A Heel spur (calcaneal spur) is a type of bone anomaly that grows where the plantar fascia connects to the heel bone. Remarkably, for some individuals, this excess bone can extend as much as a half-inch. Heel spurs are not always accompanied by pain, so some patients accidentally discover that they have them when they’re X-Rayed for other conditions.
The connection between heel spurs and plantar fasciitis isn’t about one causing the other, but instead, they share some common risk factors, such as having high arches, being overweight, or applying excessive stress on the foot muscles and ligaments. A heel spur usually develops over the course of several months and is caused not only by excessive strain and stress but also by over-stretching of the plantar fascia. As a result, tiny tears on the membrane covering the heel may develop. Although anyone can develop heel spurs, it is a common condition for athletes who perform constant jumping or running.
Causes & Symptoms
Generally, there is no cure for heel spurs in the heel, and doctors are hesitant to operate on the heel, in case they happen to damage any of the hundreds of nerve endings in the feet. Most patients that develop a heel spur will have to live with them for the rest of their days. However, there are steps you can take to treat the condition and help reduce the symptoms. Here are some common symptoms and their effects:
Sharp pain in the heel
The very first symptom of heel spurs that catches the attention of an affected person is severe pain located in their heel that occurs as they get out of bed in the morning. Osteophytes (bone spurs) do not present pain symptoms until they have reached a critical mass that is much greater than half an inch or so. However, when they do reach a large size, the pain symptoms come on relatively quickly. Symptoms of sharp pain may increase if the patient experiences the growth of multiple spurs in the same heel. In some cases, the pain may be so severe that the affected individual will be required to use a walking aid, such as crutches or a walker, to mitigate the symptoms when moving around.
Dull aching sensation
The symptoms of heel pain related to osteophytes tend to worsen in the morning. When the patient sleeps, the tissues in the heel begin to heal, and inflammation starts to subside. However, when the patient wakes up in the morning, their feet are at their most sensitive level, and pain symptoms are at their peak during this time. As the day progresses, pain symptoms typically begin to decline to a tolerable level. However, the patient may notice that they develop a dull aching pain that lasts until they go to bed in the evening. In most cases, this pain does not stop the patient from being able to walk, and it’s possible for doctors to mitigate any pain symptoms with the use of painkillers to help manage the condition. Additionally, dull pain in the heels is normally only a concern for seniors that develop multiple heel spurs and are already dealing with other bone issues such as arthritis.
The development of heel spurs causes significant amounts of inflammation to develop in the heel and sole. Patients with severe inflammation notice that their heel turns bright red and pulsates with pain. These signs of inflammation are easy to spot and usually occur when the growth of the spurs starts to accelerate. Inflammation symptoms can vary widely, depending on the age of the patient, and the size of the spurs. Individuals with multiple large spurs in their heel may also experience inflammation and swelling that becomes so severe that they need to have the fluid drained from their heel. Inflammation may also be a sign of the onset of tendinitis as well. The heel attaches to the plantar fascia, a ligament that extends from the heel and connects to the toes; people who develop plantar fasciitis experience a thickening of the tendon due to stress on the heel. The pain symptoms associated with plantar fasciitis may significantly exacerbate your pain symptoms.
Heel spurs present pain symptoms when walking. As the patient places their heel on the floor, the spurs irritate the soft tissues in the foot. This irritation produces symptoms of pain that vary in intensity, depending on the size and quantity of spurs in the heel. Some people may only experience mild pain that is more irritating than sore, while others may develop pain symptoms so severe that they prevent them from being able to walk. Standing around for long periods also produces pain symptoms in those individuals dealing with heel spurs. Standing places pressure on the lower limbs and heel, forcing the spurs to dig into the soft tissues in the heel, causing excruciating pain symptoms.
Who Gets Heel Spurs?
There are a set of risk factors that make some people more prone to developing heel spurs than others. If you fall into any of the following risk categories, it is recommended to seek medical attention with a podiatrist to discuss the health of your feet and what you can do to mitigate symptoms of the condition going forward in your life. Here are some risk factors linked to heel spurs, including the following:
- Women who wear high-heel shoes with pointy toe-boxes.
- People over the age of 60 years.
- Patients who are dealing with rheumatoid arthritis or osteoarthritis.
- Runners and athletes that have a heavy heel-strike in their running posture.
- Runners who wear running shoes with poor design or poor fitment.
- Receiving trauma to the ankle or heel through physical impacts, such as jumping off to a higher platform.
- People who are obese or overweight.
Who Do They Affect You? How Serious Are They?
Chronic inflammation located at the insertion of soft-tissue tendons or plantar fascia is a common cause of heel spur. However, heel spurs can be located at the back of the heel or under the heel, beneath the arch of the foot. Heel spurs at the back of the heel are frequently accompanied by inflammation of the Achilles tendon (tendinitis) and cause tenderness and heel pain to worsen while pushing off the ball of the foot.
