The Foot Clinic

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Heel spur and calcaneal spurs

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Heel Spur syndrome, the medical term for this condition is Calcaneal spur is quite common and a common cause of foot pain. Other definitions include Calcaneussporn and also Fascilitis plantaris (tendinitis in the foot sole). A heel spur can be very painful and occurs at the heel bone. It is shown on an X-Ray as a spinelike, fossilised extraction of the heel bone (calcalneus). Often these long heel spurs just a symptom, and not the actual cause of heel pain. Patients with splayed feet, fallen arches or even high arches are more prone to heel pain than other people. In Germany it is estimate some 4 million people suffer from heel spur syndrome every daily. Risk groups include the over fifties and athletes. Also young adolescents may suffer from heel pain, which is referred to as Severe's Disease and is often a side effect of growing pains.

What exactly causes a heel spur?

Previously it was thought that increased pressure on the inside of the heel bone leads to inflammation. Today we know that heel spur is a result of overloading or improper loading of the plantar fascia ligaments under the foot. This leads to microtrauma and therefore causes inflammation at the base of the tendon. The plantar fascia is a coarse and broad tissue, which starts from from the toes and runs under the arch of the foot to the heel bone and then tapers into a small attachment. The primary function of these tendons is supporting the longitudinal foot arch for stabilisation of the foot, especially in propulsive phase of walking gait. If tension is placed on the tendons over a longer period, chronic inflammatory develops and a deposition of calcium occurs where the tendon inserts into the calcaneus. This is an automatic repair action of the body, in order to reduce the excess tension on the ligament structures. This in turn leads to further irritation and inflammation, causing a stabbing pain with normal walking no longer possible. The emergence of a heel spur or Fersensporn can also be traced to the deformity of the foot arch (flat foot and over-pronation) which increases the strain on that tendon. Not the presence of a heel spur is causing the discomfort, but the inflamed tendons around the spur. Various factor play a role in the formation of heel spurs and plantar fasciitis, including overload and overuse because of sports and work activities. Being overweight or sudden weight gain will place pressure on the heels and plantar fascia. Pre-existing rheumatoid arthritis can contribute to spurs formation. A low arch, flat arch or over-pronating foot causes a problem too.

Symptoms of heel spur

If the heel pain is present when lifting the toes against resistance a heel spur is likely. Stinging pain in the heel bone while walking. Dull, irregular pain even without weight bearing. Initial pain especially in the morning. Strong sensitivity to palpation (pressure applied to the heel by your doctor). Sometimes there is swelling in the ankle area present or pain spreads out to the back of the heel (achilles tendonitis). Treatment for heel spur syndrome or Fersensporn includes orthopaedic shoe inserts or orthotics and orthoses. Physiotherapy, muscles of the calf and tendons at the sole of the feet are stretched with special exercises. Anti-inflammatory medications are important. As a last resort maybe cortisone injections and surgery (the spur is removed, possibly with nerve transsection). For acute heel pain, homeopathic treatment may prove useful to reach lasting pain relief.

Any foot injury that does not respond to treatment in 3-4 weeks may be more serious, then previously assumed. Always consult a physician for a thorough evaluation and diagnosis of foot and heel pain syndrome. Most of the time heel spur is a result of a biomechianical problem such as overpronation which causes a twisting and stretching of the plantar fascia. The plantar fascia then becomes irritated and microtears may occur.