Heel Spurs – The Complete Treatment Guide




What Are Heel Spurs

A heel spur is also called a calcaneal spur because it occurs on the calcaneus, which is the Latin term for the heel bone. The most simple explanation for a bone spur is that it is an extra growth of bone on top of existing, normally formed bone tissue. Heel spurs tend to be small pointed growths of bone. Their presence is usually associated with soft tissue structures that attach to bones. Two of the most common soft tissue structures that can be related to the development of heel spurs are the tendons and the fascia of the foot.

There are various types of heel spurs. A posterior heel spur is one that develops on the back of the heel, right at the point where the Achilles tendon is connected to the heel bone. An inferior heel spur develops on the bottom of the heel bone and often a complication of another condition known as plantar fasciitis. This means that heel spurs in this location, also described as beneath the sole of the foot, can be related to inflammation of the plantar fasciia, which is the large tendon covering the bottom of the foot. It can also be related to the arthritic condition of akylosing spondylitis.

heel spur picturePosterior heel spurs are frequently large and bulbous enough to be felt through the skin. Because they are located at the point where the Achilles tendon joins the bone, they can be related to the condition of Achilles tendonitis. This condition basically refers to irritation and inflammation of the Achilles tendon, which is the tendon that gives each foot most of its strength. Heel spurs at the back of the heel can cause pain, tenderness, and discomfort whenever the patient pushes off using the ball of his foot, since this action stretches the Achilles tendon. Therefore, when Achilles tendonitis is treated, heel spurs may have to be removed in order to make the treatment as effective as possible.

What Causes Heel Spurs?

To understand what causes heel spurs, it's important to understand a little more detail about the interior anatomy of the foot. Many heel spurs are associated with the condition of planter fasciitis. This condition involves the plantar fasciia, which is a very thick, strong ligament that runs lengthwise across the bottom of the foot. It is the structure that gives the foot most of its flexibility and strength. If the planter fasciia is not in good condition, walking, standing, and the ordinary activities of life will become painful, difficult, or in extreme cases, even impossible.

heel spursThe plantar fasciia is connected at one end of its run to the calcaneus, which is the heel bone. It connects to the bottom of the heel bone rather than the back of it. On the other end, the plantar fasciia connects to the ball of the foot. The plantar fasciia runs between these two location and is a very strong and tight structure, helping the foot to maintain its characteristic arched shape. Whenever we walk, run, or stand, an enormous amount of pressure and stress is being absorbed by the plantar fasciia. It supports our weight when we are engaged in these activities.

Understanding the plantar fasciia is key to getting a grasp on the formation of heel spurs because heel spurs often form as a consequence of this ligament structure getting damaged or inflamed. This can happen due to exercise, poor footwear, or other factors (see Risk Factors). The condition of plantar fasciitis refers to the plantar fasciia tissue becoming worn out or irritated. As this happens, the plantar fasciia can become even tighter than usual. A tight ligament is a good thing and represents normal body function, but one that is overtight can and will cause problems. In the case of plantar fasciitis, this tightness is associated with pain, particularly early in the morning. Normal movements may cause the plantar fasciia to stretch out a bit, which will cause the pain and tightness to lesson somewhat, but use of the feet such as in standing, walking, or running, can cause it to flare up again.

How does this relate to heel spurs? The answer is quite simple. Patients who have plantar fasciitis, particularly those who have suffered from the condition for a considerable period of time, have a strong tendency to develop heel spurs. How strong? The numbers are quite startling and illustrate the direct relationship between plantar fasciitis and the formation of heel spurs. It turns out that almost three-fourths of patients with plantar fasciitis also have a heel spur.

However, this is not to say that heel spurs are solely caused by the underlying condition of plantar fasciitis. X-ray analysis has revealed heel spurs in many patients who show no signs or symptoms of plantar fasciitis.

Symptoms of Heel Spurs

The main symptoms of heel spurs include:

  • pain on the bottom of the foot
  • pain in the pad of the heel
  • heel pain when standing for long periods
  • heel pain while walking

Risk Factors for Heel Spurs

Some patients are more likely than others to develop heel spurs. If you have a long history of foot pain or you have had trouble with plantar fasciitis in the past, you are more likely to develop heel spurs as well. Those with diabetes are also at special risk of developing heel spurs, as are overweight people. Previous injuries to the foot, including straining the ligaments and tendons, can make it more likely that heel spurs will develop in later life.

One of the most prevalent risk factors is wearing poor footwear, including:

  • high heels
  • tight shoes
  • shoes that are too loose and don't properly support the foot
  • shoes without enough padding to absorb shocks, particularly during vigorous exercise.

Heel spurs can be found in all age groups, but heel spurs associated with the condition of inflammation on the plantar fasciia (plantar fasciitis) are more often seen in people of middle age. This includes both men and women.

