RS Podiatry Clinic

Heel Spur

A heel spur, also known as a calcaneal spur, is a bony growth that develops on the underside of the heel bone (calcaneus). It typically forms in response to long-term tension and stress on the foot’s ligaments and muscles, particularly the plantar fascia—a thick band of tissue connecting the heel bone to the toes. The repeated pulling of the fascia on the heel bone can lead to the development of a bony protrusion over time.

Heel spurs are often associated with a condition called plantar fasciitis, which involves pain at the origin of or along the plantar fascia. However, it’s important to note that not all individuals with heel spurs experience pain or other symptoms. In fact, many people are unaware of their heel spurs unless they are detected during an X-ray or imaging examination for an unrelated foot problem.

The presence of a heel spur does not necessarily mean that it is the primary cause of heel pain. Other conditions that can cause similar symptoms and should be considered in the differential diagnosis include:

  1. Plantar Fasciitis: A condition often leading to heel pain, especially during the first steps in the morning or after prolonged periods of rest.

  2. Achilles Tendinitis/tendinopathy:  Pain at the back of the heel on the Achilles Tendon which connects the calf muscles to the back of the heel, can cause heel pain and stiffness.

  3. Bursitis: Inflammation of the bursa, a fluid-filled sac that cushions and reduces friction between tissues such as tendons, muscles, and bones, can occur in the heel area, leading to pain and swelling.

  4. Tarsal Tunnel Syndrome: This condition involves compression or irritation of the posterior tibial nerve as it passes through a narrow tunnel in the inner ankle. It can cause heel pain and tingling sensations.

  5. Stress Fracture: A small crack or fracture in the heel bone or surrounding foot bones can cause localized pain and tenderness.

  6. Nerve Entrapment: Conditions like Baxter’s nerve entrapment or entrapment of other nerves in the foot can cause heel pain.

To determine the exact cause of heel pain, a comprehensive evaluation by a healthcare professional, such as a podiatrist or orthopaedic specialist, is recommended. They will consider the individual’s symptoms, medical history, physical examination findings, and possibly imaging tests like X-rays or MRI scans to make an accurate diagnosis and develop an appropriate treatment plan.

When it comes to treating symptoms associated with heel spurs, a podiatrist may employ various approaches, which can include (The above is not a treatment plan nor should be taken as official advice.):

  1. Conservative Measures: In most cases, heel spur pain can be alleviated with conservative treatments. These may include:

    • Rest and Modification of Activities: Avoiding activities that worsen symptoms and providing ample rest to the affected foot.
    • Ice Therapy: Applying ice packs to the affected area to reduce inflammation and pain.
    • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Prescribing oral NSAIDs, such as ibuprofen, to help reduce pain and inflammation.
    • Physical Therapy: Recommending specific stretching and strengthening exercises for the foot and calf muscles to improve flexibility and support the arch of the foot.
    • Orthotic Devices: Providing custom orthotic inserts or shoe modifications to provide support, cushioning, and relieve pressure on the heel spur.
    • Night Splints: Suggesting the use of night splints, which are devices worn while sleeping to keep the foot and calf muscles stretched, promoting healing and reducing morning pain.
    • Footwear Recommendations: Offering advice on proper footwear choices with adequate arch support, cushioning, and shock absorption.
  2. Corticosteroid Injections: In some cases, when conservative measures don’t provide sufficient relief, a podiatrist may administer corticosteroid injections into the affected area to reduce inflammation and pain.

  3. Extracorporeal Shock Wave Therapy (ESWT): This non-invasive procedure involves directing shock waves to the heel area, which can help stimulate healing and alleviate pain associated with heel spurs.

  4. Surgical Intervention: Surgery is typically considered a last resort for heel spurs and is only recommended when conservative treatments have been exhausted, and severe pain persists. Surgical options may involve removing the heel spur or releasing the plantar fascia to relieve tension and alleviate symptoms.

It’s important to consult with a podiatrist to receive a proper diagnosis and to discuss the most suitable treatment options based on individual circumstances and the severity of symptoms. The above is not a treatment plan nor should be taken as official advice.