A heel spur is a common finding: an abnormal, bony projection (osteophyte) that develops on the calcaneus, the large bone forming the heel of the foot. This formation occurs over a long period of time in response to chronic mechanical stress. Because this condition involves a change to the dense bone structure, X-rays are the standard, non-invasive tool utilized by healthcare professionals to confirm the presence and location of the spur. The high prevalence of these bony growths means that many individuals will have them, often without ever knowing they exist.
What Exactly is a Heel Spur?
A heel spur is formed when calcium deposits build up over a long duration on the heel bone, or calcaneus. This process is the body’s attempt to reinforce the area where soft tissues attach to the bone under conditions of repeated, excessive strain. The most common type is the inferior calcaneal spur, which forms on the underside of the heel where the plantar fascia connects to the bone.
Less frequently, a posterior calcaneal spur can develop at the back of the heel where the Achilles tendon inserts into the bone. The underlying mechanism involves chronic strain and microtrauma to the soft tissue attachments, leading to the formation of new bone tissue. This bony outgrowth may measure up to half an inch in length.
The formation is associated with biomechanical factors that increase tension on the foot’s structures, such as abnormalities in walking gait or having flat feet or high arches. Age and excess body weight are also considered contributing factors, as they increase the load and stress placed on the heel.
Visualizing the Spur: What the X-Ray Shows
The standard method for identifying and characterizing a heel spur is through a plain radiograph, specifically a lateral view of the foot. This side-profile image clearly captures the relationship between the calcaneus and the soft tissue structures of the sole. Because bone is dense and mineralized, the heel spur appears bright white, or radiopaque, against the darker background of the soft tissues on the X-ray film.
The spur presents visually as a dense, triangular, or hook-like projection extending from the heel bone. In the case of an inferior spur, this projection juts forward along the bottom of the foot, often pointing toward the toes. A radiologist or physician will use the X-ray to measure the size of the spur and note its precise orientation and location on the calcaneus.
This visual confirmation is important for diagnosis and for ruling out other causes of heel pain, such as a stress fracture or arthritis. While the X-ray provides an excellent view of the bony architecture, it offers limited information about the condition of the soft tissues, such as the plantar fascia or the fat pad.
When the Spur is Not the Pain
A significant clinical finding is that the presence of a heel spur on an X-ray does not automatically mean it is the source of a person’s pain. Studies indicate that a considerable percentage of the population, ranging from 16% to over 40%, have heel spurs visible on X-ray but experience no symptoms. These individuals are considered to have an asymptomatic heel spur.
The discomfort commonly attributed to the spur usually originates from the associated inflammation of the surrounding soft tissues, most notably a condition called Plantar Fasciitis. This involves irritation and degeneration of the plantar fascia ligament where it attaches to the heel bone. The pain is caused by the strain and inflammation in this ligament, not by the bony projection itself.
The intensity of a patient’s heel pain rarely correlates with the measured size of the spur on the X-ray image. A small spur can be present in a patient experiencing severe pain, while a person with a very large spur may have no pain at all. Clinicians therefore focus treatment on resolving the soft tissue inflammation, which is the true source of the patient’s discomfort, rather than the bony spur.
Initial Management After Diagnosis
Once an X-ray has confirmed the presence of a heel spur and a diagnosis of associated heel pain is made, the initial course of action is almost always conservative, non-surgical management. The primary goal of this approach is to reduce inflammation and relieve the mechanical strain on the plantar fascia and surrounding structures. Patients are advised to limit activities that aggravate the pain and to avoid walking barefoot or wearing flat, unsupportive shoes.
A regimen of specific stretching exercises is often prescribed, focusing on increasing the flexibility of the calf muscles and the plantar fascia itself. These stretches help to reduce the tension that pulls on the ligament’s attachment site, which is the underlying cause of irritation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to help manage pain and decrease local inflammation in the short term.
Supportive footwear, sometimes combined with over-the-counter heel cups or prefabricated orthotic shoe inserts, is utilized to redistribute pressure away from the irritated area. These devices provide cushioning and arch support to correct abnormal foot mechanics and reduce the constant tugging on the plantar fascia. This multi-faceted conservative approach is successful for the vast majority of patients experiencing heel pain related to a spur.