Heel Spurs

What is a Heel Spur?

A heel spur is a bony protrusion that forms where the fascia tissue connects to the heel bone. The bony protrusion is a result of calcium deposits that build up over time on the underside of the heel bone.

When discussing heel spurs, we look at two distinct types and the heel spur location. There are the more common bone spurs on the bottom of the heel, and the more difficult to treat bone spurs on the back of the heel.

So, what are spurs? Spurs are additional growths of bone, not just calcium deposits as some patients have asked me about. Bone is made of many minerals like phosphorous including calcium, collagen and matrix of hydroxylapatite and more. Calcium deposits are just calcium and can be found in many areas of the body. BUT bone is NOT just calcium. So, spurs are not just calcium but TRUE bone.

Specifically, this blog will discuss bone growths coming off the calcaneus or heel bone. Bone is a living organism and like all parts of the body will grow larger when there is force or stress on it. (Wolff's law, developed by the German anatomist and surgeon Julius Wolff (1836–1902) in the 19th century, states that bone in a healthy person or animal will adapt to the loads under which it is placed.) In other words, as the heel bone has stress applied to it, it will grow additional bone to handle the stress.

Types of heel spurs

1. Plantar heel spurs

Heel spurs on the bottom of the heel are known as "plantar" heel spurs. Plantar means the bottom of the foot. Heel/bone spurs on the back of the heel are known as "posterior" heel spurs. The theory of plantar heel spurs is that excess force from the plantar fascia, which connects to the heel bone, causes the spur to grow. One theory is that as the foot pronates (when the foot rolls in and the arch lowers), the foot lengthens as the arch drops. This causes the plantar fascia to be stretched and pulls on its insertion on the heel bone. Another theory is that dysfunction of the big toe joint, which is the other end of the plantar fascia, causes the fascia to again pull on the heel when we walk. There are also diseases that can cause heel spurs, such as ankylosing spondylitis which is a type of arthritis.

2. Posterior heel spurs

Heel spurs on the back of the heel, also known as posterior heel spurs, are located where the achilles tendon attaches to the heel bone. The theory is that excess pull on the achilles from its muscle attachments in the leg (gastrocnemius and soleus) causes stress to the heel bone causing heel spur at the achilles/heel bone interface. What is the reason for excess force on the achilles tendon? Here again, pronation of the foot plays is the cause. One major function of the two leg muscles that attach to the achilles (gastrocnemius/soleus) is to decelerate or reduce pronation of the foot when walking or running. When there is excess pronation (which has many causes), the muscles overwork and put extra strain on the achilles causing bone spurs on the back of the heel. Another cause of posterior heel spurs is some types of arthritis.

What are the Symptoms of Heel Spurs?

Many people who have heel spurs are usually asymptomatic and they don’t even know they have them until an x-ray of their foot is performed. For others, that is not the case and they can experience pain in the heel area that may come and go or can become chronic. Misdiagnosis is frequent as the pain does not come from the bony protrusion rather from the surrounding tissues, tendons and muscles. In fact, most people pinpoint their pain as plantar fasciitis which causes sharp pain after a prolonged rest period such as sleeping.

Heel Spur Symptoms can Include:

• Sharp pain in the heel when standing after a night’s sleep
• Heel spur pain during the day that can reoccur after intermittent periods of activity and rest
• An inflamed and swollen heel area
• Area of the heel that is warm to the touch
• A small bone protrusion on the underside of the heel
• Difficulty stepping on the heel and walking due to increased sensitivity on the underside of the heel

Other causes of heel spurs include:

• Performing physical activities on solid hard surfaces that pound and stress the heel

• Women usually suffer from heel spurs more than men as a result of wearing high heel shoes that strain the plantar fascia and place increased pressure on the heel area

• Injury to the heel can lead to heel spurs

• During the natural aging process, the fat pad thins out and provides less protection and shock absorption in the heel

• The more someone weighs, more stress is placed on their feet and heels

• Overpronation can cause heel spurs when the ligaments stretch and flatten the feet

• Shoes lacking support and cushioning

• Plenty of rest is recommended which will reduce the pressure, swelling and inflammation on your feet and heels.
• Limit the amount of physical activity, especially high impact activities that can worsen the condition.
• Ice the painful area to numb the pain and reduce swelling.
• Shoes for heel spurs should be worn as they provide heel spur relief and prevention. Never walk barefoot since the contact between the heel and the floor is hard and will aggregate the area. Look for heel spur shoes designed with the features listed below. If you don’t wear outside shoes in your home, purchase slippers for heel spurs that provide the same support and protection as shoes.
• • Orthotic insoles support the arch and foot and help alleviate tension on the tendon, easing pain and discomfort.
  • Thick cushioning in the heel area to provide protection and padding.
  • Ergonomic soles with rocker bottom facilitate foot motion and help reduce strain on the plantar fascia and heel.
• If your shoes are not constructed with orthotic insoles, it is recommended to purchase insoles for heel spurs that will support the arch and cushion the heel from shock forces.
• Non-steroidal anti-inflammatory medication can help with swelling, inflammation and heel spur pain relief.
• Cortisone injections can be administered to the painful area to reduce inflammation and swelling.
• In rare cases when all the above treatment options have failed to improve the condition, removal of the heel spur via surgery can be performed.