Heel spur

The heel spur or heel spur (medically calcaneal spur) is a benign bone outgrowth (exostosis) caused by bone formation in the lower part of the heel or back of the heel bone.

As a rule, it forms in the inner area of the heel bone, at the origin of the tendon plate, or it is found in the posterior upper heel area, at the base of the Achilles tendon.

A heel spur is not painful, nor are the osteophytes-related bone outgrowths (osteophytes) in the joints; in addition, it develops very slowly: if a heel spur can be seen on the X-ray, its growth has already begun 10 years earlier.

The cause of this bone outgrowth is an inflammation of the sole tendon plate at the level of its attachment to the heel (tendon inflammation or ethesiopathy) and the resulting calcium salt deposit.
In the long run, the accumulation of calcium in the heel area leads to the formation of a heel spur.

The patients with diagnosed heel spurs who appear for physiotherapy are adults, often they must wear safety shoes at work; footwear is, in fact, a factor that favors the development of a heel spur.
Not all my patients with heel spurs are overweight, according to statistics only 40%, but almost all of them work mainly standing.

Normally, only one foot is affected, but a heel spur can occur on both sides. No reliable statistics can be created for this, because usually only an X-ray is taken of the painful foot, although the other foot could also be affected.

Many athletes suffer from heel pain, i.e. a diffuse pain under the heel bone, especially track and field athletes, football, basketball and tennis players.
These two symptoms should not be confused with each other, because they must be treated differently.


Causes of a heel spur

A calcaneal spur is formed when calcium is deposited in the lower part of the heel bone; this is usually a lengthy process that takes many months. The heel spur is often caused by injuries to muscles and ligaments of the foot, strains of the tendon plate and repeated tears of the membrane surrounding the heel bone. It is particularly common in athletes who complete long running sessions and many jumps.

Risk factors in developing a heel spur include:

  • an unnatural gait in which the heel bone, ligaments and nerves on the heel are subjected to increased pressure;
  • running and jogging, especially on hard surfaces;
  • inappropriate footwear, especially if the arch of the foot is not sufficiently supported;
  • Overweight and obesity.

In addition, the following aspects can be associated with fasciitis plantaris:

  • age: with age, the flexibility of the sole tendon plate decreases and the subcutaneous fatty tissue protecting the heel becomes thinner;
  •  Diabetes;
  • much of the day is spent standing;
  • many short training sessions or competitions;
  • Flat or hollow foot.

What are the symptoms?

Many doctors make the mistake of attributing the heel spur to the cause of all foot problems. They are convinced that the pain can only be caused by an anatomical deformity, but this is often not the case, it may just as well be bursitis of the heel or plantar fasciitis.
The heel spur is a bone outgrowth, the tip of which points to the toes; it is usually located in the lower-inner area of the heel bone and the pain occurs stabbing exactly at this point.

According to patients, the most painful moments of the day are getting up in the morning, getting up after sitting for a long time and the evening after spending a lot of time standing during the day.

Those who get out of bed in the morning after sleeping all night feel intense pain because the tendon plate suddenly stretches out and pulls on the heel bone.
The pain is perceived as an intense sting, which leads to limping, but disappears after about half an hour; at the end of the working day, it makes itself felt again, especially in people who have walked a lot.

Safety shoes, elegant shoes or shoes with heels can increase the symptoms.
The heel spur is often asymptomatic, estimated in about 30% of cases.
Heel pain, on the other hand, causes diffuse pain under the entire heel, in some patients not exactly in the middle, but rather laterally.
The symptoms occur in the morning and worsen if the affected person walks or stands for a long time; sometimes he is forced to sit down and rest because of the severe pain.
In most cases, the sole of the foot has calluses, because the patient puts the foot on in an unnatural way, there is an imbalance to the inside.
One should know that an incorrect placement of the foot can also worsen the overall posture and cause back pain or neck pain.

How is the diagnosis of heel spur made?

