A heel spur (calcaneal spur) is a bony outgrowth composed of a calcium deposit. It forms on the underside of the heel bone (calcaneus) in response to chronic strain on the foot’s tissues over an extended period. When investigating the cause of heel pain, the X-ray remains the primary, non-invasive tool for visualizing this specific bony change.
Understanding the Diagnostic Role of X-Rays
An X-ray is typically ordered for heel pain to confirm the existence of a heel spur and serve a broader diagnostic purpose. Since X-rays are good at imaging dense structures like bone, they clearly show any bony changes or formations that may be the source of discomfort. The image confirms the presence of the spur, which is a hardened calcification of tissue at the bone attachment site.
The imaging procedure is also instrumental in excluding other conditions that mimic the symptoms of a heel spur or plantar fasciitis. These alternative diagnoses include stress fractures of the calcaneus, bone cysts, or tumors. By ruling out these other possible causes of pain, the physician can focus on soft tissue issues. A standard lateral non-weight-bearing X-ray view provides the necessary profile to accurately assess the heel bone structure.
Visual Interpretation: The Appearance of the Spur
When viewing a lateral X-ray of the foot, the heel spur appears as a distinct, white, opaque projection extending from the calcaneus bone. This opacity results from the calcium deposit being much denser than the surrounding soft tissue, which is typical for any bony structure on a radiograph. The shape of the spur is often described as a hook, spike, or beak-like protrusion.
Most commonly, the formation is a plantar spur, originating at the bottom of the heel bone where the plantar fascia attaches. On the X-ray, this type of spur projects forward, running along the sole of the foot and aligning with the fascial fibers. A less frequent presentation is the posterior spur, which develops on the back of the heel where the Achilles tendon inserts. This distinction in location is important, as the two types of spurs are associated with different biomechanical stresses.
Clinical Significance of the X-Ray Finding
The visibility of a heel spur on an X-ray does not automatically confirm it as the source of a person’s pain. Studies show that about 15% of the general population have visible heel spurs but experience no heel pain. Conversely, many individuals suffering from severe heel pain, primarily caused by inflammation of the plantar fascia, may not have a spur visible on their X-ray.
The spur itself is often considered an incidental finding, meaning it is present but not the primary cause of the discomfort. Instead, the pain is typically attributed to inflammation and micro-tears in the plantar fascia, a condition known as plantar fasciitis. When a spur is confirmed on imaging, it serves as evidence that the patient has experienced long-standing, chronic stress on the heel, as these bony changes take six to twelve months to develop. Therefore, a physician correlates the X-ray image with the patient’s reported symptoms and physical examination findings to confirm the diagnosis.
Next Steps Post-Imaging
Once the X-ray confirms the presence of a heel spur and rules out other issues, the focus shifts to conservative, non-surgical management. The treatment plan for a heel spur is the same as that for plantar fasciitis, regardless of the spur’s size, since soft tissue inflammation is the source of the pain. The goal is to relieve tension and stress on the tissues around the heel bone.
Initial steps include activity modification, such as reducing activities that aggravate the pain, and the use of over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) to manage inflammation. Physical therapy is a major component of recovery, focusing on stretching exercises for the Achilles tendon and the plantar fascia, as well as strengthening the foot and lower leg muscles. Supportive footwear and custom or over-the-counter orthotic devices, such as arch supports or heel cups, are also recommended to provide cushioning and proper foot alignment. These conservative measures are effective in resolving symptoms for approximately 90% of patients.