Heel Spurs: Symptoms, Causes, Treatment

What are the symptoms of heel spurs?

Heel spurs often do not cause symptoms themselves; instead, they are typically associated with other conditions that cause heel pain. When symptoms do occur, they can include:

Pain: Heel spurs themselves are often painless because they are bony protrusions that form on the underside of the heel bone (calcaneus). However, they can cause pain when they press against soft tissues like the plantar fascia or the Achilles tendon.
Heel Pain: Pain is typically felt on the underside or back of the heel, especially during weight-bearing activities such as walking or standing. The pain may be sharp, stabbing, or dull, and it can range from mild to severe.
Tenderness: The affected area of the heel may feel tender to the touch, especially when pressure is applied directly over the heel spur.
Inflammation: Heel spurs can lead to inflammation of surrounding soft tissues, such as the plantar fascia (plantar fasciitis) or the Achilles tendon (Achilles tendinitis), exacerbating heel pain and discomfort.
Stiffness: Some individuals may experience stiffness or limited range of motion in the foot and ankle, particularly in the morning or after periods of rest.
Radiating Pain: Pain from the heel spur may radiate to other parts of the foot or up the leg, depending on the location and extent of irritation to nearby structures.

It’s important to note that heel spurs are often incidental findings on X-rays and may not necessarily be the cause of heel pain. The presence of heel spurs does not always correlate with the severity of symptoms, and treatment typically focuses on addressing the underlying condition causing the pain, such as plantar fasciitis or Achilles tendinitis.

If you suspect you have heel spurs or are experiencing persistent heel pain, it’s recommended to consult with a healthcare provider for a thorough evaluation, accurate diagnosis, and appropriate treatment plan tailored to your specific symptoms and condition.

What are the causes of heel spurs?

Heel spurs are bony growths that develop on the underside of the heel bone (calcaneus). They typically develop over time in response to repetitive stress or tension on the ligaments and muscles that attach to the heel bone. Common causes of heel spurs include:

Plantar Fasciitis: One of the primary causes of heel spurs is plantar fasciitis, a condition characterized by inflammation of the plantar fascia—a thick band of tissue that runs along the bottom of the foot from the heel to the toes. Chronic tension and pulling of the plantar fascia where it attaches to the heel bone can lead to the formation of a heel spur.
Achilles Tendinitis: Inflammation of the Achilles tendon, which attaches the calf muscles to the heel bone, can cause chronic irritation and spur formation at the back of the heel bone.
Excessive Pronation: Overpronation or excessive inward rolling of the foot during walking or running can strain the plantar fascia and other supportive structures of the foot, leading to heel spurs over time.
Repetitive Stress or Microtrauma: Activities that involve repetitive stress or impact on the heel, such as running, jumping, or occupations that require prolonged standing or walking on hard surfaces, can contribute to the development of heel spurs.
Poor Footwear: Wearing shoes that lack proper support or cushioning, or shoes with inadequate shock absorption, can increase stress on the heel bone and contribute to heel spur formation.
Obesity: Excess body weight places increased pressure and stress on the feet, particularly the heels, which can contribute to the development of heel spurs.
Age: As individuals age, the protective fat pad under the heel may naturally thin, reducing its ability to cushion and support the heel bone. This can increase the likelihood of developing heel spurs and experiencing heel pain.
Biomechanical Factors: Structural abnormalities of the foot, such as flat feet (pes planus) or high arches (pes cavus), can alter foot mechanics and increase the risk of developing heel spurs.
Inflammatory Conditions: Certain inflammatory conditions, such as arthritis (e.g., ankylosing spondylitis or reactive arthritis), can affect the joints and soft tissues of the feet, potentially leading to heel spur formation.

It’s important to note that not all individuals with heel spurs experience symptoms, and the presence of heel spurs on X-ray does not necessarily mean they are the cause of heel pain. Treatment for heel spurs typically focuses on addressing the underlying condition causing the pain, such as plantar fasciitis or Achilles tendinitis, rather than the spur itself.

How is the diagnosis of heel spurs made?

The diagnosis of heel spurs is typically made through a combination of clinical evaluation, medical history, and imaging studies. Here’s how it’s typically done:

Medical History: Your healthcare provider will first discuss your symptoms and medical history. They will inquire about the location, duration, and severity of your heel pain, as well as any activities or factors that worsen or alleviate the pain.
Physical Examination: A thorough physical examination of the foot and ankle will be conducted. Your provider will palpate (feel) the affected heel area to assess for tenderness and swelling. They will also evaluate your foot mechanics, range of motion, and gait to identify any biomechanical issues that may contribute to your symptoms.
Imaging Studies: X-rays are commonly used to confirm the presence of a heel spur. X-rays can show the bony growth on the underside of the heel bone (calcaneus). However, it’s important to note that heel spurs are often incidental findings and may not necessarily be the cause of heel pain. X-rays can also help rule out other possible causes of heel pain, such as fractures or arthritis.
Diagnostic Injections (Optional): In some cases, your healthcare provider may perform a diagnostic injection of local anesthetic into the painful area around the heel spur. If the injection temporarily relieves your pain, it can help confirm that the heel spur is contributing to your symptoms.
Differential Diagnosis: Heel spurs are commonly associated with conditions like plantar fasciitis or Achilles tendinitis, which may also be evaluated during the diagnostic process. Differentiating between these conditions is important for developing an appropriate treatment plan.
Additional Tests (Rare): In rare cases where the diagnosis is unclear or if there are atypical symptoms, additional imaging studies such as MRI or ultrasound may be ordered to further evaluate soft tissues, ligaments, or tendons around the heel.

Once a diagnosis is made, treatment typically focuses on addressing the underlying cause of heel pain rather than the heel spur itself, as not all heel spurs cause symptoms. Treatment options may include rest, ice therapy, stretching exercises, orthotics, footwear modifications, medications, physical therapy, or in some cases, surgical intervention if conservative measures fail to alleviate symptoms.

It’s important to consult with a healthcare provider for an accurate diagnosis and personalized treatment plan based on your individual symptoms and medical history.

What is the treatment for heel spurs?

Treatment for heel spurs typically focuses on managing the underlying condition causing the symptoms, such as plantar fasciitis or Achilles tendinitis, rather than the spur itself. Here are common treatment approaches:

Rest and Activity Modification: Avoid activities that exacerbate heel pain, such as prolonged standing or running. Rest allows the affected area to heal and reduces stress on the heel.
Ice Therapy: Apply ice packs to the affected heel area for 15-20 minutes several times a day to reduce inflammation and alleviate pain. Be sure to wrap the ice pack in a cloth to protect the skin.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter medications like ibuprofen or naproxen can help reduce pain and inflammation associated with heel spurs. Always follow dosage instructions and consult with a healthcare provider if you have other medical conditions.
Stretching Exercises: Gentle stretching exercises for the calf muscles, Achilles tendon, and plantar fascia can help improve flexibility and reduce tension on the heel. Stretching should be done regularly, especially before and after activities.
Orthotic Devices: Custom orthotics or heel pads can provide additional support and cushioning, helping to redistribute pressure away from the heel spur and promote healing. Proper footwear with adequate arch support and cushioning is also important.
Physical Therapy: A physical therapist can provide specific exercises and techniques to strengthen muscles, improve flexibility, correct biomechanical issues, and reduce strain on the heel spur.
Night Splints: Splints or braces worn at night can help stretch the plantar fascia and Achilles tendon while sleeping, reducing morning heel pain associated with conditions like plantar fasciitis.
Corticosteroid Injections: In cases where symptoms are severe or persistent, a corticosteroid injection into the affected area (such as the plantar fascia or bursae) may be considered to reduce inflammation and provide pain relief.
Extracorporeal Shock Wave Therapy (ESWT): This non-invasive treatment uses shock waves to stimulate healing in the affected area and may be recommended for chronic cases of heel pain, including heel spurs.
Surgery (Rare): In very rare cases where conservative treatments fail to alleviate symptoms and the heel spur is causing significant pain or structural issues, surgical removal of the spur may be considered. This is typically considered a last resort and is not commonly needed.

It’s important to note that heel spurs may not always cause symptoms, and the focus of treatment is on addressing pain and inflammation associated with the underlying condition rather than the spur itself. A healthcare provider can help determine the best course of treatment based on your individual symptoms, medical history, and lifestyle factors.

How do I know if I have plantar fasciitis or heel spurs?

Distinguishing between plantar fasciitis and heel spurs can be challenging because they are often related conditions, and one can occur alongside the other. Here are some key points to consider for each condition:

Plantar Fasciitis:

Pain Location: The primary symptom of plantar fasciitis is typically pain at the bottom of the heel or along the arch of the foot, especially with the first steps in the morning or after periods of rest.
Nature of Pain: Plantar fasciitis pain is often described as sharp or stabbing and may improve with continued activity but worsen after prolonged standing or walking.
Risk Factors: Common risk factors include overuse (such as long-distance running), excessive standing, improper footwear, high arches or flat feet, and tight calf muscles.
Diagnosis: Diagnosis is usually based on clinical evaluation, history of symptoms, and often confirmed by tenderness along the plantar fascia insertion point on the heel bone. Imaging (like X-rays or ultrasound) may be used to rule out other causes or confirm the diagnosis.

Heel Spurs:

Presence: Heel spurs themselves often do not cause symptoms and are typically discovered incidentally on X-rays taken for another reason. They are bony growths that form on the underside of the heel bone.
Associated Pain: If heel spurs cause symptoms, it is usually due to inflammation or irritation of surrounding tissues, such as the plantar fascia or Achilles tendon, rather than the spur itself.
Diagnosis: Heel spurs are diagnosed by X-ray, where the bony growth can be visualized. However, the presence of a heel spur does not necessarily mean it is the cause of heel pain.

Differentiating Factors:

Symptoms: Plantar fasciitis typically presents with pain along the bottom of the foot, especially in the morning or after rest. Heel spurs may cause pain if they irritate nearby soft tissues, but not all spurs cause symptoms.
Physical Examination: A healthcare provider may perform a physical exam to check for tenderness and pain location. They may press on specific areas of the foot to pinpoint the source of pain.
Imaging: X-rays can show the presence of a heel spur but may not always correlate with symptoms. They are useful in ruling out other causes of heel pain.

If you suspect you have either plantar fasciitis or heel spurs, it’s essential to consult with a healthcare provider for a proper diagnosis and treatment plan. They can recommend appropriate treatments based on your symptoms, medical history, and any diagnostic findings.