What is a Heel Spur?
Heel spurs are a common source of heel pain. Heel spurs are a bony growth attached to your heel bone (calcaneus) and grow into your foot arch.
What Causes a Heel Spur?
A heel spur is caused by chronic plantar fasciitis.
Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.Your plantar fascia acts as a passive limitation to the over-flattening of your arch. When your plantar fascia develops micro tears or becomes inflammed it is known as plantar fasciitis.
When plantar fasciitis healing is delayed or injury persists, your body repairs the weak and injured soft tissue with bone. Usually, your injured fascia will be healed via fibroblastic activity. They'll operate for at least six weeks. If your injury persists beyond this time, osteoblasts are recruited to the area. Osteoblasts form bone and the end result is bone (or calcification) within the plantar fascia or at the calcaneal insertion. These bone formations are known as heel spurs.
This scenario is most common with the traction type injury. The additional bone growth is known as a heel spur or calcaneal spur.
What are the Symptoms of a Heel Spur?
How Does a Heel Spur Progress?
- You'll typically first notice early heel spur pain under your heel in the morning or after resting.
- Your heel pain will be worse with the first steps and improves with activity as it warms up.
- When you palpate the tender area you may feel a tender bony lump.
As your plantar fasciitis deteriorates and your heel spur grows, the pain will be present more often.
How is a Heel Spur Diagnosed?
Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination.
After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts.
X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal or heel spur.
Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification.
Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Risk Factors for Heel SpursYou are more likely to develop plantar fasciitis and heel spurs if you are:
Heel Spur Prognosis
- Active - Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. running, ballet dancing and aerobics.
- Overweight - Carrying around extra weight increases the strain and stress on your plantar fascia.
- Pregnant - The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation.
- On your feet - Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses.
- Flat Feet or High Foot Arches" Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force.
- Middle - Aged or Older - With ageing the arch of your foot may begin to sag putting extra stress on the plantar fascia. Wearing shoes with poor support.
- Weak Foot Arch Muscles - Muscle fatigue allows your plantar fascia to overstress and cause injury.
- Arthritis - Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
- Diabetes - Although doctors don't know why plantar fasciitis occurs more often in people with diabetes.
The good news is that heel spur pain is rarely permanent. Plantar fasciitis, the main cause of a heel spur, is reversible and very successfully treated. Over 90 percent of people with plantar fasciitis or heel spurs improve significantly with physiotherapy treatment. While you may continue to see a heel spur on Xray, once you settle the inflammation adjacent to your heel spur, the heel pain will resolve.
If your plantar fasciitis or heel spur pain continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). Cortisone injections have been shown to have short-term benefits but they may retard your progress in the medium to long-term, which can mean that you will suffer recurrent bouts for longer. Further research is required to improve results.What is the Best Treatment for Heel Spurs?
Due to poor foot biomechanics being the primary cause of your plantar fasciitis, and subsequently your heel spurs, it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the development or progression of a heel spur.
Your physiotherapist is highly-skilled in foot control assessment and its dynamic biomechanical correction. Depending upon your specific clinical assessment, your physiotherapist may provide you with manual therapy techniques such as joint mobilisations to loosen stiff joints, soft tissue massage or release, muscle flexibility or stretches, foot taping, foot, and lower limb strengthening exercises and occasionally night splints. The treatment of plantar fasciitis and heel spurs does vary from person to person so please seek the advice of your foot care practitioner.
They may recommend that you seek the advice of a podiatrist, who is an expert in the prescription on passive foot devices such as orthotics. Foot orthosis have been shown to potentially assist plantar fasciitis and heel spurs.
Active foot stabilisation exercises are an excellent long-term solution to prevent and control heel spurs and plantar fasciitis that may be prescribed by your physiotherapist.
Researchers have concluded that there are essentially 8 stages that need to be covered to effectively rehabilitate plantar fasciitis and prevent recurrence. These are:
- Early Injury Protection: Pain Relief & Anti-inflammatory Modalities
- Regain Full Range of Motion
- Restore Foot Arch Muscle Control
- Restore Normal Calf & Leg Muscle Control
- Restore Normal Foot Biomechanics
- Improve Your Running and Landing Technique
- Return to Sport or Work
- Footwear Analysis
Treatment of heel spurs is similar to plantar fasciitis treatment. Your physiotherapist will select the most appropriate treatment modalities for you.
Ultimately, biomechanical correction is the aim. Foot intrinsic muscle strengthening (including tibialis posterior and peroneus longus) and calf (gastrocnemius and soleus) stretches are almost always required.
Cases of moderate to severe biomechanical deformity should be referred for physiotherapy or podiatric assessment to prevent chronic recurrence. NSAID's and corticosteroid injection is most effective when combined with biomechanical correction.
Mechanical treatment that involves taping and orthoses has been shown to be more effective than either anti-inflammatories or accommodative modalities.
Plantar fascia night splints can sometimes work to provide short-term pain relief. The splints essentially overstretch the plantar fascia, which may provide you with some short-term relief, but ultimately elongates your passive arch structures. The medium and long-term benefits make no sense of this rationale. To the contrary, permanent elongation will predispose you to flatter arches and more likelihood of recurrent heel pain. Based on this we do NOT currently recommend plantar fascia night splints in most instances.
Weight loss and load management are an important influence upon the initiation and duration of plantar fasciitis and heel spurs. Your weight may be impacting upon your plantar fascia of heel spurs, so weight loss should be a priority for those patients who are carrying excess weight.
What Happens If You Do Nothing?
Left untreated, heel spurs grow larger and usually become excessively painful. For more specific advice about your heel spur or plantar fasciitis, please contact your PhysioWorks physiotherapist.