Do I Have A Heel Spur?

What is The Truth About Heel Spurs?

Many of us have heard the term “heel spur” before.

As a brief definition: Heel spurs are a build up of calcium which protrudes from the heel bone, towards the toes that are visible onx-ray.

Usually the name will conjure up images of sharp pain digging into the bottom of the heel like a large nail. Causing the victim to limp and generally be in extreme discomfort.

But what if I was to tell you that most of the people with heel spurs are not currently in pain?

Or that there are many people walking around who have no idea that they even have a heel spur?

Or if I said that the cause of really sharp heel pain is more often caused by inflammation in the tissue around the heel spur, and not necessarily a heel spur itself?

Well all of these statements have been proven to be true.

Heel spurs, rather than a common cause of heel pain, are more often the result of chronic heel pain and inflammation in the plantar fascial band that stretches from the bottom of the heel to the front of the foot and acts like a spring, or in the Achilles tendon.

So there are two common places where you can develop a heel spur: at the back of your heel and underneath (plantar aspect) of you heel.

To learn more about heel pain read our heel pain article here.

You can see both types of heel spur in the x-ray below.

An Xray of the foot and ankle showing two heel spurs one on the plantar surface an one at the posterior

Posterior Heel Spur: this one is at the back of the heel as pictured and forms where the Achilles tendon inserts into the calcaneus (heel bone).

The one on the bottom (plantar heel spur) forms in the plantar fascia where it originates from the plantar aspect of the calcaneus.

The Plantar Heel spur is usually the result of plantar fasciitis at some stage in your life. 

The inflammation actually stimulates osteogenesis (growth of new bone cells) within the plantar fascia until it forms a long sharp looking heel spur.

Most people who have had plantar fasciitis but no longer have it will still have a heel spur.

But luckily without the inflammation, the spur causes no pain.

Many years ago they used to remove these spurs surgically, until they realised that the surgery wasn’t actually reducing pain, and in fact could cause more permanent pain by disrupting the plantar fascia.

The posterior heel spur is a bit different. 

It is also caused by inflammation in the Achilles tendon, but unlike the plantar fascia, surgery can be a reasonable solution if you are continuing to get pain.

Most surgeons will ask the patient to explore all forms of conservative (non-surgical) treatment before they go under the knife.

This is because all surgeries carry risk, and if it possible to settle the pain through conservative therapy, then that is obviously the best result.

So, What Causes Heel Spurs?

Heel spurs have many different causes, but most of them are conditions that cause extra stress on the heel bone and the soft tissue structures that surround it.

Both types can be caused by any of the following:

  • High body mass index, or obesity, the more you weigh, the more load the plantar fascia need to absorb,
  • Poor Biomechanics (the angles of our joints can put more pressure on specific anatomy),
  • Chronic health conditions including diabetes, peripheral vascular disease, and connective tissue disorders.
Heel spurs have many different causes, but most of them are conditions that cause extra stress on the heel bone and the soft tissue structures that surround it.

Both types can be caused by any of the following:

  • High body mass index, or obesity, the more you weigh, the more load the plantar fascia need to absorb,
  • Poor Biomechanics (the angles of our joints can put more pressure on specific anatomy),
  • Chronic health conditions including diabetes, peripheral vascular disease, and connective tissue disorders.

So if we break it down into the two types of heel spur.

  •  

The plantar heel spur can be caused by:

 

    • Footwear with poor cushioning or poor support, the cushioning part I probably obvious but support in the upper of the shoe can be even more important. If your feet are not well supported, then the plantar fascia will be exposed to much more load,
    • A sudden increase in activity rather than a gradual increase, when increasing exercise, it’s smart to go up in small increments,
  •  

The posterior heel spur can be caused by the following:

  • Tight posterior muscles including the calf muscles, but also the hamstrings,
  • Lower back issues, people with lower back pain tend to tense up their posterior muscles thus creating the same problem as the first cause,
  • Poor footwear – shoes should have a small pitch (heel height to forefoot height), approximately 8-10mm, if they are less than this it can place too much tension on the Achilles tendon, if you’re used to wearing high heels, then your calves will shorten (high heel addiction!) and that will in turn cause a problem.

Which Treatments are Effective?

A pair of Asics Running Shoes
  • One of the very first things to do for either heel spur is to get yourself into a good pair of trainers. Something that has a bit of a heel pitch and the has good structure in the upper to hold your foot in a less stressful position.
    If you need to wear something more formal to work, then have a look at the Ascent range of shoes which are currently sold at The Athlete’s Foot.
    They have a range of duty shoes, boots, and Mary-Jane style shoes which have the same type of structure as a good trainer.
    (I have no financial interest in The Athlete’s Foot or Ascent Footwear)
    To read our guide to running shoes click here.
  • One of the very first things to do for either heel spur is to get yourself into a good pair of trainers. Something that has a bit of a heel pitch and the has good structure in the upper to hold your foot in a less stressful position.
    If you need to wear something more formal to work, then have a look at the Ascent range of shoes which are currently sold at The Athlete’s Foot.
    They have a range of duty shoes, boots, and Mary-Jane style shoes which have the same type of structure as a good trainer.
    (I have no financial interest in The Athlete’s Foot or Ascent Footwear)
    To read our guide to running shoes click here.
  • Massage can be helpful to stretch out the tight muscles which may be contributing to the pain,
  • Anti-inflammatory medications both topical and oral, topical are kinder to the body as they don’t have to pass through the stomach first. Always consult your physician or pharmacist before taking oral anti-inflammatroies and never take them for more than 5 days,
  • Stretching of posterior chain muscles (including the calves (gastrocnemius and soleus), hamstrings and gluteal muscles).
    This should be done gently as there is a chance of doing harm if your are too rigorous in your stretching. Gently hold in a position where the muscles feel tight for 20-30seconds,
A woman sits on the ground stretching to touch her toes.
  • Strengthening of muscles that support the arch – for more on strengthening the intrinsic muscles of the foot click here.
  • Dry needling, this is similar to acupuncture because of the needles we use. But unlike acupuncture we aren’t looking for meridians but the trigger points of your muscles to help them to relax,
  • Shockwave therapy, this can improve the blood flow to the injured area which promotes healing of damaged tissue,
  • Custom foot orthotics for offloading. This is possibly the most effective treatment long term. Orthotics can significantly reduce the tension on the plantar fascia and the Achilles tendon when you walk. They also hold the foot in a more balanced position which places less strain on all the soft tissues surrounding the feet.
    To learn more about custom foot orthotics read my blog post here.

If heel spurs, plantar fasciitis or other types of heel pain are getting in the way of you living the active life you enjoy, let us help you get pain-free.

Call 3351 8878 or book online here. 

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