What Are Heel Spurs and Why Do They Make My Heels Ache?

Heel pain is the common symptom related to the foot among many adults. This is often caused by a condition called plantar fasciitis, or inflammation of the plantar fascia, the thick ligament found at the bottom of the foot, just beneath the skin. Heels may also ache as bone spurs grow in the heels with the development of plantar fasciitis.

Heel Pain and Heel Spurs
Heel pain and plantar fasciitis are the most common reasons why people may consult a doctor regarding their feet. Most people suffering from plantar fasciitis complain that their heels ache when they take a few steps after getting out of bed or after sitting for a long time. However, they also note that have less stiffness and pain after taking a few steps. Still, the feet may hurt more as the day goes on and may hurt the most when climbing stairs or after standing for long periods.

The symptoms just described are characteristic of plantar fasciitis, where the ligament that supports the bottom of the foot becomes chronically inflamed and damaged. Doctors also often explain that these patients have heel spurs, which may be seen on plain x-rays as pointed bony outgrowth in the heel (the calcaneus bone). Calcaneal spurs or heel spurs are actually calcium deposits that develop at the back of the heel or under the heel where the plantar fascia inserts into the calcaneus or heel bone (also called the medial calcaneal tuberosity).

Not all people with heel spurs experience pain. Recent studies have shown that about 11-16% of the general population has radiographic evidence of heel spurs although not everyone consults their doctors for heel pain. In fact, in most of these patients, heel spurs are just found incidentally on x -rays.

How Heel Spurs Cause Heel Pain
Although heel spurs are often not associated with pain, the process by which they develop may lead to heel pain. The process of development of heel spurs usually starts with an increased tension in the plantar fascia. This often occurs when the foot over pronates, where one’s weight causes the foot to roll inward, causing the medial arch of the foot to collapse. Over pronation may be caused by various factors, including having flat feet, having weak tight calf muscles or wearing poor quality shoes. Other conditions like obesity, pregnancy, and arthritis can cause functional and structural abnormalities in the foot leading to over pronation. Activities such as running, jogging, or doing jobs that require long hours of standing can also cause heel pain.

Excessive pronation of the feet leads to repeated stress on the plantar fascia, causing inflammation, a condition called acute plantar fasciitis. This is accompanied by pain which is felt towards the inside of the heel or the mid belly of the plantar fascia. It is usually worse in the morning or after a long period of rest.

Progressive increase in the tension on the ligament causes the bone covering of the heel (the periosteum) to be pulled away from the bone, causing pain. The pain is specifically brought about by the disruption of the fibres connecting the periosteum to the bone (called Sharpey’s fibres), which triggers an inflammatory reaction in the portion where there is greatest tension at the plantar fascia – the medial calcaneal tuberosity attachment.

As the periosteum is chronically pulled and distorted, calcium deposits grow out to fill the space between the periosteum and the bone. Thus, a bone spur develops and protrudes at the bottom of the heel. Although heel spurs appear like sharp spike on x-rays, the actual shape of the bony outgrowth is more like a ledge.

If left untreated, the space between the bone and the plantar fascia (the bursa) may become inflamed (a condition called bursitis). This painful condition can be difficult and stubborn to treat with conservative means and may require cortisone (steroid) injection to relieve its symptoms.

Treatment for Heel Pain
Early treatment is always best for aching heels, especially when associated with heel spurs. Although bone spurs may be removed surgically, it is also possible to relieve heel pain without removing the bony outgrowths. Conservative treatments include:

• Rest – A person who suffers from heel pain must definitely take time to rest. By decreasing the amount of time spent walking, jogging, running, or standing, one will reduce the strain and damage to the plantar fascia, which will decrease inflammation.

• Avoid walking barefoot, especially on hard surfaces. Walking barefoot without support to the heel and the foot arch can worsen the tendency to over pronate.

• Ice – Apply an ice pack over the bottom of the foot or roll the foot over a cold water bottle or icepack to reduce inflammation and pain. This can be done 2-3 times a day for 10 minutes.
• Anti-inflammatory drugs – To decrease pain and inflammation, take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil), naproxen (Aleve), mefenamic acid (Ponstan), or piroxicam (Feldene). However, be cautious about taking these medications for more than a few weeks because they can cause gastric irritation and other side effects. Consult a doctor for more information on the dosage and use of NSAIDs.

• Orthotics – Orthotics, orthoses, or orthotic foot devices consist of insoles, shoe inserts, or other devices which are used to provide support for the feet. These may be made of plastic, carbon fiber, elastic, fabric, metals, or a combination of materials. They work by reducing over pronation, distributing weight, supporting the foot arch, or by realigning the foot joints while a person is standing, walking, or running. They are often used to relieve symptoms of plantar fasciitis.

• Wearing proper shoes – Wearing shoes that provide little support to the foot arch can cause plantar fasciitis. Experts recommend wearing shoes which control over pronation and support the arches of the feet. These include shoes with firm soles and good heel counters. These shoes control the alignment of the foot and ankle and provide proper support for the foot arches. Athletes and active individuals are also advised to wear the proper type of shoes for the specific activities they do (e.g., tennis shoes for playing tennis, and running shoes for running).

• Stretching exercises – Proper exercises can reduce the tightness of the calf muscles and Achilles tendons which can interfere with the natural walking pattern. Having flexible muscles is very important in the prevention and treatment of common foot and leg injuries. These exercises include stretching the calf muscles using towel exercises, Achilles tendon stretching exercises and tennis ball-rolling exercises with the foot.

• Strengthening exercises – To strengthen the plantar fascia and the foot, one can do point-and-flex exercises with the foot, calf raises, and ankle circling exercises. One can also try to pick up marbles or small stones with the toes and put them one at a time in a cup. Another way to strengthen the foot is by doing toe-tapping exercises. This is done by tapping the big toe against the floor while the heel lies flat, followed by tapping the other toes while the big toe is lifted up.

• Cortisone Injection – Injecting steroids into the affected area helps by reducing inflammation and pain associated with it. It has an advantage over orally taken drugs in that it acts locally and avoids the side effects of systemic drugs. Repeated injections, however, are associated with side effects such as injury to the joint tissues, thinning of joint cartilages, weakening of ligaments, increased inflammation due to a reaction to crystallized steroid, and possible infection.

• It will also help to lose weight if one is obese, overweight, or diabetic, because the stress on the feet will be reduced. Obesity increases the strain on the foot, leading to excessive pronation. Heel pain is also increased in overweight individuals who are active or spend long hours on their feet.

Surgery for Heel Spurs
Surgery may be considered when conservative treatments have failed to relieve pain and restore normal function. Surgical techniques may be aimed at releasing the plantar fascia or removal of the bone spurs. However, possible complications of heel surgery may include nerve damage, recurring heel pain, infection, and scarring. Plantar fascia release can also increase the risk for instability, stress fracture, foot cramps, and tendinitis.

Start your heel pain treatment today.