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A calcaneal spur (also known as a heel spur) is a bony outgrowth from the calcaneal tuberosity (heel bone). Calcaneal spurs are typically detected by x-ray examination. It is a form of exostosis.
When a foot is exposed to constant stress, calcium deposits build up on the bottom of the heel bone. Generally, this has no effect on a person’s daily life. However, repeated damage can cause these deposits to pile up on each other, causing a spur-shaped deformity, called a calcaneal (or heel) spur.
An inferior calcaneal spur is located on the inferior aspect of the calcaneus and is typically a response to plantar fasciitis over a period, but may also be associated with ankylosing spondylitis (typically in children). A posterior calcaneal spur develops on the back of the heel at the insertion of the Achilles tendon.
An inferior calcaneal spur consists of a calcification of the calcaneus, which lies superior to the plantar fascia at the insertion of the plantar fascia. A posterior calcaneal spur is often large and palpable through the skin and may need to be removed as part of the treatment of insertional Achilles tendonitis.
What is a heel spur?
A heel spur or bone spur is a bony growth that pokes out from the bottom of your heel, where your heel bone connects to the ligament running between your heel and the ball of your foot (the plantar fascia). Heel spurs affect about 15% of people.
Heel spurs develop over time. Most people don’t realize they have a heel spur until they seek help for heel pain. While heel spurs can be removed with surgery, healthcare providers recommend non-surgical treatments to ease symptoms associated with heel spurs.
Signs of heel spurs
Heel spurs cause discomfort on the bottom of the foot, especially close to the base of the heel. The pain worsens when you wake up in the morning or after a long rest. The pain is typically sharp and may feel as if there is a needle in the sole of the foot. The pain may also start after exercising.
What is the problem?
You need to be aware of the cause of heel spurs. If your shoes are old and do not offer sufficient support for your feet, you may constantly deal with this issue. It may be time to get a new specialized shoe with good cushioning and plenty of support for your feet. You may also consider using shoe inserts or custom arch supports.
Are heel spurs the same thing as plantar fasciitis?
Heel spurs and plantar fasciitis are related conditions but they’re not the same. Here’s how the two conditions intersect:
- Plantar fasciitis happens when overuse stretches or tears your plantar fascia — the ligament that runs between your heel and the ball of your foot. If you have plantar fasciitis, you’ll probably feel intense stabbing heel pain that comes and goes throughout your day. The pain eases once you walk for a bit but comes back if you sit and then get up to walk some more.
- Heel spurs can happen as a reaction to stress and inflammation caused by plantar fasciitis. Over time your body responds to the stress by building extra bone tissue. This extra tissue becomes a heel spur. Most people don’t feel pain from their heel spur, but when they do, the pain is like plantar fasciitis pain.
What causes heel spurs?
Heel spurs are your body’s response to stress and strain placed on your foot ligaments and tendons. For example, when you develop plantar fasciitis, your body responds to the stress by creating a heel spur.
You can also develop heel spurs by repeatedly tearing the covering that lines your heel bone or if you have a gait disorder. (A gait disorder is when an illness or condition affects your balance and coordination so you can’t walk as you usually do.).
How do healthcare providers diagnose heel spurs?
Healthcare providers typically examine your foot and ask about physical activity that might have caused your heel pain. Ultimately, X-rays are one of the most common tests that healthcare providers use to diagnose heel spurs.
Signs and symptoms
Major symptoms consist of pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may report heel pain to be more severe when waking up in the morning. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.
What’s the treatment for heel spurs?
Healthcare providers treat heel spurs the same way they treat plantar fasciitis. That’s because heel pain blamed on heel spurs is actually caused by plantar fasciitis. Treating the symptoms of plantar fasciitis can ease pain associated with heel spurs. Typical treatment includes:
- Resting your heel. If you run or jog, taking a break will help your heel pain.
- Using cold packs or ice. “Icing” the bottom of your foot can help ease heel pain.
- Taking oral anti-inflammatory medicine.
- Wearing footwear or shoe inserts that support your arches and protect your plantar fascia by cushioning the bottom of your foot.
Will I need surgery for my heel spur?
Your heel spur might be removed as part of plantar fasciitis surgery, but healthcare providers rarely perform surgery to remove heel spurs.
Do heel spurs go away without surgery?
Once formed, heel spurs are permanent. Surgery is the only way to remove a heel spur. Since heel spurs usually don’t hurt, treating the condition that caused your heel spur should help ease your heel pain.
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.
They 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
- Night splints
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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
More than 90 percent of people get better with nonsurgical treatments. If conservative treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. Surgical techniques include:
- Release of the plantar fascia
- Removal of a spur
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.
Heel Spur Surgery Recovery Time:
Following heel spur surgery, individuals should anticipate wearing a bandage over the incision for up to two weeks. Crutches are often used to assist with weight-bearing activities during the heel spur surgery recovery process. Over-the-counter pain medications can help with mild pain and discomfort. The RICE method should be used to help minimize pain and swelling immediately after surgery. Bandages and wraps may be used to achieve compression. Keeping the surgically treated foot elevated (ideally above the heart) will also minimize swelling. While most patients should expect a heel spur surgery recovery time of a few weeks, it may take up to three months for some patients to make a full recovery following heel bone spur surgery.
According to a 2015 review, physical therapy can help people with heel spurs improve their range of motion and keep their joints mobile. The AAOS recommend trying the following exercises for 4–6 weeks, under the supervision of a doctor.
Surgery is the only way to get rid of heel spurs entirely. However, as people with heel pain often have other conditions that cause pain, such as plantar fasciitis, they may find relief by following the general recommendations for reducing heel pain.
Rest, ice, NSAIDs, and physical therapy can help people with heel pain, and cushioned pads and shoes can reduce the impact of walking on the feet. In more severe cases, doctors may prescribe steroid injections or surgery.
People with heel pain should discuss their symptoms with their doctor, who can diagnose the cause of the pain and recommend the best approach.
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