A calcaneal spur, commonly known as a heel spur, is a bony growth forming on the heel bone. While not all calcaneal spurs cause pain, they can lead to discomfort that significantly impacts daily activities and mobility.
What is a Calcaneal Spur?
A calcaneal spur is an osteophyte, a type of bony outgrowth, that develops on the heel bone (calcaneus). These spurs typically form on the underside of the heel, where the plantar fascia connects, or at the back, where the Achilles tendon inserts. When observed on an X-ray, the spur can appear as a hook-like or shelf-like projection, sometimes extending up to half an inch. The pain associated with a calcaneal spur often stems from inflammation of the surrounding soft tissues, rather than the spur itself.
What Causes Calcaneal Spurs?
Calcaneal spurs result primarily from chronic strain and repetitive stress on the foot’s muscles and ligaments, particularly the plantar fascia. This continuous stress can lead to the body depositing calcium in the area, forming the bony outgrowth over several months. Several factors can contribute to this ongoing stress, including biomechanical issues like flat feet or high arches, which can cause uneven weight distribution. Improper or worn footwear, prolonged standing, obesity, and certain physical activities such as running or jumping on hard surfaces can also increase the risk of spur formation. The spur develops as a response to micro-tears and inflammation in the affected tendons and fascia.
Recognizing Calcaneal Spur Symptoms
The main symptom of calcaneal spurs is heel pain. This pain is often most pronounced with the first steps in the morning or after a period of rest, such as sitting. Individuals may describe the pain as sharp or stabbing initially, which can then dull to an ache as the day progresses. The discomfort typically worsens with increased activity or weight-bearing and tends to improve with rest. Not all calcaneal spurs produce symptoms; some individuals have spurs visible on X-rays without experiencing any pain.
How Calcaneal Spurs Are Diagnosed
Diagnosis of a calcaneal spur starts with a physical examination of the foot. A healthcare provider assesses the area for tenderness and evaluates the foot’s range of motion. Confirmation of a bony outgrowth is achieved with an X-ray of the foot. While an X-ray clearly shows the presence of the spur, the diagnosis of heel pain is primarily clinical, considering the patient’s symptoms and physical findings.
Treatment Approaches for Calcaneal Spurs
Treatment for calcaneal spurs primarily focuses on conservative, non-surgical methods, which are effective for the majority of individuals. Initial approaches often involve rest from activities that worsen the pain and applying ice to the affected area for 15-20 minutes several times daily to reduce inflammation. Stretching exercises for the plantar fascia and calf muscles are important to improve flexibility and reduce tension. Supportive footwear with good arch support and cushioning is recommended, and custom or over-the-counter orthotics can help redistribute pressure.
Over-the-counter anti-inflammatory medications, such as ibuprofen, may be used to manage pain and inflammation. Physical therapy can provide structured exercise programs and modalities to aid recovery. For persistent inflammation, corticosteroid injections may be administered, though repeated injections are generally avoided due to potential tissue damage. Surgery, which may involve releasing the plantar fascia or removing the spur, is considered a last resort only after extensive conservative treatments have failed to alleviate persistent pain, typically after 9 to 12 months.