What is a heel spur?
A heel spur is a bony overgrowth, or a collection of bony growths on the underside of your heel bone (shown in red in the diagram on this page). Also called an osteophyte, they may or may not cause pain. A patient often confuses having a heel spur with having another foot condition called plantar fasciitis. In short, plantar fasciitis is irritation of a band of fibrous tissue spanning along the bottom of the foot. Since the plantar fascia attaches at the heel bone, often this area would present with localized foot pain. For more information about plantar fasciitis, click here.
Not all heel spurs cause pain, though, and a lot of people have bone spurs without ever finding out they have one. In fact, having a heel spur does not predispose a patient to have foot pain. In fact, one out of ten people have heel spurs, but only one out of twenty people with heel spurs have foot pain. Heel spurs, therefore, are not known to be contributors to plantar fasciitis, and so, therefore, removal of a heel spur bay is not a solution to patients’ foot pain.
What are the causes of heel spurs?
A bone spur typically forms on the body as a result of repetitive trauma. The body has mechanisms to lay down more bone and tissue that help beef up the body’s defenses against repetitive trauma, and since our heel bones contact the floor with every step we take, a heel spur is a very common occurrence. Most patients are found to have heel spurs tend to be middle-aged men and women, but they can also be found in patients of all age groups.
Heel spurs can also be formed as a result of repeated strain placed on foot muscles and ligaments and not just contact on our heel bone. Heel spurs can also be formed from repetitive trauma to the plantar fascia. If this plantar fascia is abnormally overstretched and strained, a heel spur may develop. Some sports and activities may also cause repeated injury to the membrane that lines the heel bone and causes excessive pressure on the back of the heel, causing the patient to feel tight in the area.
Following are some sports and activities that may accelerate heel spur growth because of the repetitive landing on the heel area:
- Excessive walking (especially if you are not used to walking for long distances)
- Running in improperly-fitted shoes
- Jumping activities like basketball, volleyball and tennis could strain the plantar fascia and trigger bone spur growth
- Step aerobics and recreational stair climbing
- Sudden weight gains such as obesity and pregnancy
What are the symptoms of having a heel spur?
Most patients assume that having a bone spur would be likened to sharp stabbing pain in their foot - like stepping on a rock in your shoe. In fact, heel spur bone growth is usually smooth and flat, and typically would not cause sharp stabbing pain. Though they may not cause pain on their own, heel spurs may lead to excess formation of calluses - again a body’s reaction to pad the heel even more with laying down of even more body tissue over the area of stress. Over time, this excessive collection of tissue can start to compress neighboring ligaments, nerves or tendons, and inflammation ensues. The caveat is that this inflammation, in turn, triggers, even more, collagen and tissue lay-down and may encourage the heel spur to grow larger.
Previously mentioned, a heel spur is often confused with the symptoms of plantar fasciitis. Though they are separate conditions of the foot, they are often seen together. Plantar fasciitis symptoms include swelling, localized tenderness and pain with weight-bearing. Plantar fascia pain is always worse in the morning because plantar fascia is shortened at night when we sleep as our feet point downwards in a relaxed position. Plantar fascia pain is typically characterized by pain at the bottom of the foot upon the first step in the morning, sometimes close to the underside of the heel. Plantar fascia pain is worse when strain and tension are placed on the tissues - walking on tip-toe, or overpronating, or jumping motions.
How are heel spurs diagnosed and what is the conventional treatment for heel spurs?
Heel spurs are diagnosed through X-ray. About 70% of patients with true plantar fasciitis pain will also show a positive film for heel spurs.
Because bone spurs typically are not the cause of pain, they rarely require extensive treatment unless it is found that they are actively damaging surrounding tissues. Because of the cause for heel spurs and the cause for plantar fasciitis are the same, the treatment for painful heel spurs would be the same as well.
Treatment will involve rest and modifying activities so as not to make the strain on the foot worse. If pain is ensued shortly after running, for example, then the patient would be advised to stay temporarily off the sport or activity - or at the very least modify it to a minimum level. This is easier said than done though, because the symptoms may manifest several hours or days after the activity - making it hard to identify the offending activity.
Icing the bottom of the foot may be helpful for calming down any inflammation in an acute onset of pain (acute meaning within 1-2 days of injury). Calf muscle stretching is also a good method of elongating and stretching the posterior compartments of the lower leg - and since fibers that make up the calf complex are shared with the fibers on the underside of the heel - calf stretching could calm the strain experienced at the heel bone. Calf stretching should be done several times a day, holding it for longer than 30 seconds for plastic changes to the tissue, and more effective for pain relief in the morning before the first weight-bearing, and after long bouts of sitting/inactivity.
It is also important to make sure you wear well-fitting shoes that fit your stride and lower body strength. Your physical therapist can recommend proper footwear for you, along with over-the-counter orthotics fitted for your activity level and body type. Typically, we recommend a maximum mileage of 300-500 miles of wear on a pair of running or walking shoes.
Heel cushions could also provide a great deal of support and padding if the heel is sensitive to pressure. Night splints worn at night while sleeping can help avoid tightening of the plantar fascia and, therefore, allow the foot to have a prolonged stretch.
Over-the-counter anti-inflammatory medications like Ibuprofen can also help to relieve plantar fasciitis and foot pain though these drugs can cause side effects after prolonged use. Consult with a physician before starting any medication regime, and especially when side-effects occur.
What can Physical Therapy do?
Heel spur treatment from a physical therapists will start with deep tissue mobilization and massage to ease tension on the plantar fascia and tissue. It is shown through scientific evidence that there is a high success rate with ASTYM therapy when performed on the lower leg, calf muscles and plantar fascia. We also perform low-dye arch taping tailored to the patient’s foot that helps support the foot arches reduce strain. This allows for the foot to ‘rest’ from the undue tension that builds up with weight-bearing. When symptoms are moderate or severe, we may recommend the use of over-the-counter orthotics to help support the foot.
Gait retraining and analysis will also show weaknesses further up the lower extremity chain. Weakness in hips and knees can often contribute to a faulty landing pattern, which would predispose to plantar-fasciitis and heel-spur-causing pain. Strengthening muscles and normalizing gait mechanics play a big role in helping the foot land in a healthier manner
What can a Podiatrist do?
If foot pain continues even after conservative physical therapy, a podiatrist may opt to use a steroidal injection at the site of pain. Not a lot of physicians and podiatrists choose this route of treatment though because side effects like excess tissue damage, can worsen symptoms. Complications can also include fat necrosis (death of healthy fat tissue that pad the foot) rupture of the plantar fascia.
Some podiatrists may opt to remove surgically a heel spur or surgically loosen plantar fascia if the symptoms are very severe and causing disability on the patient. Though these surgeries are about 80% effective in select patients who have not been successful with physical therapy, symptoms may still return if preventative treatment protocol (wearing proper footwear, gait retraining, stretching, etc.) is not adhered to.
Come to one of our Portland Therapy Clinics for your Heel Spur Treatment today!