What are the common types of heel spurs. How does heel spur syndrome develop. What causes insertional Achilles tendonitis. Why do bone spurs form in the heel. How can heel pain be managed effectively.

The Two Main Types of Heel Spurs: Plantar and Dorsal

Bone spurs are bony protrusions that can develop on various bones in the body, including the heel. Two common painful heel conditions associated with bone spurs are:

• Heel spur syndrome (plantar spurs)
• Insertional Achilles tendonitis (dorsal spurs)

These conditions can cause significant discomfort and impact daily activities. Understanding the differences between these two types of heel spurs is crucial for proper diagnosis and treatment.

Heel Spur Syndrome: When Plantar Fasciitis Leads to Bone Growth

Heel spur syndrome involves the formation of a bone spur at the bottom of the heel, on the sole of the foot. This condition is often associated with plantar fasciitis, a common foot ailment.

What causes heel spur syndrome?

Heel spurs develop as a bone’s response to stress from:

• Straining foot muscles and ligaments
• Over-stretching the plantar fascia
• Repeated tearing of the thin lining of the heel bone

The plantar fascia is a band of fibrous tissue that stretches along the bottom of the foot. When this tissue is repeatedly stressed or injured, it can lead to the formation of a bone spur where it connects to the heel bone.

Who is at risk for developing heel spurs?

Heel spurs are more common in:

• Athletes participating in sports involving running and jumping
• Older individuals
• People with obesity
• Those with osteoarthritis

Interestingly, not all heel spurs cause pain. In fact, only about 5% of people with heel spurs experience foot pain directly related to the spur itself.

Insertional Achilles Tendonitis: When Bone Spurs Affect the Achilles Tendon

Insertional Achilles tendonitis affects the back of the heel, where the Achilles tendon inserts into the heel bone. This condition is often associated with the development of dorsal spurs.

How does insertional Achilles tendonitis develop?

In this condition, a bone spur gradually forms around the area where the Achilles tendon attaches to the heel bone. This spur can irritate the tendon, potentially causing more damage and pain. Additionally, the inflamed or damaged portion of the Achilles tendon may calcify or harden over time.

What are the risk factors for insertional Achilles tendonitis?

This condition is associated with:

• Decreased ankle range of motion
• Increasing age (often affecting people in their 40s, 50s, or 60s)
• Activities involving jumping and running
• Negotiating stairs

Unlike acute injuries, insertional Achilles tendonitis usually develops gradually and is not linked to a single incident or trauma.

The Formation of Bone Spurs: Understanding Enthesophytes

Bone spurs that develop with plantar fasciitis or Achilles tendonitis are sometimes referred to by their medical name: enthesophytes. These bony outgrowths form at the site where tendons or ligaments insert into bone.

Why do enthesophytes form?

Enthesophytes develop as a response to chronic stress or inflammation at the attachment site of tendons or ligaments. This process is the body’s attempt to strengthen the connection between soft tissue and bone, but it can sometimes lead to pain and reduced function.

Are bone spurs more common with age?

Yes, the likelihood of developing bone spurs increases with age. This is due to the cumulative effects of stress on the body’s tissues over time, as well as age-related changes in bone and soft tissue metabolism.

Diagnosing Heel Spurs and Associated Conditions

Proper diagnosis of heel spurs and related conditions is crucial for effective treatment. Healthcare providers use a combination of methods to diagnose these issues.

What diagnostic tools are used to identify heel spurs?

• Physical examination
• Patient history
• X-rays
• MRI (in some cases)

X-rays can reveal the presence of bone spurs, while MRI scans may be used to assess soft tissue damage and inflammation.

How can healthcare providers differentiate between heel spur syndrome and insertional Achilles tendonitis?

The location of pain is a key differentiator:

• Heel spur syndrome typically causes pain on the bottom of the heel
• Insertional Achilles tendonitis causes pain at the back of the heel

Additionally, the pattern of pain onset and aggravating factors can help distinguish between these conditions.

Treatment Options for Heel Spurs and Associated Pain

Treatment for heel spurs and related conditions often begins with conservative measures aimed at reducing pain and inflammation.

What are the common non-surgical treatments for heel spur syndrome?

• Rest and activity modification
• Ice therapy
• Stretching exercises
• Orthotic devices
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Physical therapy

How is insertional Achilles tendonitis typically managed?

Treatment for insertional Achilles tendonitis may include:

• Rest and activity modification
• Eccentric strengthening exercises
• Heel lifts or orthotic devices
• NSAIDs
• Physical therapy
• Extracorporeal shockwave therapy (in some cases)

In both conditions, surgery may be considered if conservative treatments fail to provide relief after several months.

