Heel Spurs

Heel Spurs

A heel spur is a calcium deposit on the underside of the heel bone. On an X-ray, a heel spur protrusion can extend forward by as much as a half-inch. Without visible X-ray evidence, the condition is sometimes known as "heel spur syndrome."

Although heel spurs are often painless, they can cause heel pain. They arefrequently associated with plantar fasciitis, a painful inflammation of the fibrousband of connective tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the ball of the foot. 

Treatments for heel spurs and associated conditions include exercise, custom-made orthotics, anti-inflammatory medications, and cortisone injections. Ifconservative treatments fail, surgery may be necessary.

Causes of Heel Spurs

Heel spurs occur when calcium deposits build up on the underside of the heel bone,a process that usually occurs over a period of many months. Heel spurs are oftencaused by strains on foot muscles and ligaments, stretching of the plantar fascia,and repeated tearing of the membrane that covers the heel bone. Heel spurs areespecially common among athletes whose activities include large amounts of running and jumping.

Risk factors for heel spurs include:

• Walking gait abnormalities,which place excessive stress on the heel bone,ligaments, and nerves near the heel.
• Running or jogging,especially on hard surfaces.
• Poorly fitted or badly worn shoes,especially those lacking appropriate archsupport.
• Excess weight and obesity.

Other risk factors associated with plantar fasciitis include:

• Increasing age, which decreases plantar fascia flexibility and thins the heel'sprotective fat pad.
• Diabetes.
• Spending most of the day on one's feet.
• Frequent short bursts of physical activity.
• Having either flat feet or high arches.

Symptoms of Heel Spurs

Heel spurs often cause no symptoms. But heel spurs can be associated withintermittent or chronic pain -- especially while walking, jogging, or running -- ifinflammation develops at the point of the spur formation. In general, the cause ofthe pain is not the heel spur itself but the soft-tissue injury associated with it.

Many people describe the pain of heel spurs and plantar fasciitis as a knife or pinsticking into the bottom of their feet when they first stand up in the morning -- apain that later turns into a dull ache. They often complain that the sharp pain returns after they stand up after sitting for a prolonged period of time.

Non-Surgical Treatments for Heel Spurs

The heel pain associated with heel spurs and plantar fasciitis may not respond well to rest. If you walk after a night's sleep, the pain may feel worse as the plantar fascia suddenly elongates, which stretches and pulls on the heel. The pain often decreases the more you walk. But you may feel a recurrence of pain after either prolonged rest or extensive walking.

If you have heel pain that persists for more than one month, consult a health care provider. He or she may recommend conservative treatments such as:

• Stretching exercises
• Shoe recommendations
• Taping or strapping to rest stressed muscles and tendons
• Shoe inserts or orthotic devices
• Physical therapy

Heel pain may respond to treatment with over-the-counter medications such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve). In many cases, a functional orthotic device can correct the causes of heel and arch pain such as biomechanical imbalances. In some cases, injection with a corticosteroid may be done to relieve inflammation in the area.

Surgery for Heel Spurs

If conservative treatment fails to treat symptoms of heel spurs, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include:

• Release of the plantar fascia
• Removal of a spur

In most cases, plantar fascia release -- with or without heel spur removal -- has proven effective. But pre-surgical tests or exams are required to identify optimal candidates, and it's important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is risk of instability, foot cramps, stress fracture, and tendinitis.

Prevention of Heel Spurs

You can prevent heel spurs by wearing well-fitting shoes with shock-absorbent soles, rigid shanks, and supportive heel counters; choosing appropriate shoes for each physical activity; warming up and doing stretching exercises before each activity; and pacing yourself during the activities.

Avoid wearing shoes with excessive wear on the heels and soles. Lose weight if you're overweight or obese.