Heel pain is a frustrating problem that can make walking, exercising, and even standing uncomfortable. While plantar fasciitis often gets the blame, another culprit frequently involved is the heel spur. A heel spur is a bony growth that develops on the underside of the heel bone, usually as a result of long-term strain on the ligaments and muscles of the foot. Although not every heel spur causes pain, when it does, it can interfere with daily life and require treatment. Understanding what heel spurs are, how they develop, and what treatment options exist can empower patients to seek the right care and find relief.
What Are Heel Spurs?
A heel spur is a calcium deposit that causes a bony protrusion on the bottom of the heel bone (calcaneus). These spurs can range in size, sometimes extending up to half an inch, though most are smaller. They develop gradually over time and are often linked to chronic inflammation of the plantar fascia — the thick band of tissue connecting the heel to the toes.
Contrary to popular belief, the spur itself is not always the source of pain. Many patients with heel spurs never experience symptoms. Instead, discomfort is often caused by the soft tissue irritation or plantar fasciitis that accompanies the spur. This overlap is why the two conditions are often discussed together.
Causes and Risk Factors
Heel spurs form due to prolonged stress and tension on the foot’s supporting structures. When the plantar fascia or surrounding tissues are repeatedly stretched and strained, the body responds by depositing calcium in the affected area. Over time, this buildup hardens into a spur.
Risk factors that increase the likelihood of developing heel spurs include repetitive high-impact activities like running or jumping, spending long hours standing on hard surfaces, wearing poorly cushioned shoes, having flat feet or very high arches, being overweight, and advancing age, which naturally reduces the elasticity of ligaments and soft tissue.
Symptoms and Daily Impact
The hallmark symptom of a painful heel spur is sharp, stabbing heel pain, particularly during the first steps in the morning or after sitting for long periods. This pain often improves with walking but can return after extended activity. Some patients describe a dull ache throughout the day or discomfort after exercise.
The daily impact can be significant. Patients may find it difficult to perform simple activities like grocery shopping, standing at work, or exercising. Over time, chronic heel pain can alter walking patterns, which may lead to knee, hip, or back discomfort from compensating.
Diagnosis
A podiatrist typically diagnoses heel spurs through a combination of patient history, physical exam, and imaging. During the exam, areas of tenderness on the heel are identified. An X-ray can confirm the presence of a bony spur. However, because not all spurs cause pain, the decision to treat depends more on the patient’s symptoms than the X-ray findings alone.
Conservative Treatment Options
The majority of patients improve with nonsurgical care. Resting the foot, applying ice, and stretching the calf and plantar fascia can reduce inflammation. Supportive footwear with cushioned soles and proper arch support is essential. Custom orthotics are particularly effective because they redistribute pressure and relieve stress on the heel.
Night splints, which hold the foot in a stretched position while sleeping, can reduce morning pain. Anti-inflammatory medications or corticosteroid injections may provide temporary relief in stubborn cases. Physical therapy focused on stretching, strengthening, and gait training often plays a key role in long-term recovery.
Advanced and Surgical Treatments
For patients who do not respond to conservative care after several months, advanced options may be considered. Extracorporeal shockwave therapy (ESWT) uses sound waves to stimulate healing in damaged tissue. Platelet-rich plasma (PRP) injections are another regenerative treatment that can enhance the body’s natural repair process.
Surgery to remove a heel spur is rare but may be an option when pain is severe and persistent. Often, surgical procedures target both the spur and the tight plantar fascia, releasing the tension that fuels inflammation. While most patients recover well, surgery involves downtime and is reserved for cases where all other options have been exhausted.
Prevention
Preventing heel spurs revolves around reducing stress on the heel. Wearing properly cushioned, supportive shoes is the first step. Maintaining a healthy weight, warming up before exercise, and avoiding prolonged standing on hard surfaces all reduce strain. For athletes, incorporating cross-training and low-impact activities can minimize repetitive stress. Regular stretching of the calves and plantar fascia keeps the tissues flexible and less prone to micro-injury.
Myths About Heel Spurs
A common myth is that heel spurs always cause pain. In reality, many are discovered incidentally on X-rays for unrelated issues. Another misconception is that surgery is always required to treat a spur. In fact, most patients improve with conservative care. Finally, some believe that heel pain will simply “go away on its own.” While minor heel discomfort sometimes resolves, persistent pain lasting more than a few weeks should be evaluated to prevent chronic problems.
Conclusion
Heel spurs are a common and often misunderstood cause of heel pain. While not every spur is painful, when symptoms do occur they can significantly affect mobility and quality of life. The good news is that most patients find relief through nonsurgical treatments such as orthotics, stretching, physical therapy, and advanced options like shockwave therapy or PRP. Prevention through proper footwear, weight management, and stretching is key to reducing risk. For patients living with heel pain, a podiatrist can provide the guidance and treatment needed to get back on their feet comfortably.