SYDNEY HEEL PAIN CLINIC

Heel Spurs: What are they?

Heel spurs are the name given to bone-like growths that occur when calcium deposits on the heel bone (the calcaneus). In medical terminology, they are referred to as calcaneal spurs or osteophytes. They may be pointed, hooked or shelf-like in shape. Heel spurs can form either underneath the heel or at the back of the heel. They may be present on one heel or sometimes both heels of the patient, depending on the cause. It is common for heel spurs to be associated with plantar fasciitis and Achilles tendonitis, which can both be inflammatory conditions.

What causes the development of heel spurs?

Heel spurs are the body’s response to prolonged pulling of a muscle, tendon or ligament. Over a period of months or years of continual excessive stress, the body begins to deposit calcium at the site of attachment of the stressed ligament or tendon to the heel bone. Patients who have developed heel spurs associated with plantar fasciitis will have the growth underneath their heel bone, in the location where the plantar fascia ligament attaches to the calcaneus. This type of spur is called a plantar calcaneal spur. Patients with Achilles tendonitis-associated heel spurs will have a spur at the back of the heel bone, where the Achilles tendon attaches. This type of spur is known as a retrocalcaneal exostosis.

Heel spurs are caused by repeated strain from walking, running, or jumping barefoot. This strain is greatly increased if the activity is occurring on hard surfaces. Heel spurs are also a common complaint in people with suboptimal foot biomechanics (less than ideal gait/walking pattern in the foot due to malalignment or imbalances in the muscles and other structures in the lower leg and the foot).

Some other causes of heel spurs may include arthritis, wearing unsupportive footwear such as flip-flops, generally poorly fitting shoes, and overweight and obesity.

What are the clinical signs and symptoms of heel spurs?

Heel spurs are usually associated with pain that is localized relevant to the location of the spur. The pain may vary from person to person and descriptions of this range from sharp and intermittent to constant and chronic. Heel pain related to heel spurs is usually worst first thing in the morning or following an extended period of rest. In these cases, it is typically initially sharp, but then subsides to a dull aching. Patients with heel spurs normally experience more intense pain when walking or running barefoot, especially on hard surfaces. In some cases, heel spurs don’t cause any symptoms at all, and they are only discovered on xrays when another condition is being investigated.

In the past, it was thought that heel spurs are the direct cause of heel pain in patients. Nowadays, it is widely accepted in the medical community that the heel spurs themselves do not cause the pain. Conversely, the heel pain patients with spurs experience is caused by the inflammation of the surrounding tissues. The inflammation could be due to inflammatory overuse syndromes such as plantar fasciitis or Achilles tendonitis, or it could be caused by the physical pressure on soft tissue structures such as the bursae or heel fat pad, where the heel spur physically ‘digs in’ to the tissue.

How are heel spurs diagnosed?

The pain and symptoms associated with heel spurs are quite similar to many other common foot and ankle problems. For this reason, it is important to make an appointment with your sports podiatrist, who will go through a series of diagnostic steps to rule out any other differential diagnoses.

It is important to note that heel spurs are usually only observable on xrays, and generally cannot be detected with the naked eye. However, there are other steps that your sport podiatrist will take before requesting you have an xray. They will want to ask you a number of questions about the pain you’re experiencing, including whether it is worse at certain times of the day or with particular activities. Your sports podiatrist will collect information about your current and past exercise history and whether you’ve sustained any injuries. A physical examination of your lower leg and foot will typically follow, including palpating (physically feeling) the areas of the foot to pinpoint the painful area.

Biomechanical assessment in diagnosing heel spurs

It is likely that your sports podiatrist may want to conduct a biomechanical analysis as part of their examination. Biomechanical analysis can be a valuable tool when determining what causes stress and injuries and, looking forward, how to prevent them recurring. Using a specialized camera and software, they will carry out a motion analysis of your lower leg and foot, while you walk or run on a treadmill. The special technology will allow your sports podiatrist to determine the alignment of the structures in your and ankles and feet as they strike the treadmill’s surface. This way, your sports podiatrist can identify any imbalances in your gait (walking pattern), which provides important information about which areas of your foot are under the greatest stress as you walk or run. Ultimately, this greatly assists your sports podiatrist in making their diagnosis.

How are heel spurs treated?

Treatment for heel spurs is aimed at relieving pain by reducing inflammation in the area. Your sports podiatrist will be able to recommend treatments that will be effective for your individual circumstances.

Some types of treatments commonly used in patients with heel spurs include:   

• Shock wave therapy. This stimulates blood flow and collagen and hence improves healing
• Physically staying off the affected foot helps with removing the pressure on the feet, therefore reducing inflammation and helping to relieve the pain
• You can use an ice pack or cold compress for 15-20 minutes a few times a day to reduce inflammation in the sore foot
• Custom-made orthotics. Your sports podiatrist may recommend shoe inserts such as heel pads or orthotics, to provide you with control, NOT CUSHIONING and support where you need it and reduce pain
• Your sports podiatrist can demonstrate which types of exercises are appropriate for stretching and strengthening the tissues in the lower leg and foot. This will help with pain management in the long term. Your podiatrist will determine an exercise regime for your individual condition, so that you can be sure that you are only engaging in beneficial exercise and not worsening your condition
• Non-steroidal anti-inflammatories that are available over-the-counter may be recommended to you for short-term use if your pain is severe and cannot be managed using the conservative approaches mentioned above. These drugs do have some side-affects though, so they are not a long-term solution to the pain.

Rarely, in cases of heel spurs that are associated with very severe and ongoing pain, surgery may be indicated. This is quite uncommon. Of the very few patients that ultimately undergo surgical removal of their heel spurs, the large majority are also suffering with an associated condition such as plantar fasciitis or Achilles tendonitis, so the surgical method is usually corrective for these conditions at the same time.  

Preventing heel spurs

Taking note and paying close attention to the overall health of your feet and foot bio-mechanics is the best way to prevent heel spurs from forming. Repetitively over-stretching or straining the ligaments and tendons in your ankle and foot ultimately may lead to heel spurs and their associated pain. Some simple considerations you can make in order to reduce your risk of developing heel spurs include:

• Trying to maintain and healthy body weight
• Ensuring that you are wearing correctly fitting and appropriately supportive footwear
• Taking the time to warm up and cool down before and after exercise, with functional stretches that are relevant to the activity you are engaging in
• As much as is practical, avoid running and jumping on hard surfaces, especially barefoot
• Speak to your sports podiatrist about having a biomechanical assessment and gait analysis, as this will identify any malalignment or imbalances in the lower leg and foot, allowing you to prevent any problems before they arise.

Perhaps the most important thing to remember is to never continue to push through any type of heel pain. Keeping in mind that heel spurs develop from prolonged and repeated stress, you should not continue to engage in particular exercise or wear particular shoes that cause you to feel pain. If you do experience heel pain at any time, you can safely apply an ice pack to the sore foot, elevate it and rest it. Speak to your sports podiatrist to make an appointment them as soon as is practical for a professional medical assessment.

Please be advised that the information regarding heel spurs provided in the article above should not be taken as general medical advice. If you are experiencing heel pain or you are concerned that you may have a heel spur, you should consult with a qualified sports podiatrist. You can make an appointment with one of our sports podiatrists by heading online to www.sydneyheelpain.com.au or by calling 93883322.

Karl Lockett – sports podiatrist.