, it is likely that the spur may remain and not cause you any problems.
Prevention
It is not clear why heel spurs develop in some people with tissue stress on their heel bone and not others, but the best way to help preventheel spurs developing is to treat any heel pain that arises promptly, without allowing significant stress to continue for prolonged periods.This is where working with your podiatrist for your heel pain is key. As podiatrists are foot health experts, by working with yourpodiatrist, you can expect:
- To be fully informed about what is truly causing your heel pain, whether that is a heel spur, plantar fasciitis or something else
- To be equipped with the information and tools to help you optimise your recovery at home
- To know how to help prevent your heel pain from recurring in the future
- To feel fully supported with experienced, caring health professionals every step along the way
