What Is a Heel Spur?
A heel spur refers to a small, pointed calcaneus outgrowth from the underside of the heel. The outgrowth may be seen under the heel or at the back of the heel. Both conditions may remain painless, or it can cause pain while pressure is applied to the ball of the foot.
Patients may not have any symptoms of having a spur. Heel spurs are often associated with plantar fasciitis, which is the inflammation of the tissue that is found under the sole and connects the ball of the foot to the heel. Both conditions may be found separately or occur together.
A heel spur is attributed to chronic inflammation at the insertion of soft-tissue tendons or fascia in the area. A heel spur may occur beneath the sole of the foot, at the back of the heel, or under the heel. If they are located at the back of the heel, they are frequently associated with inflammation of the Achilles tendon. This can make the area tender and painful. Normally, heel spurs are about a quarter of an inch in length, so they may not be visible to the naked eye.
Heel Spur with Plantar Fasciitis
Plantar fasciitis involves the inflammation of a thick band of tissue. This tissue runs across the bottom of the foot and connects the heel bone to the toes. Plantar fasciitis is a major cause of heel spur. It causes tenderness and pain when stepping on the heel.
A heel spur and plantar fasciitis can occur alone or together. It can be related to some underlying medical condition such as reactive arthritis, spondylitis, and diffuse idiopathic skeletal hyperostosis. Having plantar fasciitis eventually increases the risk of heel spurs.
Causes
Heel spurs do not suddenly appear, but develop over a period of time. They tend to occur when the initial symptoms are ignored. The common causes of heel spurs are repetitive stress from walking, running, or jumping on hard surfaces. Other causes may be arthritis, bruising of the heel, poorly fitted shoes, worn-out shoes, excess body weight, and walking gait issues.
Heel spurs often develop by the gradual deposition of calcium on the underside of the heel bone. Muscle and ligament strain is one of the most common causes of heel spurs. Tearing of the membrane that covers the heel bone may also lead to the formation of bony outgrowths from the heel. Athletes who participate in activities that involve a lot of jumping or running are often affected by heel spurs.
Diagnosis
Heel spurs may not cause any symptoms at all. They can be incidentally discovered in an X-ray or other tests for foot ailments. Diagnosis is difficult since the symptoms of heel spur are similar to other forms of heel pain and foot problems. An orthopedic surgeon or a podiatrist needs to be seen for proper diagnosis.
Usually, an X-ray of the foot is done to identify the spur of the heel bone. Ultrasound scans and MRI can be done to identify any plantar fasciitis tears, calcification, or inflammation. Pathology tests, such as the screening for the HLA-B27 antigen can help identify spondyloarthritis. They cause symptoms similar to plantar fasciitis.
Risk Factors for Heel Spur Development
- Plantar fasciitis
- Diabetes
- Prolonged standing
- Being overweight
- Pregnancy
- Flat feet or high foot arches
- Aging
- Arthritis
- Jobs that involve a lot of walking or standing
- Sports that put increased stress on the heel bone and attached tissues
- Running and jumping on hard surfaces
- Wearing ill-fitting shoes that do not provide good support
Symptoms
Initially, you will notice heel spur pain under the heel in the morning or after resting. Pain is worse upon the first steps taken after waking and then improve with activity. Palpitating the tender area, you will feel a tender bony lump.
Heel spurs may remain asymptomatic for a long time. In some cases, pain while walking, jogging, and running, may be noted. Inflammation and tissue injury at the point of spur formation triggers the pain in most of the cases. The pain resembles that of a pinprick in the region where the spur is present, commonly when one stands up in the morning. As the day progresses, this pain will tone down to a dull ache. However, prolonged standing or sitting during the day may revive the prickling pain. Resting may not decrease heel spur pain. In fact, moving around after resting may start the pain as the tissue stretches.
