A heel spur is a pointed bony outgrowth of the bone of the heel (the calcaneus bone). They are attributed to chronic local inflammation at the insertion of soft tissue tendons or fascia in the area.
Heel spurs can be located at the back of the heel or under the heel, beneath the sole of the foot. Heel spurs at the back of the heel are frequently associated with inflammation of the Achilles
tendon (tendinitis) and cause tenderness and pain at the back of the heel made worse while pushing off the ball of the foot.
Diseases such as arthritis may lead to chronic inflammation in the tissue surrounding the heel and over time this can lead to the accumulation of calcium deposits. Ankylosing spondylitis, for
example, is one particular form of arthritis that frequently develops along with heel spurs. This condition can damage bones all over the body and even lead to the fusion of spinal vertebrae.
The pain caused by a calcaneal spur is not the result of the pressure of weight on the point of the spur, but results from inflammation around the tendons where they attach to the heel bone. You
might expect the pain to increase as you walk on the spur, but actually it decreases. The pain is most severe when you start to walk after a rest. The nerves and capillaries adapt themselves to the
situation as you walk. When you rest, the nerves and capillaries rest, also. Then, as you begin to move about again, extreme demands are made on the blood vessels and nerves, which will cause pain
until they again adjust to the spur. If excessive strain has been placed on the foot the day before, the pain may also be greater. A sudden strain, as might be produced by leaping or jumping, can
also increase the pain. The pain might be localized at first, but continued walking and standing will soon cause the entire heel to become tender and painful.
A heel spur is often seen on X-ray as a bony protrusion, which can vary in size. However, because a Heel Spur only indicates increased load on the plantar fascia, and not pain, an ultra sound may be
required to assess other actual cause of the heel pain such and may include checking to see if the plantar fascia is inflamed or degenerated.
Non Surgical Treatment
Heel spurs and plantar fasciitis are treated by measures that decrease the associated inflammation and avoid reinjury. Local ice applications both reduce pain and inflammation. Physical therapy
methods, including stretching exercises, are used to treat and prevent plantar fasciitis. Anti-inflammatory medications, such as ibuprofen or injections of cortisone, are often helpful. Orthotic
devices or shoe inserts are used to take pressure off plantar spurs (donut-shaped insert), and heel lifts can reduce stress on the Achilles tendon to relieve painful spurs at the back of the heel.
Similarly, sports running shoes with soft, cushioned soles can be helpful in reducing irritation of inflamed tissues from both plantar fasciitis and heel spurs. Infrequently, surgery is performed on
chronically inflamed spurs.
Surgery to correct for heel spur syndrome is a common procedure which releases plantar fascia partially from its attachment to the calcaneous (heel bone). This part of the surgery is called a plantar
fasciotomy due to the fact the fascia is cut. This is most often done through an open procedure as any heel spur or bursa can be removed at the same time. If the spur is not removed during the
surgery, it will probably be just as successful, as the large spur is not the true problem. Some physicians use an endoscopic approach (EPF) where a small camera aids the physician during surgery
with typically smaller incisions on each side of your foot.
There are heel spur prevention methods available in order to prevent the formation of a heel spur. First, proper footwear is imperative. Old shoes or those that do not fit properly fail to absorb
pressure and provide the necessary support. Shoes should provide ample cushioning through the heel and the ball of the foot, while also supporting the arch. Wearing an orthotic shoe insert is one of
the best ways to stretch the plantar fascia and prevent conditions such as heel spurs. Stretching the foot and calf is also helpful in preventing damage. Athletes in particular should make sure to
stretch prior to any physical activity. Stretching helps prevent heel spurs by making tissue stronger as well as more flexible. In addition, easing into a new or increasingly difficult routine should
be done to help avoid strain on the heel and surrounding tissue.