What is a Heel Spur?

Heel spurs refer to an abnormal bone growth on the heel bone (calcaneus). Calcium deposits in the area where the plantar fascia (tissue bands that join the heel to the toes) attaches to the heel bone and forms a mass. This protruded mass, tears into the plantar fascia, each time the foot is moved. This micro-trauma causes pain, inflammation, and muscle strain in the feet.

Causes, Incidence and Risk Factors

Heel spurs themselves are not painful, but the associated inflammation and irritation of the plantar fascia causes pain.

Almost 10% of those seeking medical help for heel pain suffer from heel spurs. Women are to be more prone to the condition than men. Heel spurs affect the middle-aged population to a large extent.

Certain existing deformities of the foot may increase the risk of heel spurs. These are flat foot or a high arched foot. Women who wear improper footwear are also at a greater risk of developing heel spurs. Being overweight may be another risk factor.

Signs and Symptoms

The main symptom that is noticed is pain in the foot that increases after a long period of inactivity, such as early in the morning. The pain subsides after initiating activity but again worsens. There may be tenderness at the heel. There is difficulty in performing weight bearing activities like running, jogging, or climbing stairs.

Screening and Diagnosis

A physical examination shows tenderness at the heel. Laboratory investigations are not required for diagnosis of heel spurs. Radiographic studies are necessary for a correct diagnosis. An X-ray of the foot shows calcium deposits on the heel bone.

Treatment

Medical Treatment:

Conservative methods are helpful in relieving most of the symptoms.

• Rest
• Avoid activities that aggravate the pain
• Apply ice to ease the pain
• Stretching exercises are done to relax the soft tissue.
• Non-steroidal anti-inflammatory drugs (NSAIDs) are used, to relieve the pain and inflammation of the plantar fascia.
• Shoe inserts can be used to release the pressure on the heel, while engaged in weight bearing activities.
• Splints can be worn at night to prevent contraction of the fascia.
• Corticosteroid injections are often helpful, if the above mentioned methods fail. However, there are complications like rupture of the plantar fascia and fat pad atrophy associated with steroid injections administered locally.

Surgical Treatment:

Surgery is reserved for people who do not respond to medical treatment. Surgery to release the plantar fascia is performed and is effective in 80% of the cases.

Occasionally, a physician will inject the plantar fascia with a corticosteroid to reduce the inflammation. However, this is only a temporary fix and can weaken the plantar fascia to the point that is tears.

Prevention

• Avoid standing for long periods of time
• Early treatment of existing foot deformities
• Wear proper shoes, with adequate arch support
• Stretch in the morning and before activities
• Lose excess weight