What Causes a Heel Spur?
A heel spur is caused by chronic plantar fasciitis.
Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.Your plantar fascia acts as a passive limitation to the overflattening of you arch. When your plantar fascia develops micro tears or becomes inflammed it is known as plantar fasciitis.
When plantar fasciitis healing is delayed or injury persists, your body repairs the weak and injured soft tissue with bone. Usually your injured fascia will be healed via fibroblastic activity. They’ll operate for at least six weeks. If your injury persists beyond this time, osteoblasts are recruited to the area. Osteoblasts form bone and the end result is bone (or calcification) within the plantar fascia or at the calcaneal insertion. These bone formations are known as heel spurs.
This scenario is most common in the traction type injury. The additional bone growth is known as a heel spur or calcaneal spur.
More information: plantar fasciitis.
What are the Symptoms of a Heel Spur?
- You’ll typically first notice early heel spur pain under your heel in the morning or after resting.
- Your heel pain will be worse with the first steps and improves with activity as it warms up.
- When you palpate the tender area you may feel a tender bony lump.
How Does a Heel Spur Progress?
As your plantar fasciitis deteriorates and your heel spur grows, the pain will be present more often.
How is a Heel Spur Diagnosed?
Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination.
After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts.
X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal or heel spur.
Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification.
Risk Factors for Heel Spurs
You are more likely to develop plantar fasciitis and heel spurs if you are:
- Active – Sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle from a previous ankle sprain, which limits ankle movement eg. running, ballet dancing and aerobics.
- Overweight – Carrying around extra weight increases the strain and stress on your plantar fascia.
- Pregnant – The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation.
- On your feet – Having a job that requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses.
- Flat Feet or High Foot Arches – Changes in the arch of your foot changes the shock absorption ability and can stretch and strain the plantar fascia, which then has to absorb the additional force.
- Middle-Aged or Older – With ageing the arch of your foot may begin to sag – putting extra stress on the plantar fascia.
- Wearing shoes with poor support.
- Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury.
- Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.
- Although doctors don’t know why, plantar fasciitis occurs very often in people with diabetes.
Heel Spur Treatment
- Due to poor foot biomechanics being the primary cause of your plantar fasciitis it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the development of a heel spur.
- Your physiotherapist is an expert in foot assessment and its dynamic biomechanical correction. They may recommend that you seek the advice of a podiatrist, who is an expert in the prescription on passive foot devices such as orthotics.