A heel spur is a calcium deposit that creates a bony protrusion on the heel bone where it connects to the plantar fascia. These bony growths typically develop due to prolonged stress on the foot ligaments from excessive weight-bearing activities. The initial symptom of heel spurs is often pain in the heel that intensifies throughout the day. Many patients report experiencing a distinctive sharp, stabbing pain when taking their first steps in the morning, which is considered the hallmark symptom of this condition.
What is a Heel Spur?
A heel spur represents a bony growth or protrusion that forms as calcium accumulates in the heel region. Various factors contribute to this condition, including excessive weight, flat feet, and inflammation of the plantar fascia (the ligament connecting the heel bone to the toes). This orthopedic condition typically remains asymptomatic during periods of rest but becomes painful during movement, with discomfort intensifying toward the end of the day. Heel spurs significantly restrict mobility and impact daily activities.
Patients with heel spurs often describe the sensation as walking with a nail or pebble embedded in their heel. The primary symptom is heel pain that progressively worsens throughout the day. Heel spurs generally develop from sustained pressure on ligaments and stress on bones, and walking barefoot on hard surfaces can exacerbate the condition. Many individuals remain unaware of having heel spurs until they experience severe pain. With early diagnosis, effective treatment options are available. The critical factors for successful management include appropriate diagnosis and implementing the right treatment approach.
Conservative treatment approaches such as adequate rest, application of ice compresses, utilizing heel support devices, topical pain-relieving preparations, and therapeutic massage can provide significant relief from heel spur symptoms. When applied correctly, these methods can rapidly alleviate discomfort associated with heel spurs.
What Causes Heel Spur?
Heel spurs develop when inflammation occurs due to stretching of the fascia (connective tissue beneath the skin) or tearing of the membrane covering the heel bone. The resulting inflammation promotes calcium accumulation, leading to the characteristic bony outgrowth known as a heel spur. Common contributing factors include excessive physical activity or prolonged inactivity, obesity, running on unyielding surfaces, inappropriate footwear lacking orthopedic support, abnormal walking patterns that place undue pressure on the heel, structural foot abnormalities (flat feet or high arches), and standing for extended periods.
Causes of heel spurs include:
- Tension, strain or stress on foot muscles and ligaments
Walking or running on hard ground Abnormal gaits that put too much pressure on the heel Use of non-orthopedic or non-arch-supporting shoes Having flat feet or high arched feet Frequent use of flip-flops Standing for long periods during the day Standing for long periods of time Heel inflammation known as plantar fasciitis Conditions such as diabetes and arthritis Obesity
Tension, strain, stress in foot muscles and ligaments
Excessive tension and strain affecting the foot muscles and ligaments, particularly the plantar fascia, can trigger heel spur formation and result in considerable pain.
Walking barefoot on hard ground
Repetitive impact and pressure from walking, especially running or jumping, on unyielding surfaces represents a significant risk factor for developing heel spurs.
Use of orthopedic or non-arch-supporting shoes
Footwear with rigid soles can damage heel bones and contribute to heel spur development. Women’s ballerina flats and men’s hard-soled leather dress shoes are typical examples of problematic footwear.
Using the wrong shoes during exercise
During physical activity, foot ligaments and muscles experience substantial strain. When combined with inappropriate footwear, this increased stress can damage the plantar fascia and promote heel spur formation.
Weight gain and obesity
Excess body weight significantly increases pressure on the heel bone, potentially leading to plantar fascia inflammation and intense heel pain.
Injuries to the heel
Traumatic injuries affecting the heel bone and surrounding ligaments can predispose individuals to heel spur development.
Spending most of the day standing
Prolonged standing or sudden weight-bearing on the heel region creates pressure on the fascia fibers, contributing to heel spur formation.
What are the symptoms of heel spurs?
The primary and most significant symptom of heel spurs is pain localized in the heel. Patients typically experience pain in the sole of the foot and stinging heel pain upon waking in the morning, as well as heel pain that intensifies by day’s end following extended foot use. Another characteristic sign is the development of a bony projection on the heel’s underside.
Symptoms of heel spurs include:
- Severe heel pain when taking the first step after waking up in the morning or after a long rest
Pain in the area of the foot near the heel Small, bony protrusion on the underside or back of the heel Feeling of warmth in the heel area Increased heel pain after long walks Inflammation of the heel Numbness or tingling if nerves are affected Increased pain with exercise and activity Difficulty walking with pain
How do we know if we have a heel spur?
The primary indicator of a heel spur is heel pain, which manifests in two distinct patterns. First, patients experience foot sole pain and stinging heel discomfort upon morning awakening. Second, they notice heel pain that intensifies by evening following extended foot use throughout the day.
How is Heel Spur Diagnosed?
