Heel Spurs

Heel Spur Facts

  • A heel spur appears on an X-ray as a pointed bony outgrowth of the bone of the heel (the calcaneus bone).
  • Heel spurs under the sole of the foot (plantar area) are associated with plantar fasciitis.
  • Heel spurs on the back of the heel are often associated with Achilles tendonitis/tendonosis.
  • Heel spurs can occur alone or be related to underlying diseases.
  • Heel spurs are treated by measures that decrease the associated pain or inflammation and avoid reinjury.

What Are Heel Spurs?

A heel spur is a bony outgrowth of the calcaneus bone in the heel. Heel spurs are attributed to chronic local inflammation at the insertion of soft-tissue ligaments or fascia in the area. Heel spurs can be located at the back of the heel or under the heel, beneath the sole of the foot. Heel spurs at the back of the heel are frequently associated with inflammation of the Achilles tendon (tendinitis) and cause tenderness and pain at the back of the heel that's made worse while pushing off the ball of the foot.

What Causes Heel Spurs?

Heel spurs are most commonly caused by strain injury of the tendons and tissues that attach to the heel bone (calcaneus). This can occur after repetitive athletic stress or strain injury. Heel spurs can also be caused by inflammatory diseases, including reactive arthritis, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis.

What Are Risk Factors for Heel Spurs?

Risk factors for heel spurs are Achilles tendinitis, ankylosing spondylitis, reactive arthritis (formerly Reiter's disease), gout, diffuse idiopathic skeletal hyperostosis, and psoriatic arthritis.

What Are Heel Spur Symptoms and Signs?

Heel spurs themselves usually cause no symptoms. Nevertheless, they can be associated with heel pain and tenderness of the tissues adjacent to the spur, such as on the bottom of the heel or the back of the heel where the ligament (plantar fascia) or Achilles tendon attach. This can make it difficult to stand, walk, or run, especially when barefoot on hard surfaces because of tenderness and pain at the back of the heel or under the heel.

Heel spurs can be identified with traditional X-ray testing and/or ultrasound imaging, which produce an image of the calcium-containing bony outgrowth in the calcaneus bone of the heel.

How Do Heel Spurs Relate to Plantar Fasciitis?

Heel spurs under the sole of the foot (plantar area) are sometimes associated with inflammation of the plantar fascia (fasciitis), the "bowstring-like" tissue stretching underneath the sole that attaches at the heel. Plantar heel spurs and plantar fasciitis cause localized tenderness and pain made worse when stepping down on the heel or pushing off the ball of the foot.

How Do Doctors Diagnose Heel Spurs?

Heel spurs are diagnosed with ultrasound or X-ray imaging of the foot to identify the bony prominence (spur) of the heel bone (calcaneus). If the spur is symptomatic, identifying the underlying diagnosis such as plantar fasciitis, Achilles tendonosis, or a systemic arthritis is required in order to treat appropriately.

Diagnosis of Heel Spurs

Ultrasound

Ultrasound (also termed sonography, ultrasonography, and Doppler study) is a non-invasive diagnostic medical technique that uses high frequency sound waves to produce images (sonogram) of the internal structures of the body. These sound waves are not detectable by human hearing.

Using an ultrasound machine (ultrasonography), a technician or doctor moves a device called a transducer (probe) over part of your body. The transducer emits sound waves which bounce off the internal tissues, and creates images from the waves that bounce back. Different densities of tissues, fluid, and air inside the body produce different images that can be interpreted by a physician, typically a radiologist (a physician who specializes in imaging technologies). Many studies are done by a trained technologist (sonographer) and then interpreted by a radiologist.

What Are Treatments and Home Remedies for Heel Spurs?

Symptomatic heel spurs are treated by measures that decrease the associated inflammation or avascularity and avoid reinjury. Typically, treatment is directed toward the associated condition such as plantar fasciitis, Achilles tendonitis/tendonosis, or arthritis that caused the heel spur to form. Local ice applications both reduce pain and inflammation. Physical therapy methods, including stretching exercises, treat and prevent plantar fasciitis. Anti-inflammatory medications, such as ibuprofen (Advil) or injections of cortisone, are often helpful in providing pain relief.

Orthotic devices or shoe inserts are used to control the excess motion that strains the plantar fascia ligament and/or Achilles tendon. In some cases, orthotics can take pressure off plantar spurs (donut-shaped insert), and heel lifts can reduce stress on the Achilles tendon to relieve painful spurs at the back of the heel. Similarly, sports running shoes which are stable with soft, cushioned soles can be helpful in reducing irritation of inflamed tissues from both plantar fasciitis and heel spurs. Infrequently, surgery is performed on chronically inflamed spurs. More recent treatments include radiofrequency ablation, injections of platelet rich plasma (PRP), extra-corporal shock wave therapy (ESWT), prolotherapy injection, and ultrasonic micro debridement.

What Is the Prognosis of Heel Spurs?

The outlook is generally good. The inflammation usually responds to conservative, nonsurgical treatments. Infrequently, surgical intervention is necessary.

Is It Possible to Prevent Heel Spurs?

It's only possible to prevent heel spurs by treating any underlying associated inflammatory disease, wearing proper footwear with orthotics, and stretching regularly.

Reviewed on 9/11/2017

REFERENCE:

Firestein, G.S., et al. Kelley's Textbook of Rheumatology, 9th Edition. China: Saunders, 2012.

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