A heel spur is a pointed bony outgrowth of the bone of the heel (the calcaneus bone). They’re attributed to 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 causes tenderness and pain at the back of the heel made worse while pushing off the ball of the foot. The heel bone is the largest bone in the foot and absorbs the most amount of shock and pressure.
A heel spur develops as an abnormal growth of the heel bone. Calcium deposits form when the plantar fascia pulls away from the heel area, causing a bony protrusion or heel spur to develop. The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Heel spurs can cause extreme pain in the rearfoot, especially while standing or walking. Heel spurs under the sole of the foot (plantar area) are associated with inflammation of the plantar fascia (fasciitis), the “bowstring-like” tissue stretching underneath the sole that attaches at the heel.
Causes of Heel Spurs
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches—either overly flat feet or high-arched feet—are more prone to developing plantar fasciitis. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when a person’s job requires long hours on their feet. Obesity also contributes to plantar fasciitis.
Symptoms of Heel Spurs
The symptoms of plantar fasciitis are:
- Pain on the bottom of the heel.
- Pain that is usually worse upon arising.
- Pain that increases over a period of months .
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking, the pain decreases, because walking stretches the fascia. For some people, the pain subsides but returns after spending long periods of time on their feet.
Treatment of Heel Spurs
- Determine the cause. The key for the proper treatment of heel spurs is determining what’s causing the excessive stretching of the plantar fascia. When the cause is overpronation (flat feet), then an orthotic device with rearfoot posting and longitudinal arch support should be effective enough in dealing with the condition, allowing your heel to mend itself.
- Don’t aggravate the symptoms. Afterwards, the next treatment step is avoiding activities that aggravate symptoms. For example, take a few day off jogging or prolonged standing to try to rest the painful foot. Just resting usually helps eliminate the most severe pain and will allow the inflammation to begin to settle down.
- Use ice. Icing will help diminish some of the symptoms and control the heel pain. Icing is especially helpful after an acute exacerbation of symptoms. In addition to using the ice pack in the morning, also use a heat pack in the evening for a more effective and all-around treatment.On that note, reusable Hot and Cold Gel Packs is proven therapy for plantar fasciitis. By alternating the application of heat and cold coupled with gentle massage, this method works wonders to relieve pain, reduce swelling and promote healing.
- Exercise and stretch. Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, often help patients feel better quickly. Stretching exercises for plantar fascia and Achilles tendon can provide effective results if combined with other treatment options.
- Use anti-inflammatory medications. They help control pain and decrease inflammation. Over-the-counter medications are usually sufficient, but prescription options are also available.
- Use shoe inserts. Shoe inserts are often the key to successful treatment of plantar fasciitis. The shoe inserts often permit patients to continue their routine activities without pain.
- Use night splints. Plantar fascia night splints immobilize and stretch fascia, and can be effective if used for several weeks. They’re usually worn to keep the heel stretched out when you sleep. They prevent the arch of the foot from becoming contracted at night, and is hopefully not as painful in the morning.
- Use a stretching aid. A stretching aid is yet another device that stretches the foot in the proper position to relieve heel pain.
- There are many other treatments. Other common treatments include elevating the heel with the use of a heel cradle, heel cup or orthotic device. Heel cradles and heel cups provide extra comfort and cushion to the heel the same way a shoe insert could, thus reducing the amount of cumulative shock and strenuous forces experienced from everyday activities. In particular, Silicone Heel Cups treats morning heel pain quite well and provides excellent support and pain relief.
- Don’t use ultrasound and lasers. Ultrasound and lasers are found to have little or no benefit to heel spurs, so don’t even bother investing money in these treatment methods.
- Try ESWT. Extracorporeal shock wave therapy (ESWT) is another method, but reaction to its authenticity is also mixed; there are vastly differing views about the safety and effectiveness of this treatment. ESWT uses energy pulses to induce microtrauma to the tissue around the heel spur. This microtrauma is thought to induce a tissue repair process by the body. ESWT is recommended in patients who have failed the previously mentioned treatments, and are considering surgical options.
- Use NSAIDs. NSAIDs (Non Steroidal Anti-Inflammatory Drugs) treat the symptoms and provide temporary relief but do not treat the underlying cause. Observe usual cautions and contraindications as these can have long term implications on your health.
- Steroid/local anesthetic injection is not one of the preferred treatment options.
- These treatments alone should cure the plantar fasciitis pain in most patients. Be forewarned that the symptoms will not resolve quickly. Most patients find relief within about three months, and over 90 percent within one year. In a small number of cases (usually less than five percent), patients may not experience relief after trying the recommendations listed above. As such, it’s important that conservative treatments should be performed for at least a year before considering surgery.
- Time can heal. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.
Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This surgery is about 80 percent successful in relieving pain in the small group of patients who don’t improve with conservative treatments. - Use surgery with caution. Surgery ‘opens’ or executes an endoscopic plantar fascia release. This method has no good evidence of effectiveness, and complications include increased pain, nerve injury, fascial rupture and infection. This should only be considered for really resistant cases of plantar fasciitis.
- Use cortisone. If the pain does not resolve, an injection of cortisone can decrease the inflammation of plantar fasciitis. However, many physicians don’t like to inject cortisone around the heel area because of potentially serious side effects. The two problems that cause most concern are fat pad atrophy and plantar fascial rupture. Both difficulties occur in a small percentage of patients, but they can significantly worsen heel pain symptoms.
- Use proper fitting footwear. To prevent the recurrence of heel spur symptoms after treatment, proper fitting footwear is essential. Many people continue using shoe inserts to relieve pressure over the tender area. Custom orthotics can also be made if there appears to be a problem with the mechanical structure of the foot. It’s also important to continue the stretching and exercises. These simple exercises will help maintain the flexibility of the foot and prevent the plantar fasciitis pain from returning.
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process, the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays, a bone scan or magnetic resonance imaging (MRI) may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain.
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