Furthermore, heel spurs occur in approximately 70% of patients with plantar fasciitis. The plantar fascia is one of the major transmitters of weight across the foot as you walk or run. When the plantar fascia becomes inflamed, a heel spur can form at the point between the fascia and the heel bone.
Additionally, heel spurs may also be associated with another underlying condition, including osteoarthritis, reactive arthritis, and ankylosing spondylitis.
Other serious causes of heel spurs include overuse, in which activities such as running and jumping, especially if done on hard surfaces, may cause heel spurs by wearing down the heel and arch of the foot.
Recommended Treatment & Rehabilitation
Heel spurs are first diagnosed based on the history of heel pain and tenderness localized to the area of bony involvement. They are specifically identified when there is point tenderness at the bottom of the heel, which makes it difficult to walk barefoot on hard surfaces, like tile or wood floors. X-Ray examination of the foot is used to identify the bone prominence of the heel bone.
More than 90% of patients with heel spurs do not require surgery and are able to see significant improvement with physiotherapy alone. While physiotherapy cannot eliminate heel spurs altogether, it can reduce inflammation that causes pain and impedes mobility. An experienced physiotherapist will likely combine stretching, taping, massage, and lower leg strengthening exercises to create a heel spur recovery plan that is safe, effective, and well-designed to prevent further re-injury. Typically, a heel spur physiotherapy plan will primarily focus on pain relief, then flexibility, range of motion, and muscle control, and finally a return to your regular activity.
Heel spurs are treated by measures that decrease the associated inflammation and avoid re-injury. Local ice applications both reduce pain and inflammation. Anti-inflammatory medications, such as naproxen, ibuprofen, or injections of cortisone, are often helpful. Additionally, orthotic devices or shoe inserts are used to take pressure off plantar spurs (a donut-shaped insert), and heel lifts can reduce stress on the Achilles tendon to relieve painful heel 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 heel spurs. Infrequently, surgery is performed on chronically inflamed spurs.
As for exercises for our feet, mobility, and strength are essential to keep us moving pain-free. The goal of these exercises is to strengthen the muscles in the feet and calves while improving flexibility in the Achilles tendon and plantar fascia. Here are some exercise examples you can try, including the following:
While in a standing position with the feet close together, place a tennis ball in between the heels and maintain the position of the ball by squeezing the heels together. Afterwards, in a controlled motion, raise up on the toes and then return to the start position. Complete this exercise 2 sets of 10 repetitions twice a day.
Standing calf stretch
Stand facing a wall and place your foot up against the wall. With your knee bent, lean forward until you feel a stretch in the calf closest to the wall and hold the position. Complete this stretch 2-3 times a day.
Standing gastroc stretch
Firstly, stand and place both hands on a wall. Secondly, place one leg behind the other, slightly staggered, and lean your body forward without bending the back knee until you feel a stretch in your back calf. Remember to keep the correct arch position in your foot and keep the heel on the ground. Finally, ensure both feet are facing upward before repeating the stretch 2 more times of up to 60-second holds twice a day.
Plantar fascia release
Sit in a chair to help control the pressure put on your feet. Then, take a tennis ball and place it under your affected foot. Apply downward pressure on the lacrosse ball with the foot. Next, stay off the heel and ball of the foot, keeping the ball inside the foot. Move the ball under your foot to find tender sports. Once you are on a tender spot, hold the position while applying pressure. Continue to massage for up to 30 seconds before repeating 2-3 times.
Alternative & Homeopathic Treatment
Here are some easy home remedies that can help provide a good degree of relief from pain linked to heel spurs:
- Essential oils – Gently massage your heels with this treatment product. Pure essential oils like rosemary or lavender and ever everyday oils such as coconut and olive oil may help reduce pain due to their anti-inflammatory properties. Coconut oil also acts as a natural moisturizer that softens your heels. Just simply warm up the oil slightly and rub it deeply but gently into your affected heel.
- Supportive footwear – Try to wear shoes that provide good arch support and have a low heel, especially if you are going to be on your feet more often. This helps to support your plantar fascia and prevent it from becoming inflamed.
- Night splints – Night splints help to relieve heel spurs by stretching your arches and calves overnight. These tend to work best for patients who also had plantar fasciitis for at least six months. Most are meant to be used for one to three months and come in both hard and soft models.
- Massage – You can perform simple massage techniques to soothe the pain in your heels. Use your thumbs to massage your arches and heels, working from the balls of your feet up to your heel. You may also use a golf ball to massage your arches. Put your foot on the golf ball, hang on to a stable item, and roll the golf ball under your arches.
- Ice application – While an ice cube can result in a good massage, an ice pack can also help reduce inflammation. Cover your ice pack with a cloth or thin towel and hold it over the painful area three to four times daily for 15-20 minutes at a time.
- Rest – Sometimes, heel spurs are a sign that your feet simply need to rest, especially if you regularly do high-impact sports. Giving your feet a break for a few days can help reduce inflammation and let your plantar fascia heal. While you heal, try a low-impact activity, such as swimming.