Heel Spurs: Symptoms, Causes, Tests, and Treatments

A heel spur or calcaneal spur is a foot condition characterized by a bony outgrowth on the underside of the heel bone. This outgrowth is formed by calcium deposits as a response to repetitive strain on muscles and ligaments around the heel. A recent study revealed that the incidence of plantar heel spur increases with age.

Although heel spurs typically originate at the heel, they can eventually impact other areas of the foot. Many people with heel spurs don't experience symptoms; however, for those who do, walking can become extremely painful. While there is no cure for heel spurs, various non-surgical options are available for managing symptoms, including exercise, custom-made orthotics, anti-inflammatory medications, and cortisone injections.

Here's everything you need to know about heel spurs.

Symptoms

When a heel spur does present with symptoms, you can expect the following:

• A knife-like or pin-sticking pain when standing up in the morning or after a prolonged sitting
• Inflammation at the bottom of the heel
• Small protrusion under the heel
• Dull pain in the heel throughout the day
• Swelling at the front of the heel

Causes

Heel spurs are often caused by strain on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. The following risk factors can predispose you to develop heel spurs:

• Walking/gait abnormalities: Abnormal gait leads to uneven weight distribution on the feet during movement, causing excess stress on the heel bones, ligaments, and nerves, thus resulting in spur formation and pain.
• Poor foot mechanics: People with flat feet or high arches have uneven pressure distribution on the heel bone, leading to the growth of spurs.
• Excess weight or obesity: Excess weight means more impact/load; hence additional stress on the arches of the foot and tissues around the heel, causing heel spur.
• Improper footwear: Poorly fitted shoes, especially those lacking appropriate arch support or cushioning, can contribute to the development of heel spurs.
• Aging: As we age, the flexibility of the plantar fascia decreases, and there is also thinning of the heel's protective fat pad, making it more susceptible to spur formation.
• Spending most of the day on one's feet: The heel bone bears the most contact weight while standing. Spending most of the day on your feet places excessive pressure on the heel bone, causing spur formation.
• Running or jogging on hard surfaces: Running on hard surfaces place repetitive impact on the heel, causing microscopic damage to the plantar fascia and leading to the development of spurs over time.

How to Test for Heel Spurs

Diagnosing a heel spur by yourself may be difficult because the symptoms are similar to other forms of heel pain and foot problems. Therefore, we encourage you to visit your healthcare provider if you notice any of the symptoms above.

Your healthcare provider will start by taking your medical history, which involves asking you specific questions to discover the activities that might have caused your heel pain. After that, a physical examination of the foot is carried out to locate the area of tenderness. Heel spurs 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. They also check if there is a limited range of motion in the ankle or foot, swelling, and difference in foot alignment in comparison with the other foot.

Bony protrusions aren't usually visible to the naked eye, so diagnosis is confirmed by an X-ray, which shows calcaneal spur formation or calcification at either the insertion of the Achilles tendon or the origin of the plantar fascia.

Treatment Options

In the case of a heel spur, conservative and surgical treatment options are available. However, surgery is often not necessary because symptoms improve in over 80 percent of people undergoing conservative management. These include:

• Ice therapy: Applying ice to the plantar side of your foot can relieve heel pain and reduce swelling and any other signs of inflammation on your foot. This can be done for 15-20mins, twice a day.
• Pain medications: Over-the-counter pain medications such as ibuprofen also help to reduce pain and inflammation.
• Physical therapy: Physical therapy aims to improve the flexibility of the tendon Achilles and plantar fascia, reducing tightness of calf and foot muscles with various stretching exercises. It also employs heat therapy to loosen tense muscles and promote blood flow to the affected area.
• Stretching exercises before bed: This helps to reduce the pain you feel in the morning. It relaxes your plantar fascia and foot muscles. These exercises include towel stretch, heel cord stretch, and towel curls.
• Rest: This is done majorly to relieve pain and does not mean complete immobilization. You can still walk around but take a break from high-impact activities like running and jogging.
• Insoles and orthotics: Customized shoe insoles can reduce pressure on the heel and provide additional support to the feet.
• Footwear modifications: Wearing shoes that provide additional arch support, cushioning, and a wide toe box can help to distribute pressure evenly on the foot, reducing the likelihood of developing heel spurs.

Taming Heel Pain

Though heel spurs can't be cured, you can manage the symptoms without limiting your daily activities. Preventing heel spurs involves wearing well-fitting insoles with shock-absorbent footbeds, rigid shanks, and supportive heel counters, such as Footora's selection of the best insoles for heel spurs. Warming up, stretching exercises before each activity, and pacing yourself during activities will also help.