The existence of plantar fasciitis in a particular patient does not mean, however, that the patient does have or will have at some point have heel spurs. This is because the heel spur proper is not regarded as the dominant source of pain, tenderness, and discomfort in such patients. Instead, the inflammation of the soft tissue is the underlying cause of pain and heel spurs can develop as a secondary issue based on the damage being done to soft tissue structures.

Determining if a given patient in fact has a heel spur is not done through the diagnosis of planter fasciitis itself, but rather through the use of x-ray radiology.  A physician must see a tiny "hook" of bone tissue that has grown at the insertion point of the plantar fasciia – the location where the plantar fasciia itself is attached to the bottom of the heel bone. In the case of a posterior heel spur, the characteristic growth of bone will be seen at the back of the heel bone.

Treatment Options for Patients with Heel Spurs

Because heel spurs and plantar fasciitis are related conditions that often appear together, similar treatments are used for both. The main goals of treatment are

  • avoid reinjuring the soft tissue structures of the foot, such as the plantar fasciitis ligament
  • reduced inflammation of these soft tissue structures

Rest as a Treatment Option for Heel Spurs

Obvious as it may sound, the very first step in any treatment regimen for heel spurs is to have the patient rest. This is effective because the symptoms of heel spurs are aggravated by exercise, particularly the vigorous kind. Rest recommendations include all of the following considerations:

  • stop any ongoing exercise routine for at least a few days
  • avoid any activities which involve running or large amounts of walking
  • avoid any activities which require the patient to stand for any prolonged length of time
  • adjust work and home life responsibilities as needed to avoid periods of standing. The use of a shower chair, for example, may be beneficial to be sure the patient gets as much rest as possible.
  • use mobility devices such as crutches in order to avoid putting weight on the affected foot. This will help provide it with even more rest. It is probably best to avoid walking as much as possible in any case, but if it simply cannot be avoided, then crutches are better than hobbling on the injured foot, which will not only cause pain and discomfort but may aggravate the underlying condition and make it worse.

This basic step of resting the foot suffering from a heel spur may help to alleviate the pain levels. An added benefit is that it will help the inflammation to begin to decrease.

However, rest alone is not usually a total solution, but rather a necessary first step that can take place while other treatment options are being simultaneously put in place.

Ice as a Treatment Option for Heel Spurs

Icing the injury is often done in conjunction with the rest therapies discussed above. The application of ice to the areas experiencing pain will decrease pain levels and have the added benefit of decreasing tenderness, swelling, and inflammation. Ice treatments should take place every two or three hours over the course of a few days. Each treatment should last between ten and fifteen minutes. Other helpful tips for ice treatments include the following considerations:

  • There are several methods for applying ice. Commercial ice packs may be filled with ice cubes from the freezer and used. Gel packs that are stored in the freezer may be more comfortable for the patient because they are malleable and do not contain hard chunks of ice as a traditional ice pack will.
  • A method that requires no additional purchases is to plunge the foot into cold water laced with ice. This only needs a bucket, an item which most people have on hand in any case.
  • Another inexpensive option is to put used bottles to good use. Water bottles, sports drink bottles, or soda bottles will all work equally well, as long as they are in the 10 to 16 ounce range. To use these bottles are effective foot pain ice packs, fill them with water, leaving at least one half inch of headroom so the bottle won't crack when ice forms. Freeze the bottle solid. To use, place the bottle under the sole of your foot and roll it back and forth for ten or fifteen minutes at a stretch.

 

Not only does this target the ice very well to help alleviate aggravation and inflammation of the plantar fasciia on the bottom of your foot, it also provides your foot with some good exercise that may tend to help stretch and lengthen the plantar fasciia. In this way, ice is being combined with some valuable physical therapy, and the patient doesn't have to make time for a separate exercise session unless he or she desires to use additional kinds of exercises that a health care professional may recommend.

Other Common Treatment Options Apart from Ice and Rest

The most common initial treatments are similar to measures taken for many kinds of sports injuries. Just as with other injuries, ice and rest should be used in conjunction with the following:

 