For a correct diagnosis, it is necessary to consult a doctor who will inquire about the history of the disease and conduct a clinical examination to assess the signs and symptoms.
The doctor may also order technical examinations; this will usually be an X-ray under stress, because here a heel spur is clearly visible.
Magnetic resonance or ultrasound also provide information about bruising, inflammation, thickening of the tendon plate or lesions.

What can be done? Treatment options for a heel spur

Medical and pharmacological treatment of a heel spur

In the case of heel spurs or plantaris fasciitis, the pain in the heel does not necessarily subside by sparing, but running training and sports that aggravate the symptoms should be avoided at all costs.

Usually, the pain gradually subsides at the first steps. The stitches may recur after a long rest or after standing for a long time.

If the pain in the heel lasts more than a month, a doctor should be consulted. He or she may recommend the following natural remedies, such as:

  • stretching and gymnastics exercises for the ankle and toes;
  • appropriate footwear;
  •  Kinesio taping to relieve stretched muscles and tendons;
  •  orthopedic insoles.

Physiotherapy helps to relieve pain: a treatment cycle laser Co2/Yag therapy or ultrasound therapy with 1 MHz frequency, because the sound waves penetrate deeper than those of 3 MHz, plus stretching exercises.
Magnetotherapy is not suitable in this case.
Some doctors recommend performing ultrasound therapy underwater, even if it works more on the instep where it is not actually needed.
As a rule, the symptoms disappear after completion of a course of treatment, in persistent cases, a few more sessions of shock therapy may be necessary. The shock wave does not destroy the heel spur, but promotes the formation of new blood vessels and creates microbleeding that subsides or greatly improves the inflammation.
Physiotherapy can not remove the heel spur,this should be clear, only the surgeon can do that, but the spike would form again in a short time. As a rule, the patient does not undergo surgery because the symptoms can be completely eliminated or at least greatly improved with the help of physiotherapy.

The pain at the heel may respond to over-the-counter medications, such as acetaminophen (Ben-u-ron) or ibuprofen. In many cases, an orthopedic insole is helpful to correct a flat or hollow foot and the pronation/supination of the ankle.

The doctor may inject cortisone injections into the affected area as an anti-inflammatory measure; however, this can have desirable side effects, such as a weakening of the soft tissue under the heel bone.

Surgery for a heel spur

Surgical intervention is considered as a last resort for the patient.
It is usually not considered until conservative treatment is unsuccessful.
The severe pain caused by a heel spur can become unbearable, every movement becomes a torment.
In most cases, surgery is an effective remedy for pain, but there may be certain side effects that the patient needs to know before undergoing surgery.

In the case of heel spurs, there are two different surgical procedures.

Endoscopically performed, plantar fasciotomy is the first way to eliminate pain. In this procedure, two holes are made in the heel; on one side, a mini camera is inserted through one of these openings, which shows the surgeon the injured area.
With the help of a small scalpel, the surgeon cuts the tendon plate or detaches it from the heel bone, reducing tension and pain; the new fascial tissue can develop in the free space created. In this procedure, the tension through which the heel spur or plantaris fasciitis has formed is released.

There is also another surgical procedure for the heel spur, which is slightly different. Here, not the entire tendon plate is severed, but only a part of the tendon.
Some surgeons believe that this method is not as effective as endoscopic plantar fasciotomy, while others are convinced of the opposite and attribute better results to it. Regardless of this, the patient should discuss with the surgeon which surgical procedures are possible in his case in order to select the most sensible solution for him.

During the operation, the surgeon can also remove the heel spur.
In this case, the surgeon – supported by a small camera – completely removes the heel spur. In this way, the frequency of pain can be reduced because the calcaneal spur can no longer damage the surrounding tissue.

How long does it take to heal?

Without treatment, the pain caused by heel spurs lasts for a very long time, some patients visit the practice a year or two after the onset of symptoms.

After successful treatment, appropriate footwear must be worn so that the symptoms of the heel spur do not recur.
Many patients use insoles in the shoes, which provide pressure relief at the pain-sensitive area.
Custom-made insoles can be used for mechanical structural problems of the foot.
It is important to continue to perform the stretching exercises.
With these simple exercises, the foot is kept supple and a return of pain is prevented.

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