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.

Article by John Miller

Common Youth Leg Injuries

Why are Children's Injuries Different to Adults?

youth sports injuries

Adolescent Leg Injuries

Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

In the adolescent leg, common injuries include:

Osgood-Schlatter's Disease

Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.

More info: Osgood Schlatter's Disease

Sinding-Larsen-Johansson Disease

Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.

More info: Sinding Larsen Johansson Syndrome

Anterior Knee Pain

Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.

More info: Patellofemoral Pain Syndrome

Knee Ligaments

The cartilage between the leg bones has a better blood supply and is more elastic in adolescents than adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.

More info: Knee Ligament Injuries

ACL (Anterior Cruciate Ligament) Injuries

This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.

More info: ACL Injury

Meniscal Injuries

Your meniscus is crescent-shaped cartilage between the thigh (femur) and lower leg (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.

More info: Meniscus Tear, Discoid Meniscus

Sever's Disease

Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.

More info: Sever's Disease

Ankle Sprain

An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. With the correct treatment, a low ankle sprain usually improves in two to six weeks. Your ankle physiotherapist should check even simple ankle sprains to eliminate high-ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.

More info: Sprained Ankle

Patellar Instability

Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.

More info: Patella Dislocation

Osteochondritis Dissecans

The separation of a bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.

More info: Juvenile Osteochondritis Dissecans (JOCD)

Growth Plate Fractures

A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.

Avulsion Fractures

youth pelvis hip avulsion

Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children

An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow, and ankle are the most common locations for lower limb avulsion fractures in young sportspeople.

Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well.  You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.

An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.

For more information regarding your youth sports injury, please consult your physiotherapist or doctor.

Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back Pain

Common Youth Arm Injuries

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.