  • medication to reduce both pain and inflammation. The most commonly used medications, therefore, are the anti-inflammatories such as ibuprofen (Motrin, Advil) and sodium naproxen (Aleve).
  • cortisone injections to the injury site in an attempt to reduce inflammation and pain caused by the inflammation
  • physical assistive devices such as shoe inserts or other orthotics. There are several types which can be helpful:
    • Inserts shaped like donuts can be positioned so that the heel spur sticks out through the hole. This serves to take pressure off the heel spur because the edges of the donut absorb the shocks associated with standing, walking, and running. This type of insert is used to help with posterior heel spurs, or those that occur at the back of the heel and are associated with stress on the Achilles tendon's insertion point on the bone.
    • Heel lifts. These serve to take pressure off the bottom of the foot and can help with heel spurs that occur there. Such heel spurs are the ones associated with inflammation of the planter fasciia ligament.
  • cushioned shoes such as those designed for sports activities such as running. These shoes have padding in the soles that can provide relief for both heel spurs and plantar fasciitis.
  • physical therapy and exercises, and prescribed or managed by a health care professional. See the section on exercises for more detail about this treatment option.
  • Rarely, surgery can be an option. This is used as a last resort and is reserved for heel spurs which meet two criteria:
    • the heel spur does not respond adequately to the treatments outlined above
    • the heel spur is chronically (habitually) inflamed, causing the patient great discomfort as well as an inability to perform the daily functions of life.

Before surgery is seriously considered, all the other treatment options are usually explored in detail and deemed inadequate.

Exercise as a Treatment Option for Heel Spurs

The same exercises that are effective in treating plantar fasciitis may be prescribed for heel spurs that occur on the sole of the foot, since in many cases these conditions are related. The main purpose of the exercises is to stretch out the plantar fasciia so that the foot becomes more flexible and the patient is more comfortable. These are all manipulated stretches in that they involve the application of pressure form a source outside the foot itself. This is important since in cases of plantar fasciia tightening, which can in many cases be related to heel spurs, the patient can't stretch the foot out on its own.

These stretches should be slow and gentle, not sharp yanks or tugs. Once the stretch is achieved, hold it in position for five to fifteen seconds. Then allow the ligament to rest for a moment before repeating. Ten repetitions in a session are usually enough, but patients may want to schedule more than one such session per day. The best policy to follow is to consult a qualified physical therapist or other health care professional and follow their precise recommendations as to type, duration, and scheduling of heel spurs exercises.

A few of the common types of stretches used in the treatment of heel spurs are:

  • Assisted pull: Sit on the floor. Use a piece of cloth such as a towel or strip of fabric. Grasp the ends and loop the middle portion around your foot, catching them by the toes. Pull the ends of the towel toward you with a steady, gentle pressure. Simultaneously maintain your leg in the correct position, with your knee facing the ceiling and your toes pointing straight up.
  • Crossed stretch: To perform this stretch, sit on a chair and cross one leg over the other. Reaching across, grasp your toes and pull them in a line with that leg while you hold your foot in position using your free hand. This will cause a stretch lengthwise across the bottom of your foot.
  • Calf stretching: This stretch is performed in a standing position. Stand facing a wall with your feet one to two feet away from the base of the wall. Hold out your arms in front of you and place your palms on the wall. Lean into the wall and allow it to take some of your weight. Move your feet so that one is roughly underneath the position of your shoulders, and the other one is behind you. This generally involves simply moving one foot backwards a half step. Move the back foot so that it is resting flat against the floor. This will cause a distinct stretching sensation to occur in the back area of your heel, where the Achilles tendon is located.

For this reason, the calf stretching exercise is best used when the heel spur is one that is located on the back of the heel. Otherwise, the Achilles tendon was most likely not instrumental in the development of that hell spur. It's possible to achieve an even more effective calf stretch if during the exercise the patient tries to angle his back knees facing the ground somewhat. This must be done while the foot stays in position, flat on the floor, in order to make a difference in the degree of the stretch.

  • Toe Dipping:  The toe dipping exercise requires some advance preparation. The patient must find something he or she can step up onto. Just six inches of elevation will do, but the object to be stepped onto must be sturdy enough to hold the patient's weight. The last thing any patient wants to happen during physical therapy is to take a bad fall and end up injured even worse. Position the box or step so that there is something to hold on to for balance. This is not just for the sake of safety; it's also essential for the performance of the exercise itself.

 

Once the advance preparation is ready, the patient should stand on the step, then move backwards slightly so that the back of the foot is hanging over the edge. Be sure to hold your handrail or other assistive device.  Manipulate the foot in order to drop the heel toward the ground. This will cause a stretch to occur in the Achilles tendon, which is located in the back area of the heel.

This is best done with one foot at a time rather than both feet at once, as that will produce a much larger degree of stretch.

Heel Spurs versus Plantar Fasciitis

Patients commonly call their heel spurs "plantar fasciitis" and vice versa as if the two conditions are one and the same, or at the very least interchangeable. Even some doctors may use the words in a loose, interchangeable fashion. However, the conditions are not the same even though they are related and present themselves with similar symptoms. Plantar fasciitis properly refers to a condition in the plantar fasciia ligament. In this condition, the ligament becomes inflamed from various causes.

Heel spurs as a diagnosis really refers to a pointed bony outgrowth on a heel. Although these two conditions frequently appear in tandem, their precise relationship to one another is not fully understood at this time.

 



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