Heel spurs

A doctor holding a foot with a red pain locator symbolising pain

What are heel spurs?

X-ray of a person's heel showing a heel spur in red Heel spurs (calcaneal spurs) are bony bumps of calcium deposits that form on the heel bone. They are often the result of high prolonged periods (months and years) of stress being placed on the tendons that attach to the heel bone. The protrusions often occur in conjunction to, or as a result of Achilles tendinopathy and plantar fasciitis, as the tendon's involved with these conditions are attached to the heel bone and repetitively “pull” on the bone. This causes micro trauma and the body attempts to heal itself by creating more bone, becoming these calcified protrusions known as heel spurs. 

Causes

Like Achilles tendinopathy & plantar fasciitis, heel spurs develop from overuse or over training. This training puts extra strain on the muscles and ligaments around the heel and ankle, which eventually puts excessive strain on the heel bone, causing these spurs. 

The most common causes of heel spurs include: 

  • Overuse and over-training 
  • Inadequate footwear for activity, worn out footwear and high heels
  • Poor levels of strength, mobility and flexibility in the lower limbs
  • Muscle imbalances and dysfunction
  • Rigid feet with poor mobility and flexibility that are inadequate to absorb shock 
  • Excessive pronation of the ankle and feet 
  • Leg length difference 
  • Bowed or knocked knees 
  • Abnormal walking and running patterns that place extra stress on the heel bone and ligaments
  • Achilles tendinopathy and plantar fasciitis

Who is at risk?

If you've had plantar fasciitis or Achilles tendinopathy for over 6-8 weeks, then you're at a higher risk of developing heel spurs. 

Considering this, there are also specific groups of people that, if they have one of these conditions, are also more likely to develop heel spurs than others:

  • Women who wear high heeled shoes, which can shorten the Achilles tendon over time.
  • Older people as over time the flexibility of the plantar fascia decreases and the heel's protective fat pad that helps to cushion and protect the heel bone also thins.
  • Active runners, joggers and jumpers as more strain will be placed on the heel bone during training, especially if training on hard surfaces and for many years. 

Woman in high heels sitting down holding her ankle and heel in pain

Person sitting on the ground with their fingers on their heel in pain
Runner's feet in exercise shoes pushing off from a hard ground at sunrise or sunset

Symptoms

The thought of increased bone creation may sound uncomfortable and painful, however, it's not usually the heel spurs that cause your heel pain. Instead, the pain you feel is most likely connected to a pre-existing condition like plantar fasciitis or Achilles tendinopathy

Common symptoms associated with the condition include:

  • Pain in the heel of either one or both feet. The pain can be a sharp, throbbing or a dull ache.
  • Pain when walking barefoot or struggling to walk barefoot.
  • You might be able to feel a small, bony bump on the bottom or back of your heel.
  • Tenderness.
  • Stiffness of the foot and ankle joints.
  • Pain with activity and daily living.
  • Numbness, burning and tingling if the nerves are impacted by the spur.
  • Limited range of motion and mobility in joints.

There's also the chance that you may not experience any symptoms that relate to heel spurs. Some can go unnoticed and will only be picked up through an X-ray or other tests done for another foot related issue. 

Diagnosis

We diagnose a heel spur by taking into account your signs and symptoms and the history of the injury, as well as perform a physical assessment. If we suspect a heel spur, we will refer for X-ray imaging.

Treatment

Our treatment pathways for heel spurs are dependent on your signs and symptoms. If it is painless then our first course of action is to simply monitor for any changes. 

Commonly, heel spurs are not the source of pain so it is important to identify the real cause of your heel pain and begin, or continue, treatment for that condition (e.g. plantar fasciitis or Achilles tendinopathy). Often, treatment of the underlying condition will help to resolve your pain and heel spur surgery will not be required. 

If it's identified that you're experiencing heel pain due to another condition, then the following treatments may be required to help control your symptoms:

  • A strengthening & stretching program, especially focusing on the joints and muscles in your feet and ankles.
  • Adapt and modify your training program.
  • Gait re-training to fix any biomechanical issues that could be contributing to the injury.
  • Supportive footwear with cushioning soles.
  • Custom prescribed foot orthotics may be recommended to offload the sore, overused structures and soft tissues.
  • Foot and ankle strapping.
  • Foot mobilisation technique to mobilise the joints and bones of the foot and ankle to facilitate restoration of movement.
  • Shockwave therapy is a non-invasive effective therapy that accelerates and facilitates the healing process. It works by emitting high energy acoustic wave pulses directly into the injured area. These waves stimulate;
    • New blood vessel and collagen formation 
    • Increased blood flow 
    • Resolution of calcium build up 
    • Pain reduction 
  • Dry needling of surrounding soft tissues structures to release tension in the muscles, by targeting trigger points. 

Surgery is rarely advised, however, if these conservative treatments fail to reduce your heel pain it may be required as a last resort. 

The fact of the matter is, heel spurs do not go away without surgery, but if it's not causing you pain, then you have nothing to worry about and you can continue to live a normal life with your heel spurs.

What happens if I ignore my heel spur?

It is important to address the cause of your heel pain. If you ignore this pain for too long you could end up in a moon boot for an extended period of time, or surgery may be required. You will also have a prolonged healing period which may prevent you from exercising and completing your daily activities. 

Prevention

There are a number of factors you can implement that will help to reduce your risk of developing heel spurs:

  1. Wear properly fitting shoes with cushioned soles that help to absorb shock. 
  2. Choose appropriate footwear for the activity.
  3. Warm up and stretch before exercise or activities.
  4. Don't push through any heel pain as this can lead to long-term issues. If you're experiencing pain, rest and ice the area and see a podiatrist if the pain persists. 

FAQs

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