Published: 03/24/2014 - Updated: 01/21/2016
Author: K. Laura Garcés G
Heel spurs are the inflammation that occurs right at the place where the tendons connect to the bone. They are bumps on the bone in the form of tips or points. Pain usually occurs when an effort is made or a stimulus on the tendon of the foot occurs, causing an inflammation of the heel or sole which can extend from the heel to the toes. These bumps in the foot bone lead to a deformity called Haglund's deformity (superior calcaneal spur).
When the plantar fascia of the foot is inflamed, a stabbing pain in the heel occurs which usually happens in the morning or when you start walking. This is known as a heel spur, which appears mainly in the sole or heel cord insertion.
For its cure, even though there are surgeries available, as well as the use of templates for spurs or anti-inflammatory medications, there are many other ways to treat them naturally and very efficiently.
- Stress is one of the most frequent causes of spurs due to nervous stress, weight overload or standing for long periods of time, coupled with the stress.
- Improper footwear – wearing heels too much, subjecting the heel to overexertion.
- Walking with excessive stress or tension, strenuous sports without being trained or following a sequence, standing for a long period of time in a labour-intensive job and repeatedly ignoring the tiredness.
- Overweight and obesity
- Pressure and forced foot traction causing small tears which can irritate and erode the bone.This produces a painful swelling which causes an accumulation of calcium in the affected areas in order to repair tears occuring in this area.
- Bad foot postures when walking or standing.
Symptoms in the spur area
A superior heel spur (Haglund deformity) is primarily manifested through two symptoms: crushing pain palpations on the Achilles heel tendon, as well as pain caused by stress in the same tendon. The pressure caused by the edge of the shoe causes the skin to become red and inflamed.
The diagnosis of heel spurs is usually made based on discomforts and symptoms that point to the existence of an inflammation of the fascia of the foot (plantar fasciitis) which are usually caused by external mechanical stimuli or a spur. However, these problems can appear before a protruding bone has formed. In order to confirm the diagnosis a radiological study is performed, it is necessary to rule out other rheumatic diseases like rheumatoid arthritis, or others including ankylosing spondylitis and gout, for which the analysis may be useful for certain blood parameters.
Plantar calcaneal spur
A plantar heel spur (inferior calcaneal spur) is diagnosed by a lateral radiograph of the calcaneus: This is usually a punctiform lump recognised by its facing towards the toes and with a length of between one and five millimeters.
The diagnosis of the Haglund’s deformity or exostosis (upper calcaneus spur) takes place frequently due to the fact that the bone growth observed in the X-ray is less than the palpable clinical finding, since the tip of the spur may have a cartilaginous structure.
A heel spur treatment is required only when it involves patient discomfort. Generally speaking you can apply a conservative or surgical treatment.
When treating heel spurs, conservative therapy (i.e. non-surgical) is mainly the first port of call. It often reduces discomfort and involves an improvement in mobility. Appropriate measures in each case depend on the type of spur:
Plantar heel spur: To mitigate the pain derivatives, you can use a lower sills hole placed in the pressure-sensitive area. Additionally, if necessary, it is useful to place templates with a hole which support and reduce the load of the longitudinal arch of the foot.
Haglund's deformity: A spur in this location could be significantly improved with a simple change of footwear. Avoid rigid shoes and those close to the point of the spur.
If these measures are not sufficient to mitigate the inconvenience of the spur, conservative treatment offers the following treatment options:
Physical Therapy: This includes the application of heat or cold, as well as local sonication.
Medications: For the pharmacological treatment of heel spurs one can apply suitable bandages and ointments. These ointments may be composed of cortisone and analgesic drugs such as local anesthetics, and anti-inflammatories. They are generally applied on the point of muscular insertion. Injection can also work, pumping a mixture of local anesthetics and steroids into said zone.
Shock wave therapy: Ultrasound waves of high energy (called extracorporeal shockwaves) stimulate the growth of blood vessels and alleviate inflammation. Furthermore, they dissolve calcifications. Social Security does not normally cover treatment with shock waves of heel spurs.
Usually it is not necessary to perform surgery to treat heel spurs. Surgery should not be considered until at least nine to twelve months after conservative treatment has been performed and has not provided improvement. The operation involves removing the spur with a chisel on the section of the plantar fascia.
A heel spur is usually treated with a favorable outcome: In ninety five percent of cases, healing is achieved by conservative treatment. However, less than five percent of the patients with this disorder may require surgery. Surgery has a successful cure rate of between eighty and ninety percent. However, spur surgery involves an extended period of recovery.
The appearance of a heel spur is preventable by caring for tissues of the foot, for example, by adhering to the following recommendations:
- Warm up and stretch before playing sport
- Wear suitable shoes that are the correct size and that are not too narrow.
- Occasionally change your position at work (standing/sitting).
- It is advisable to reduce or prevent being overweight.
Family Medicine. Principles and Practice, Robert B. Taylor , 2006; Masson.
Primary Care. Concepts, organization and Clinical Practice ; darn A. Martin , JF Pérez Cano , 2003, Elsevier.
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