Heel Spur

The heel spur is a small ossification on the heel bone that often occurs on the sole of the foot, but also on the back of the foot (below the Achilles tendon). This can cause pain for the person affected.
The heel spur itself is often not the cause of the pain. The pain comes from the inflammation of the plantar fascia or the Achilles tendon.

The lower heel spur, also known as the plantar heel spur, occurs on the plantar side of the calcaneus (heel bone) and is associated with the plantar fascia.

The posterior calcaneal spur, also known as the dorsal calcaneal spur, originates on the back of the heel bone and is in contact with the Achilles tendon.

Haglund’s deformity (Haglund’s heel) is also an ossification on the back of the heel bone, but at the upper edge. It can be present from birth (congenital) or caused by overuse.

The causes of the various forms of ossification differ depending on their location. They have in common a biomechanical dysfunction that then leads to complaints.
For all forms of heel spur, obesity is an important risk factor, since several times the body weight is placed on the feet, making overloading more likely.

Inflammation of the plantar fascia, known as plantar fasciitis, is the cause of the lower heel spur. Overloading of this tendon, which spans the arch of the foot, causes inflammation. Over time, calcium is deposited in the tendon inflammation, which then becomes visible as a heel spur on an X-ray.
There are various causes for the overloading. On the one hand, there may be unaccustomed strain on the arch of the foot due to long periods of walking or jumping. However, more common causes are chronic misalignment of the foot due to conditions such as fallen arches or splayfoot.

Acute or chronic overloading can also occur on the back of the heel bone. Long distances in mountainous terrain, long runs or the pressure of certain types of shoe can lead to acute overloading of the Achilles tendon and to inflammation, known as achillodynia.
Likewise, pes valgus can lead to unfavourable loading of the tendon and thus to pain.
Very often, there is an absolute or relative shortening of the Achilles tendon that promotes overuse.
If the overuse and the associated inflammation persist for a long period of time, ossification can occur at the tendon insertion, which can be seen on an X-ray as a posterior calcaneal spur or as Haglund’s deformity, or in some cases both.

Being overweight is an important risk factor for all forms of heel spur because the leverage causes several times the body weight to bear on the feet during movement, making overloading more likely.

The symptoms of plantar heel spurs include stabbing pain when under stress, especially when walking or standing, usually especially on hard surfaces. These can become permanent over time or alternate between better and worse days.
With a posterior calcaneal spur, these symptoms occur when pressure is applied, for example by shoes or when the Achilles tendon is stretched.

Treatment for a heel spur aims to eliminate the causes, relieve pain and reduce inflammation. Measures such as physiotherapy exercises, shoe inserts, anti-inflammatory ointments and medication, cryotherapy and avoiding excessive strain can be helpful. The early application of extracorporeal shock wave therapy has proven very effective. In this process, mechanical waves are delivered directly into the tissue. This sets metabolic processes in motion that lead to an inhibition of inflammation and the breakdown of calcifications.

In more severe cases, local injections or even surgical removal may be necessary to reduce the symptoms. Cortisone is usually injected, which helps in the short term but has various disadvantages. It is now known that corticosteroids can damage the tendons and thus cause long-term problems. Alternatively, Botox and PRP (platelet-rich plasma) can be injected.

Holistic anti-inflammatory measures have proven to be a good supportive treatment. Hidden inflammations in the body, known as silent inflammations, should be identified and eliminated. These can be found, for example, in the jawbone (jaw inflammation) or in the intestines. Intestinal cleansing, INUSpheresis, intravenous laser therapy and infusion therapy have proven to be effective in removing inflammation.

Early diagnosis and personalised treatment are crucial to alleviate the symptoms and prevent chronicity. If you experience persistent or intense pain in the heel area, you should consult a doctor to determine the best course of action and avoid unnecessary strain on your quality of life. The first step should be to see an orthopaedic specialist. In the case of plantar heel spurs, an analysis of the gait and, if necessary, the underlying foot malposition should be carried out in order to initiate therapy with insoles. These are then designed with soft padding along the tendon that tenses the foot in order to relieve it. In the case of malpositions, other factors can be treated at the same time.

The rear heel spur is more difficult to treat with insoles alone. In most cases, additional bandages, heel elevations to relieve the Achilles tendon or heel soft cushioning made by the orthopaedic shoemaker are used here.

Close cooperation between orthopaedists, orthopaedic shoemakers and orthopaedic technicians leads to success in most cases.

A heel spur can cause severe pain and often restricts mobility. Here you will find answers to frequently asked questions about treatment options, exercises and other tips for relief.

The information listed contains relevant topics and serves to improve understanding.