Heel spurs are a very common problem in Australia and worldwide. They are the most common cause of all foot pain and foot problems. Fortunately in most cases they are easily treated and have a good prognosis. The following article will briefly discuss heel spurs, their causes, symptoms and management.
What are Heel Spurs?
A heel spur is a bony outgrowth that occurs on the calcaneus (the heel bone). Consequently heel spurs are also commonly known as Calcaneal Spurs. Heel spurs occur most commonly on the back of the heel bone or underneath the heel bone. Depending on where the heel spur is located will determine where the pain will occur. Heel spurs that occur on the back of the heel bone interfere with the functioning of the Achilles tendon while heel spurs that occur on the underside of the heel bone affect the plantar fascia (a tendon-like structure that runs along the sole of your foot). Inflammation of these soft tissue structures can lead to conditions known as Achilles Tendonitis and Plantar Fasciitis. A common misunderstanding is that the heel spur itself is the cause of pain. This is not true however. It is the inflammation and irritation of surrounding soft tissue that causes the pain (in most cases). In rare cases the heel spur itself may fracture or completely avulse. In these rare situations it is the heel spur that is the cause of the pain in addition to possible soft tissue inflammation.
Causes of Heel Spurs
Heel spurs and their causes are not that well understood unfortunately. However a few key factors have been identified as being the most common and probable causes in the development of heel spurs:
- Poor foot biomechanics (excessively flat or high-arched feet)
- Poor footwear (excessively worn footwear, poor supportive footwear, excessive high-heel wearing)
- Muscle weakness, tightness or imbalances (especially in the calf muscles)
- Overweight or obese (especially putting on a lot of weight in a small amount of time)
- Occupations that require standing and/or walking all day (especially on hard surfaces)
- Excessive activity or decreased rest between activity (especially when combined with poor foot and/or lower limb biomechanics and poor footwear)
Who is Affected by Heel Spurs
Middle-aged females are the most commonly affected by heel spurs. Middle-aged males are the second group most commonly affected. Heel spurs can develop in anyone however and in any age group. Interestingly, a large portion of the population has asymptomatic heel spurs. In other words they have a heel spur but it is not causing them any problems. For those that do have symptoms this can often make diagnosing the exact cause of pain very difficult, it may be the heel spur causing the problem but it may not be.
Symptoms of a Heel Spur
The following are the most commonly experienced signs and symptoms in those individuals suffering from a heel spur:
- Can affect one or both feet
- Pain first thing in the morning (First Step Pain) that eases with walking
- Pain when getting up after sitting for long periods
- Pain most intense after periods of inactivity
- Aching, sharp, stabbing or burning pain
- Pain in the bottom or back of the heel bone
- Pain on palpation of the heel and its surrounding soft tissue structures
- Redness and swelling of surrounding tissue (may or may not be present)
Treatment & Management of Heel Spurs
Fortunately the symptoms caused by heel spurs are usually easily treatable. The following is a list of some of the most common and not so common treatment methods utilised:
- Resting or activity modification
- Icing the painful area (20 minutes of ice followed by 40 minutes without, then repeat
- Compression and elevation of the painful area
- Pain management (medications usually
- Strapping of the foot for temporary relief
- Offloading the painful area (insoles, foot orthotics)
- Muscle stretching and strengthening
- Footwear change
- Avoiding barefoot walking
- Cortisone injections (usually a last resort)
- Surgery (in very rare cases surgery may be warranted. This usually involves removing the bony outgrowth in order to relive symptoms).
Heel Spurs in Athletes
The prevalence of heel spurs in athletes is not known. The prevalence of Plantar Fasciitis and Achilles Tendonitis in athletes however, both of which can be caused by heel spurs, is quite high. Athletes are very prone to developing these conditions due to their excessive activity (running, jumping, sprinting etc). When combined with other factors such as poor footwear and poor foot biomechanics, this is when problems can occur. The high prevalence of these conditions begs the question; is there a higher incidence of symptomatic heel spurs in the athletic population? However no research has been undertaken to investigate this.
Heel Spurs in Bodybuilders
Another interesting point is in regards to strength athletes and bodybuilders. Most bodybuilders have excessively flat feet purely as a result of them carrying around extra weight. Interestingly however there have been no studies that have examined whether the prevalence of foot problems (including heel spurs) is higher in the bodybuilding population. One would imagine that with the high prevalence of flat feet (which is a very common cause of heel spurs) there would be more bodybuilders suffering with foot problems. However there is simply no credible information available to confirm this.
Seeking Medical Attention for Heel Spurs
Medical attention should be sought if: pain levels are not improving despite resting and other treatments or if pain levels are worsening, if the area becomes especially tender to touch, if there is any deformity present, if there is pain experienced during night time or that wakes you from your sleep. In conclusion heel spurs are a very common problem in both the normal and athletic population. They can be asymptomatic but in some people they result in excessive soft tissue irritation and inflammation, leading to symptoms. Fortunately in most cases these conditions are easily and quickly treated.