Heel spurs are bony outgrowths of the calcaneus – the heel bone. They develop as a result of overuse and excessive straining on the foot muscles and ligaments, stretching of the plantar fascia, or continuous tearing of the membrane covering the heel bone. The constant microtrauma causes inflammation and damage to the tissue, which defends itself by deposing calcium, and these calcium deposits eventually form a heel spur. This usually happens in two places: in the lower part of the heel bone, where the plantar fascia attaches to it, or in the back part, where the Achilles tendon attaches.
Heel spurs are common in athletes (especially marathon runners), people who spend a lot of time standing, and overweight people, as well as people with shortened calf muscles, inflexible Achilles tendons, flat feet, or high instep. Sometimes, they develop as a result of wearing inadequate shoes and high heels.
The patients are typically middle-aged people, and some researches state they’re slightly more often seen in women than men. Pregnant women have a higher chance of developing heel spurs, and so do people suffering from diabetes or arthritis. Heel spurs are not rare: around 10% of people will develop them. However, they rarely give any symptoms which would require medical treatment.
Typically, a person feels (and ignores) a slight heel pain for a long time before a heel spur develops. However, the heel spur itself does not need to cause pain: this mostly depends on the place it develops and its shape. The length of the spur is a less important factor: a small spur can cause pain, while a long spur can be asymptomatic. The pain will emerge if the spur presses and irritates surrounding soft tissues and nerves. It is estimated that only around 5% of people who have a heel spur suffer pain from it.
The pain from the heel spur is usually located in the lower (sole) or inner part of the heel, and it can be acute and chronic. In the acute phase, the pain is sharp and intense and sometimes spreads to the toes. It is the most pronounced upon waking up in the morning and after long periods of inactivity (standing or sitting). Chronic pain is dull and of less intensity, starts during walking or running, develops slowly, and lasts all day.
A growing heel spur can cause irritation, inflammation, and damage to the surrounding tissues, which is followed by redness and swelling in the foot.
Many other conditions can cause heel pain apart from the heel spur - a careful examination along with the typical symptoms can help differentiate between possible causes of heel pain. A definitive diagnosis is made rather easily, as a heel spur can be clearly seen on X-ray imaging.
When starting the heel spur treatment, it is important to always bear in mind that the development of a heel spur is a consequence of tendons and plantar fascia overuse and damage and that therefore it is the primary problem that the treatment process must address, not the heel spur itself.
Heel spur pain doesn’t go away on its own, and it is not a problem to be solved by a period of resting or low activity. The treatment usually lasts several weeks, depending on the severity of the condition, the method of choice, and the quality of the applied therapy. Each patient must be assessed and treated with an individual approach.
There are several possible ways to ease the pain and treat the condition.
When it comes to sharp, acute pain, these are the first aid soothing methods. It is advised to massage the painful area with an ice cube or hold an ice pack over it for around 10 minutes and repeat this 4-5 times a day. Gently massage and stretch the involved muscles. Make sure not to put ice directly on the skin, as it can damage it. Instead, wrap the ice in a cloth before applying.
There are specifically designed orthopedic shoe inserts and insoles on the market for people suffering from heel spurs and some other heel pain causing conditions. These inserts are soft and spongy, with an opening in the heel area to allow better support and less load on the heel during walking. They are useful to facilitate moving and performing daily activities with less pain, but, they do not treat the condition.
Physical therapy is the key treatment for the heel spur, as it works towards the underlying causes while helping remove the calcium deposits. Kinesitherapy is the main modality of physiotherapy in this respect, and it includes mainly strength-enhancing and stretching exercises for the foot and calf muscles. These simple exercises should be performed about 2 times per day. Other methods, such as ultrasound therapy, TECAR, electrophoresis, or laser, can also be used with certain indications. Apart from (or along with) surgery, it is the main treatment that can cure the condition.
Shockwave therapy is a non-invasive form of treatment in which the painful, affected area is hit with high-energy mechanic waves, to cause inflammation, encourage the healing processes in soft tissues and tendons, and help the resorption of deposited calcium. This procedure is only used when the condition has turned to the chronic phase, and it has been proven to ease the pain long-term and/or cure the condition in a reasonable time in most patients. It is particularly helpful in those who would otherwise require surgery. However, the procedure itself is rather uncomfortable and painful.
Non-steroid anti-inflammatory drugs such as ibuprofen, diclofenac, or naproxen can be used in the phases of acute or intense chronic pain to diminish the symptoms and facilitate daily functioning. A combination of NSAIDs and corticosteroids is recommended in some patients. Drugs, however, shouldn’t be taken without consulting a medical professional first.
Surgical treatment is rarely needed: over 90% of patients with symptoms from a heel spur can be cured by the previously listed conservative methods of treatment. For rare patients who don’t respond to conservative therapy, with symptoms lasting over 6 months, surgical treatment is the final option in dealing with heel spur.
Heel spurs don’t develop overnight – they develop over weeks and months as a result of ignored, untreated or mistreated pain from damage to the heel bone and foot tissues. Some of the actions that can be taken to prevent the development of heel spurs in those who occasionally experience heel pain include:
