Heel Spur

Heel Spur

Article by John Miller

Heel Spur

What is a Heel Spur?

Heel spurs are a common source of heel pain. Heel spurs are bony growth attached to your heel bone (calcaneus) and grow into your foot arch.

What Causes a Heel Spur?

Your plantar fascia is a thick fibrous band of connective tissue originating on the calcaneus’s bottom surface (heel bone) extending along the sole towards the toes. Your plantar fascia acts as a passive limitation to the over-flattening of your arch. When your plantar fascia develops micro tears or becomes inflammed, it is known as plantar fasciitis. In short, chronic plantar fasciitis causes a heel spur.

When you delay plantar fasciitis healing and injury persists, your body repairs the weak and injured soft tissue with bone. Usually, your injured fascia heals via fibroblastic activity. Fibroblasts naturally operate for at least six weeks. If your injury persists beyond this time, osteoblasts recruit to the area. Osteoblasts form bone, and the result is bone (or calcification) within the plantar fascia or at the calcaneal insertion. These bone formations are known as heel spurs.

This scenario is most familiar with the traction type injury. The additional bone growth is a heel spur or calcaneal spur—more information: plantar fasciitis.

What are the Symptoms of a Heel Spur?

heel spur

  • You’ll typically first notice early heel spur pain under your heel in the morning or after resting.
  • Your heel pain will be worse with the first steps and improves with activity as it warms up.
  • When you palpate the tender area, you may feel a sore bony lump.

How Does a Heel Spur Progress?

As your plantar fasciitis deteriorates and your heel spur grows, the pain will be present more often.

How is a Heel Spur Diagnosed?

Your physiotherapist or sports doctor diagnoses heel spurs and plantar fasciitis based on your symptoms, history and clinical examination.

After confirming your heel spur or plantar fasciitis, they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts.

X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This additional bone is known as a calcaneal or heel spur.

Ultrasound scans and MRI identify any plantar fasciitis tears, inflammation or calcification.

Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.

Risk Factors for Heel Spurs

You are more likely to develop plantar fasciitis and heel spurs if you are:

  • Active – Sports place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, limiting ankle movement, e.g. running, ballet dancing and aerobics.
  • Overweight – Carrying around extra weight increases the strain and stress on your plantar fascia.
  • Pregnant – The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, leading to mechanical problems and inflammation.
  • On your feet – You had a job that requires a lot of walking or standing on hard surfaces, i.e. factory workers, teachers and waitresses.
  • Flat Feet or High Foot Arches – Changes in the arch of your foot change the shock absorption ability and stretch and strain the plantar fascia, which then has to absorb the additional force.
  • Middle-Aged or Older – With ageing, your foot’s arch may begin to sag – putting extra stress on the plantar fascia.
  • You were wearing shoes with poor support.
  • Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury.
  • Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, leading to plantar fasciitis.
  • Diabetes. Although doctors don’t know why plantar fasciitis occurs more often in people with diabetes.

Heel Spur Prognosis

The good news is that heel spur pain is rarely permanent. Plantar fasciitis, the leading cause of a heel spur, is reversible and very successfully treated. Over 90 per cent of people with plantar fasciitis or heel spurs improve significantly with physiotherapy treatment. While you may continue to see a heel spur on Xray, once you settle the inflammation adjacent to your heel spur, the heel pain will resolve.

If your plantar fasciitis or heel spur pain continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). Cortisone injections have shown to have short-term benefits, but they may retard your progress in the medium to long-term, which can mean that you will suffer recurrent bouts for longer. Further research is required to improve results.

What is the Best Treatment for Heel Spurs?

Due to poor foot biomechanics being the primary cause of your plantar fasciitis and your heel spurs, you should have your foot biomechanics assessed. It is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the development or progression of a heel spur.

Your physiotherapist is highly skilled in foot control assessment and its dynamic biomechanical correction. Depending upon your specific clinical examination, your physiotherapist may provide manual therapy techniques to loosen stiff joints. Additionally, they may offer soft-tissue massage or release, muscle flexibility or stretches, foot strapping, foot and lower limb strengthening exercises and occasionally night splints. The treatment of plantar fasciitis and heel spurs varies from person to person, so please seek your foot care practitioner’s advice.

They may recommend seeking a podiatrist’s advice, who can prescribe custom made passive foot devices such as orthotics. Foot orthosis may assist plantar fasciitis and heel spur potentially.

Active foot stabilisation exercises are an excellent long-term solution to prevent and control heel spurs and plantar fasciitis that your physiotherapist may prescribe.

Researchers have concluded that eight stages need to be covered to rehabilitate plantar fasciitis and prevent a recurrence effectively. These are:

  1. Early Injury Protection: Pain Relief & Anti-inflammatory Modalities
  2. Regain Full Range of Motion
  3. Restore Foot Arch Muscle Control
  4. Restore Normal Calf & Leg Muscle Control
  5. Restore Normal Foot Biomechanics
  6. Improve Your Running and Landing Technique
  7. Return to Sport or Work
  8. Footwear Analysis

Treatment of heel spurs is similar to plantar fasciitis treatment. Your physiotherapist will select the most appropriate treatment modalities for you.

Ultimately, biomechanical correction is the aim. Foot intrinsic muscle strengthening (including tibialis posterior and peroneus longus) and calf (gastrocnemius and soleus) stretches are almost always required.

Cases of moderate to severe biomechanical deformity should undertake physiotherapy or podiatric assessment. NSAID’s and corticosteroid injection is most effective when combined with biomechanical correction.

Mechanical treatment that involves taping and orthoses can be more effective than either anti-inflammatories or accommodative modalities.

Plantar fascia night splints can sometimes work to provide short-term pain relief. The braces essentially overstretch the plantar fascia, which may give you some short-term relief, but ultimately elongates your passive arch structures. The medium and long-term benefits make no sense of this rationale. On the contrary, permanent elongation will predispose you to flatter arches and more likelihood of recurrent heel pain. Based on this, we do NOT currently recommend plantar fascia night splints in most instances.

Weight loss and load management influence plantar fasciitis and heel spurs’ initiation and duration. Your weight may impact your plantar fascia of heel spurs, so weight loss should be a priority for patients carrying excess weight.

What Happens If You Do Nothing?

Untreated heel spurs can grow larger and usually become excessively painful. For more specific advice about your heel spur or plantar fasciitis, don’t hesitate to get in touch with your PhysioWorks physiotherapist.