A heel spur is a calcium deposit causing a bony protrusion on the underside of the heel bone. On an X-ray, a heel spur can extend forward by as much as a half-inch. Without visible X-ray evidence, the condition is sometimes known as “heel spur syndrome. Onset is gradual.
Heel spurs occur when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping.
Risk factors for heel spurs include:
- Walking gait abnormalities,which place excessive stress on the heel bone, ligaments, and nerves near the heel
- Running or jogging, especially on hard surfaces
- Poorly fitted or badly worn shoes, especially those lacking appropriate arch support
- Excess weight and obesity
Other risk factors associated with plantar fasciitis include:
- Increasing age, which decreases plantar fascia flexibility and thins the heel’s protective fat pad
- Spending most of the day on one’s feet
- Frequent short bursts of physical activity
- Having either flat feet or high arches
Orthotic devices or shoe inserts are used to control the excess motion that strains the plantar fascia ligament and/or Achilles tendon. Custom orthotics can take pressure off plantar spurs, 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 and have an Orthotic insert will be helpful in reducing irritation of inflamed tissues from both plantar fasciitis and heel spurs.
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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.
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.
The specialized soft tissue at the heel functions as a shock absorber. The subcutaneous structure consists of fibrous lamellae arranged in a complex whorl containing adipose tissues that attach with vertical fibers to the dermis and the plantar aponeurosis.
The heel can absorb 110% of the body’s weight during walking and 200% of the body’s weight during running. The plantar fascia is a multilayered fibroaponeurotic structure that arises predominantly from the medial calcaneal tuberosity and inserts distally through several slips into the plantar plates of the metatarsophalangeal joints, the flexor tendon sheaths, and the bases of the proximal phalanges of the toes.
Dorsiflexion of the toes applies traction stress at the origin of the plantar fascia. A contracture in the triceps surae, a pes cavus, or a pes planus can increase the traction load at the origin of the plantar fascia during weightbearing activities.
Other anatomic factors that can have similar effects are overpronation, discrepancy in leg length, excessive lateral tibial torsion, and excessive femoral anteversion. However, overuse, not anatomy, is the most common cause of plantar fasciitis in athletes. The pain of plantar fasciitis is caused by collagen degeneration associated with repetitive microtrauma to the plantar fascia
An inflammatory response and reparative process can double the thickness of the plantar fascia, which is normally approximately 3 mm. Biopsy specimens reveal collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, and calcification.
The heel pain can also have a neurologic basis. The tibial nerve, with nerve roots from L4-5 and S2-4, courses in the medial aspect of the hindfoot, through the tarsal tunnel, under the flexor retinaculum, and over the medial surface of the calcaneus. The calcaneal branch, arising directly from the tibial nerve, carries sensation from the medial and plantar heel dermis.
The tibial nerve divides into lateral and medial plantar nerves, which proceed into the plantar aspect of the foot through a foramen within the origin of the abductor hallucis muscles, which forms the distal tarsal tunnel. The first branch of the lateral plantar nerve changes course from a vertical to a horizontal direction around the medial plantar heel. It passes deep to the abductor hallucis muscle fascia and the plantar fascia and is the nerve supply to the abductor digiti minimi. The tibial nerve and its branches in the hindfoot can be involved with compressive neuropathies. A valgus heel can stretch in the tibial nerve.
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.
A “Gait Cycle Analysis” describes how your foot and the way you walk is affected
by your affliction. It describes in detail the rotation of your foot and ankle around
the four point of the compass and how the slight changes affect the rest of your
body, ankle, knee, hip and lower back. View the Gait Cycle Analysis and you will
learn more about the way your step has changed and how it is likely to impact
your quality of life.