Orthopedic evaluation plays a crucial role in diagnosing heel spurs. Individuals experiencing persistent or intermittent heel pain should consult an Orthopedic and Traumatology specialist. During examination, physicians typically identify heel spur presence based on the patient’s reported symptoms, pain response when pressure is applied to the heel, and complaints of stinging heel sensations. X-ray imaging provides definitive diagnosis by revealing characteristic thorn-like projections. In some cases, MRI examination may be requested to evaluate potential edema or tears where the plantar fascia attaches to the heel bone, though this imaging modality is not routinely required.
How is Heel Spur Treated?
Treatment approaches for heel spurs encompass rest, targeted exercises, customized foot immobilizers, anti-inflammatory medications, and cortisone injections. Additionally, topical analgesic preparations and massage therapy provide effective symptom management. When conservative measures prove unsuccessful, surgical intervention may be necessary depending on individual circumstances.
Patients should perform toe-stretching exercises (extending toes backward) for five minutes, 4-5 times daily, and apply ice massage to the affected heel.
The most effective treatment approaches for heel spurs include:
- Resting to reduce activities that worsen pain
Applying compresses with ice packs Performing stretching movements that stretch the calf and plantar fascia Using personalized heel spur insoles and orthotics Having a splint fitted Physiotherapy Anti-inflammatory drugs Cortisone injections Pain relieving creams Massage treatments Slippers with silicone heel part Surgery if necessary
How is needle treatment applied to heel spurs?
For patients who don’t respond to first-line therapies, second-stage treatment includes heel spur injections. These injections typically contain either cortisone or PRP (Platelet-Rich Plasma), with cortisone being more commonly utilized. If pain persists after initial injection, a follow-up treatment may be administered after 10-15 days. However, these injections are limited to two or three applications due to potential side effects and risk of cortisone-induced heel tissue tears. For patients unresponsive to cortisone, PRP injection represents an effective alternative. Needle treatment can provide both immediate relief and long-term or permanent pain resolution.
What is ESWT?
ESWT (Extracorporeal Shock Wave Therapy) treatment is offered to patients who don’t benefit from needle therapy. Commonly known as shock wave or sound wave therapy, and colloquially referred to as “breaking heel spurs,” this treatment doesn’t actually aim to fracture the heel bone protrusion visible on x-rays. Rather, it creates controlled microtrauma and microbleeding using high-energy sound waves to accelerate healing at the plantar fascia-heel attachment site.
How is radiofrequency applied?
Radiofrequency therapy represents another treatment option for heel spurs. This procedure involves numbing the affected area’s nerves using sound waves. Treatment is delivered by inserting larger-gauge needles and generating controlled heat using radiofrequency technology to desensitize the area’s sensory and pain nerves.
Is there a surgical treatment method for heel spurs?
Patients who fail to respond to all conservative measures may undergo heel spur surgery. This procedure involves surgical release of the plantar fascia attachment to the heel, providing symptom relief. However, surgical intervention is rarely necessary.
How to Get Rid of Heel Spur?
Natural remedies that may assist in heel spur management include soaking the affected heel in Epsom salt or diluted apple cider vinegar, massaging with coconut oil, consuming foods rich in fish oil, omega-3 fatty acids and vitamin D, and appropriate supplementation.
Natural methods that help to cure heel spurs are:
- Applying ice compresses
Soaking the foot in epsom salt Soaking the heel in apple cider vinegar diluted with water Heel massage with coconut oil Taking omega-3, vitamin D, fish oil and magnesium supplements Taking anti-inflammatory medications Flaxseed
Frequently Asked Questions About Heel Spur
Who is most likely to get heel spurs?
Heel spurs commonly affect individuals who neglected foot health earlier in life. The demographic most frequently diagnosed with heel spurs includes:
- People over 40 years of age
Overweight individuals Those who wear inappropriate footwear People whose occupations require prolonged standing Individuals with structural foot abnormalities (flat feet, high arches) Those with gait disorders People diagnosed with certain rheumatic conditions
What causes heel spurs?
The primary factors contributing to heel spur development include increased weight-bearing activities like walking or running that place excessive stress on foot ligaments, walking/running surface hardness, foot structural characteristics, footwear type, and excess body weight.
How to understand heel spurs?
Heel spurs typically present with intense, sharp heel pain, often occurring with the first morning step. Some patients experience pain that progressively worsens throughout the day. Additional symptoms may include burning sensations, stinging, numbness, inflammation, and visible bone protrusion, all suggestive of heel spur presence.
How long does it take for a heel spur to heal?
Following appropriate treatment, most patients experience symptom improvement within approximately three weeks.
Is anesthesia used during treatment procedures?
Since heel spur injections can be painful, clinicians first apply topical anesthetic cream, followed by cooling/numbing spray, and then administer local anesthetic injection gradually. The actual therapeutic injection follows local anesthesia.
For ESWT (sound wave therapy), regional nerve blocks are performed to prevent pain perception. The radiofrequency procedure likewise requires anesthetizing nerves supplying the plantar region.
When can patients return to their normal lives?