Treatment and Home Remedies for Heel Spurs
Below are some methods used to treat heel spurs:
1. Conventional Treatment
The aim of this treatment is to decrease the associated inflammation and avoid re-injury. Anti-inflammatory medications are often helpful. Ice can also be applied to the affected area to reduce pain and inflammation. Sports running shoes with soft soles can be beneficial to reduce the irritation and inflamed tissues present with heel spurs. The most commonly recommended treatment options for this condition include shoe inserts, stretching exercises, strapping, and physical therapy. In some cases, orthotic devices are recommended to correct the underlying problem of pain in heel spurs. Corticosteroids may be used to reduce inflammation in the affected area. In rare cases, surgery may be opted for to remove the spur or to release the plantar fascia.
Another conventional treatment is a steroid injection. However, this is not always effective since the heel is made of many structures that make it a difficult place for injection. If the pain associated with heel spur or plantar fasciitis continues a few months following conservative treatment, the doctor may inject the heel with steroidal anti-inflammatory medications. These cortisone injections have been found to have short-term benefits. The symptoms can become worse if the treatment goes wrong.
2. Surgery
Surgery is typically effective. However, the procedure can be expensive. There is a chance that heel spurs may recur after surgery if the patient continues the same lifestyle that caused the initial condition. After surgery, doctors may recommend rest, application of ice, compression, and elevation of the foot. The doctor may even advice to place weight on the affected area. Some patients may need to use bandages, splints, casts, surgical shoes, crutches, or walking sticks.
The possible complications associated with this surgical method include nerve pain, permanent numbness in the affected area, infection, recurrent heel pain, and scarring. There is a risk of foot cramps, stress fractures, tendonitis, and instability if the plantar fascia is released.
3. Active Foot Stabilization Exercises
This is an excellent long-term solution that helps both prevent and control heel spurs. To prevent the recurrence and effectively rehabilitate heel spurs and plantar fasciitis, there are eight stages that need to be covered:
- Early injury protection
- Regain full range of motion
- Restore foot arch muscle control
- Restore normal calf and leg muscle control
- Restore normal foot biomechanics
- Improve running and landing technique
- Return to sport or work
- Footwear analysis
Another treatment option is cryoultrasound therapy. It is an innovative electromedical device, which utilizes two techniques: cryotherapy and ultrasound. Cryotherapy hastens the healing process by interrupting the cycle of pain and spasms. This therapy also increases the cell metabolism and blood circulation. Additionally, it stimulates the elimination of toxins and speeds up the recovery process.
Prognosis
Generally, the outlook is good. Usually, the inflammation responds to non-surgical treatment. Surgical intervention is only required in very rare cases. Ninety percent of people with plantar fasciitis or heel spur show improvement with physiotherapy treatment.
Prevention
Heel spurs can be avoided by simply wearing well-fitting shoes with shock-absorbent soles. In addition to wearing the appropriate footwear, it is also important to warm up before any physical activity and remember to pace yourself. If you are overweight or obese, then losing weight can reduce the strain and pressure on your feet.
Natural Home Remedies for Heel Spurs
- Magnesium: This is essential for bone formation and utilization of calcium. Warm baths with Epsom salt is one way of healing heel spurs. Epsom salt contains magnesium sulfate and can relieve pain and inflammation. There are also foods that are magnesium-rich and can alleviate a heel spur. Some of these foods include spinach, avocado, banana, and black beans.
- Vitamin B5: It helps the body avoid nerve damage and accelerates the healing process. Foods rich in vitamin B5 are avocado, sunflower seeds, egg, and salmon.
- Proteolytic enzymes: They help reduce inflammation. Pineapple contains bromelain that can speed up the healing process and reduce inflammation.
- Alkaline diet: It helps maintain proper pH, which helps avoid inflammation and calcium buildup.
- Fish oil: It contains omega-3 fatty acids that help fight inflammation.
- Massage: A warm oil massage increases fluid flow and speeds up the healing process.
- Wear minimalist shoes: It is important to choose the right shoes for your lifestyle and physical activity.
