Did you know that between 10% and 50% of people have heel spurs detected on x-ray? It is very common.
The below graph is from a heel spur population study by Toumi, H et al (2014) [1]. The prevalence of plantar (underneath) heel spurs as per age groups. Heel spurs are more common in women (black bars) than men (white bars) under the age of 50 years.
Some people with pain under their heel are told it is because they have heel spurs. This isn’t exactly true. Heel spurs are not the cause of the pain in many cases of heel pain. The pain is often a result of a soft tissue condition. I don’t fault people for thinking a heel spur is the cause of their heel pain. The pain is awful and can feel very deep, bony and bruised.
This article aims to dispel some misconceptions regarding heel spurs. In future articles I will explore the complex nature of heel pain.
What is a heel spur?
The heel bone is called the calcaneus. It is a rather bumpy bone that can form spurs in many different spots. Plantar heel spurs are the ones that form underneath, on the bottom of the bone. This is the type of heel spur I will be focusing on in the article.
Heel spurs are made out calcium, the same stuff the rest of your heel bone is made from. Heel spurs are extra calcium deposits being laid down.
Why do heel spurs form?
This is not a straightforward answer because we are uncertain on exactly how plantar heel spurs form. We have a few theories.
The longitudinal traction hypothesis (pulling force on the heel)
Excessive pulling on the heel bone from the plantar fascia causes inflammation and reactive extra bone being formed. This theory isn’t as widely accepted as it used to be because most spurs aren’t located where the plantar fascia attaches to the heel bone [2]. Additionally, the spur cells aren’t formed in an alignment consistent with a pull from the plantar fascia [3].
The vertical compression hypothesis (pushing force on the heel)
Repetitive compression forces from walking, running and other weightbearing activities place stress on the heel bone causing additional bone to be made. This extra bone aims to provide extra protection against these forces and prevent microfractures of the heel bone. This may explain why plantar heel spurs are more common in people who are overweight [4].
Will I need surgery to have the heel spur removed?
It is very unlikely. In most cases, a throughout musculoskeletal assessment and treatment plan to address the pain and biomechanical abnormalities will prevent the need for surgery. There are many non-invasive treatment options for heel pain available at New Step Podiatry. There are treatments performed in the clinic including mobilisation and shockwave to activities at home including stretching and strengthening.
If someone did need surgery for heel pain, the procedure is more likely to be to address soft tissue that is squeezing a nerve. Given the above causes of heel spurs, can a surgeon give you a 100% guarantee the heel spur won’t regrow?
What should I do about my heel pain?
The straightforward answer is book in with a Podiatrist for an assessment before the heel pain gets chronic.
Recently started or acute heel pain can be relatively straightforward to treat. From my perspective and from my client’s perspective it is much easier to treat than chronic heel pain. Chronic heel pain is complex in diagnosis, cause and treatment. Chronic pain in terms of time can be defined as pain that has been present (including on and off) for over 8 weeks. Although, chronic pain is too complex to define with a time period.
Keep yourself up-to-date on all things heel pain by checking back on the New Step Podiatry blog for more articles.
References
A big thank you to all the following researchers
[1] Toumi, H., Davies, R., Mazor, M., Coursier, R., Best, T. M., Jennane, R., & Lespessailles, E. (2014). Changes in prevalence of calcaneal spurs in men & women: a random population from a trauma clinic. BMC musculoskeletal disorders, 15, 87. [2] Abeu M, Chung C, Mendes L, Mohana-Borges A, Trudell D and Resnick D (2003). Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic MR imaging, anatomic and paleopathologic analysis. Skeletal Radiology 32:13-21 [3] Li, J. and Muehleman, C. (2007). Anatomic relationship of heel spur to surrounding soft tissues: Greater variability than previously reported. Clin. Anat., 20: 950-955. [4] Menz, H. B., Zammit, G. V., Landorf, K. B., & Munteanu, S. E. (2008). Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?. Journal of foot and ankle research, 1(1), 7.