Patients can resume normal activities immediately following needle treatment. However, after ESWT (sound wave therapy), one day of rest is recommended.
Can heel spur needle treatment be applied to chronic patients?
Caution is warranted when administering cortisone injections to diabetic patients and those with hypertension, as cortisone affects blood glucose and blood pressure levels. For poorly controlled diabetics, endocrinologist consultation should precede treatment.
Cortisone administration in hypertensive patients causes sodium retention, potentially destabilizing blood pressure for several days. Both glucose levels and blood pressure should be well-controlled before needle treatment.
Additionally, patients taking anticoagulants who require needle therapy or ESWT should reduce anticoagulant use under cardiologist supervision prior to treatment, as these procedures carry bleeding risk.
Are there any age-related limits for heel spur treatment?
Heel spurs rarely affect children, primarily occurring in middle-aged and older adults. Treatment approaches are designed for these age demographics.
What are the risks of these operations?
Long-term cortisone therapy may produce systemic side effects. However, single-dose administration typically causes minimal adverse effects, with temporary impacts on hypertension and diabetes lasting 1-2 days. Needle procedures carry bleeding risk, though major vessel injury is unlikely given the anatomical treatment area.
Which doctor should you see for heel spurs and heel pain?
Patients with heel spurs should consult Orthopedics and Traumatology specialists or Physical Therapy and Rehabilitation physicians.
Are treatments for heel spurs safe?
All established heel spur treatment modalities have favorable safety profiles.
Can a heel spur break?
Despite common misconceptions, sound wave therapy doesn’t aim to fracture the bony heel projection visible on x-rays. Instead, it creates controlled injury at the painful plantar fascia attachment site to promote tissue healing.
Does heel spur pain go away on its own?
Early-stage heel spur pain sometimes resolves spontaneously with appropriate footwear changes. Hard-soled shoes often precipitate pain, and switching to soft-soled alternatives may alleviate discomfort. However, chronic, persistent pain invariably requires medical intervention.
Are there any diseases that can be confused with heel spurs?
Heel spur can be mistaken for tarsal tunnel syndrome, where nerves traveling to the foot sole become compressed. Several symptom differences help differentiate these conditions. Heel spur causes localized heel pain without sole numbness, while tarsal tunnel syndrome produces numbness throughout the foot sole, with pain affecting both the sole and toes. Additionally, burning sensations in the foot sole characterize tarsal tunnel syndrome.
What is PRP injection?
PRP (Platelet-Rich Plasma) therapy involves extracting the patient’s blood, processing it to concentrate platelets, and injecting this platelet-rich solution into targeted tissue. For heel spurs, PRP aims to accelerate healing of damaged heel tissues and provide pain relief.
Does ESWT provide a permanent solution to heel spurs?
Shock wave therapy (ESWT) represents a common treatment approach, utilizing externally generated pressure waves directed at specific body regions through an applicator.
ESWT offers an alternative for patients with contraindications to injections or those unresponsive to injection therapy. This technique, long employed for kidney stone fragmentation, provides approximately 85% permanent improvement. Early intervention increases success probability. Treatment typically involves 3-5 sessions at weekly intervals, each lasting about 20 minutes.
Following ESWT, which facilitates recovery without surgery, anesthesia, or medication in a relatively short timeframe, recurrence risk remains low.
What happens during shock wave therapy (ESWT) sessions?
During ESWT sessions, clinicians don’t target the visible bone spur seen on x-rays (contrary to popular belief). Instead, the procedure aims to promote healing by inducing controlled destruction of damaged tissue causing heel pain. Each session delivers approximately 2,000-3,000 sound waves to initiate therapeutic microbleeding. Most heel spur patients respond favorably to this treatment approach.
Who cannot receive shock wave therapy (ESWT)?
ESWT is contraindicated for pregnant women, cancer patients, individuals with bleeding disorders like hemophilia, patients taking anticoagulants, those with local infections at the treatment site, and people with cardiac pacemakers.
Do heel spur patients need surgery?
Surgery represents the final therapeutic option for heel spurs. Most patients unresponsive to massage and injection treatments achieve lasting recovery through shock wave therapy. Successful non-surgical outcomes are common, with less than 1% of patients ultimately requiring surgical intervention.
Is itching seen in the heel in heel spur disease?
Heel itching is not characteristic of heel spur syndrome.
Can heel spurs be prevented?
Footwear selection significantly impacts heel spur prevention. Soft-soled shoes like athletic footwear are recommended. In professional environments where sneakers are inappropriate, silicone heel inserts should supplement conventional footwear.
- Hard, flat and high-heeled shoes should be avoided
Weight management is essential Indoor barefoot walking should be avoided; soft-soled slippers are preferable Custom orthotic insoles should address foot pressure abnormalities and pain
Do heel spurs grow?
Without treatment addressing the underlying condition, heel spurs may continue enlarging as calcium deposition progresses.