Heel spur: what is it?
The heel spur originates from the calcaneus, one of the 7 bones that make up the tarsus which, together with the metatarsus and phalanges, forms the skeleton of the foot
When the heel is excessively stressed, subjected to loads and continuous micro-traumas of a different nature, it happens that the various joints become inflamed and favor the development of this particular type of condition.
The heel spur, so called due to its rose or claw thorn shape, is an osteophyte, that is, a bone growth caused by the calcification of cells.
When a tissue is excessively stressed, it happens that, to repair the damage, the body tries to repair the damage by producing new cells.
Their excess can induce calcification processes, precluding the proper functioning of the tendons and ligaments on which the osteophytes grow.
In the case of heel spurs, the osteophyte forms on the heel near the plantar fascia or near the Achilles tendon, consequently also inflaming these structures.
It is not uncommon to see cases in which this pathology is associated with plantar fasciitis or inflammation of the Achilles tendon.
Types of heel spurs
Depending on the area of the heel where the calcification develops, two different types of heel spurs are identified.
In the lower heel spur, the osteophyte forms at the level of the part of the heel that borders the sole of the foot.
This is where the plantar fascia originates: which is why, in most cases, this condition emerges in association with plantar fasciitis, an inflammation of the entire sole of the foot.
The heel spur is posterior when the bony protuberance grows into the part of the heel where the Achilles tendon inserts.
It is also visible to the naked eye and is associated with inflammation of this tendon.
Heel spur: the causes and risk factors
The heel spur finds among its typical causes acute or small and repeated injuries to damage not only the heel, but also other tendons and muscles of the foot.
Stretches and small repeated tears at the level of the plantar fascia and soft tissues of the sole of the foot can favor the establishment of an inflammatory process.
More rarely, the cause is reactive arthritis, ankylosing spondylitis, or diffuse idiopathic skeletal hyperostosis.
It is not possible to prevent the formation of a heel spur, but it is good to pay attention to some risk factors that can favor its appearance and accelerate its course:
- Walking with a spoiled posture. Poor posture, even while walking, puts undue stress on the heel bone, ligaments, and surrounding tissues, causing them to become inflamed.
- Running and jogging. It is good to be careful how you practice them. The excessive impact given by this type of sporting activity can damage, over time, the joints of the lower limbs, including those of the foot. The same goes for too intense physical activities or for all those sports that involve big jumps (running, athletics, basketball).
- Wearing unsuitable shoes, due to the size and shape of the foot or wearing heels frequently.
- Overweight and obesity. Having an excessively sedentary life is a risk factor for many pathologies. In fact, excessive weight generates an overload to the detriment of the joints, especially those of the foot which have to bear the load of the whole body and are involved in our every movement.
- Suffering from osteoarthritis increases the chances of developing heel spurs.
- Some anatomical pathologies of the foot can favor the onset of a heel spur (flat foot, cavus foot, valgus foot).
- Metabolic diseases that weaken the organism as a whole.
- Genetic predisposition. Those whose parents suffer from osteoarthritis are more likely to be affected during their lifetime.
Heel spur: symptoms
The growth of a heel spur is initially asymptomatic or develops so slowly that the patient is not concerned about such mild pain.
It is, in fact, only when the pathology is in an advanced stage that pain is felt that prevents the simplest movements.
Pain is the most common symptom for heel spurs.
It can be sporadic or chronic and can be felt not only during the practice of certain activities (walking, running, jogging), but also simply by standing for several minutes.
If it increases and ends up impacting the subject’s physiological gait, it is possible to use crutches to rest the joint as much as possible.
In the mildest cases, this trick is sufficient to solve the problem.
However, pain is not the only symptom: the skin of the affected area can thicken, like a callus, and soreness of the surrounding tissues can appear, with reduced sensitivity.
The feet often appear tired and swelling of the muscles and ligaments of the entire anatomical area concerned can be found.
When heel spurs lead to plantar fasciitis, inflammation occurs that causes pain in the sole of the foot after long walks, runs and many hours of standing, but also in the morning when you wake up.
The plantar fascia shortens and stiffens during rest, with problems emerging the following morning when it has to get used to movement again.
Usually this adaptation lasts a few seconds and occurs without impediments, while those with a heel spur feel this transient pain that disappears only after adequate warming up.
How a heel spur is diagnosed
If you suspect you are suffering from heel spurs, because you can see it with the naked eye near the Achilles tendon or because you feel the typical symptoms, it is advisable to contact your trusted doctor immediately in order to carry out an initial visit and book later an appointment with a podiatrist or orthopedic surgeon.
The visit consists of a first moment, aimed at investigating the patient’s clinical history with particular attention to the investigation of previous symptoms and those still present.
Later, during the physical examination, appropriate tests are carried out to understand where the patient feels pain and of what intensity.
Furthermore, it is necessary to carry out further investigations which involve the execution of radiological examinations such as the X-ray of the foot which shows the lesion and its extent in detail.
In addition, magnetic resonance and ultrasound provide even more in-depth images, allowing to evaluate the state of the soft tissues of the foot, the hematomas and lesions in progress at the level of the plantar fascia.
It is advisable to contact your doctor immediately as soon as heel spur symptoms are suspected because, when it becomes chronic, it can become a more serious and difficult to treat problem, which impacts on walking.
If not treated promptly, heel spurs require multiple physiotherapy sessions to be cured and, moreover, other pathological conditions may appear in the same area.
Heel spur, treatments and prevention
When the diagnosis of heel spur is confirmed, the specialist undertakes the most suitable therapeutic course for the patient’s clinical history.
When the pathology is asymptomatic, no specific treatments are envisaged.
In the event that the patient experiences symptoms, it is possible to resort to conservative therapy (pharmacological and physiotherapy) as a first choice.
Among the treatments offered we find:
- The rest. Activities that cause and exacerbate pain should be avoided. A more careful lifestyle helps reduce pain. Avoid long walks, running and jumping.
- Taking Non-Steroidal Pain Relieving Drugs (NSAIDs) such as ibuprofen. They reduce pain and discomfort. However, it is important not to abuse them, due to their frequent side effects.
- Daily stretching and physiotherapy sessions. By stimulating the leg muscles, it also improves the health of all ligaments such as the Achilles tendon and plantar fascia. Less stiff muscles and ligaments react better to pain.
- Use suitable shoes that do not press on the osteophyte, increasing the pain. Wearing orthotics can help.
- Massages, ultrasounds and shock waves aimed at the affected area are among the therapies preferred by patients who testify to their ability to reduce the severity of symptoms.
- Infiltrations of cortisone in the affected area. They relieve symptoms quickly but should be performed for short periods due to the important side effects.
When drug therapy doesn’t give the desired effects, doesn’t reduce pain and movement difficulty, then the doctor can opt for surgery.
Surgical therapy involves the removal of the calcaneal excrescence and the distension of the plantar fascia
Data in hand, it is an operation with a high success rate that guarantees the patient a complete recovery.
Even if the appearance of a heel spur cannot be prevented 100%, wearing comfortable and suitable footwear is useful to avoid developing the problem.
Inserting orthotics can make the footwear more suitable, allowing for better walking.
Furthermore, it is a good habit, before carrying out any physical exercise, to do an adequate warm-up, without forgetting the ankle and foot joints.
Training consistently is important for the good health of the whole body, but it must be done correctly depending on your physical condition.
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