The heel spur (or calcaneal spur) is a nail-like growth of calcium around the ligaments and tendons of the foot where they attach to the heel bone. The spur grows from the bone and into the flesh of
the foot. A heel spur results from an anatomical change of the calcaneus (heel bone). This involves the area of the heel and occasionally, another disability, such as arthritis. The heel bone forms
one end of the two longitudinal arches of the foot. These arches are held together by ligaments and are activated by the muscles of the foot (some of which are attached beneath the arches and run
from the front to the back of the foot). These muscles and ligaments, like the other supporting tissues of the body, are attached in two places. Many are attached at the heel bone. The body reacts to
the stress at the heel bone by calcifying the soft tissue attachments and creating a spur.
A strong band of sinew (plantar fascia) stretches across the sole of the foot below the surface of the skin and is attached to a point in the middle of the under surface of the heel bone. With
repeated activity on our feet, the plantar fascia can become tight and cause persistent traction (tugging) on its attachment point into the heel bone, and inflammation and pain may develop at this
site. This painful condition is known as plantar fasciitis. Sometimes a ?spur? develops at the site of this traction on the bone and protrudes into the surrounding tissue. This is a heel spur.
Heel spurs often cause no symptoms. But heel spurs can be associated with intermittent or chronic pain, especially while walking, jogging, or running, if inflammation develops at the point of the
spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it. Many people describe the pain of heel spurs and plantar fasciitis as a
knife or pin sticking into the bottom of their feet when they first stand up in the morning, a pain that later turns into a dull ache. They often complain that the sharp pain returns after they stand
up after sitting for a prolonged period of time.
Diagnosis is made using a few different technologies. X-rays are often used first to ensure there is no fracture or tumor in the region. Then ultrasound is used to check the fascia itself to make
sure there is no tear and check the level of scar tissue and damage. Neurosensory testing, a non-painful nerve test, can be used to make sure there is not a local nerve problem if the pain is thought
to be nerve related. It is important to remember that one can have a very large heel spur and no plantar fasciitis issues or pain at all, or one can have a great deal of pain and virtually no spur at
Non Surgical Treatment
Heel spurs and plantar fasciitis are treated by measures that decrease the associated inflammation and avoid reinjury. Local ice applications both reduce pain and inflammation. Physical therapy
methods, including stretching exercises, are used to treat and prevent plantar fasciitis. Anti-inflammatory medications, such as ibuprofen or injections of cortisone, are often helpful. Orthotic
devices or shoe inserts are used to 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 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.
Approximately 2% of people with painful heel spurs need surgery, meaning that 98 out of 100 people do well with the non-surgical treatments previously described. However, these treatments can
sometimes be rather long and drawn out, and may become considerably expensive. Surgery should be considered when conservative treatment is unable to control and prevent the pain. If the pain goes
away for a while, and continues to come back off and on, despite conservative treatments, surgery should be considered. If the pain really never goes away, but reaches a plateau, beyond which it does
not improve despite conservative treatments, surgery should be considered. If the pain requires three or more injections of "cortisone" into the heel within a twelve month period, surgery should be