Preventing Heel Spurs and Maintaining Foot Health

While not all heel spurs can be prevented, there are steps individuals can take to reduce their risk and maintain overall foot health.

What lifestyle changes can help prevent heel spurs?

• Maintaining a healthy weight
• Wearing supportive, well-fitting shoes
• Gradually increasing intensity in exercise routines
• Stretching before and after physical activities
• Using proper technique in sports and exercise

How can individuals with existing heel spurs manage their condition?

For those already diagnosed with heel spurs, management strategies include:

• Following prescribed treatment plans
• Using orthotic devices as recommended
• Modifying activities to reduce stress on the affected area
• Maintaining open communication with healthcare providers

By adopting these preventive measures and management strategies, individuals can reduce their risk of developing heel spurs or minimize the impact of existing conditions on their daily lives.

The Role of Biomechanics in Heel Spur Development

Understanding the biomechanics of the foot and ankle can provide insight into why some individuals are more prone to developing heel spurs than others.

How do foot mechanics contribute to heel spur formation?

Certain foot types and gait patterns can increase the stress on the plantar fascia and Achilles tendon, potentially leading to bone spur formation. These include:

• Flat feet (pes planus)
• High arches (pes cavus)
• Overpronation
• Supination

Identifying and addressing these biomechanical issues through proper footwear, orthotics, or gait retraining can help reduce the risk of heel spur development.

Can improving foot biomechanics alleviate existing heel spur pain?

Yes, in many cases, addressing biomechanical issues can help reduce pain associated with heel spurs. This may involve:

• Custom orthotics to provide proper support
• Footwear modifications
• Gait analysis and retraining
• Strengthening and stretching exercises targeting specific muscle imbalances

Working with a podiatrist or physical therapist can help individuals develop a personalized plan to improve foot biomechanics and reduce heel spur-related discomfort.

Advanced Treatment Options for Persistent Heel Spur Pain

When conservative treatments fail to provide adequate relief, healthcare providers may consider more advanced interventions for heel spur-related pain.

What are some advanced non-surgical treatments for heel spurs?

• Extracorporeal shock wave therapy (ESWT)
• Platelet-rich plasma (PRP) injections
• Radiofrequency ablation
• Low-level laser therapy

These treatments aim to promote healing, reduce inflammation, and alleviate pain without the need for surgery.

When is surgery considered for heel spurs?

Surgery may be recommended if:

• Conservative treatments have been ineffective after 6-12 months
• Pain significantly impacts daily activities and quality of life
• There is evidence of significant tendon damage or degeneration

Surgical options may include removal of the bone spur, plantar fascia release, or Achilles tendon debridement and repair, depending on the specific condition and its severity.

The Impact of Heel Spurs on Athletic Performance and Daily Life

Heel spurs and associated conditions can significantly affect an individual’s ability to participate in sports and perform daily activities.

How do heel spurs affect athletic performance?

Athletes with heel spurs may experience:

• Reduced speed and agility
• Difficulty with explosive movements
• Altered running or jumping mechanics
• Increased risk of compensatory injuries

Proper management and treatment are crucial for athletes to maintain their performance levels and prevent long-term complications.

What impact can heel spurs have on daily activities?

In everyday life, individuals with heel spurs may face challenges such as:

• Difficulty walking or standing for extended periods
• Pain when first getting out of bed in the morning
• Limitations in shoe choices
• Reduced ability to participate in recreational activities

Addressing heel spur-related pain and discomfort is essential for maintaining overall quality of life and daily function.

The Future of Heel Spur Treatment: Emerging Therapies and Research

As our understanding of heel spurs and related conditions evolves, new treatment options and management strategies continue to emerge.

What are some promising areas of research in heel spur treatment?

• Regenerative medicine techniques, such as stem cell therapy
• Advanced imaging technologies for more precise diagnosis
• Personalized treatment approaches based on genetic and biomechanical factors
• Novel drug delivery systems for targeted pain relief

These areas of research hold potential for improving outcomes and reducing recovery times for individuals with heel spurs.

How might future treatments change the management of heel spurs?

Future advancements may lead to:

• More effective non-invasive treatment options
• Improved surgical techniques with faster recovery times
• Better prevention strategies based on individual risk factors
• Enhanced understanding of the underlying causes of bone spur formation

As research progresses, individuals with heel spurs may have access to more targeted and effective treatment options, potentially reducing the need for invasive interventions and improving overall outcomes.

The 2 Common Types of Heel Spurs

Bone spurs can develop on almost any bone, including the heel, and sometimes produce pain and other symptoms. Two painful heel conditions are associated with the formation of bone spurs:

• Heel spur syndrome involves the formation of a bone spur at the bottom of the heel, on the sole of the foot. People who have a common foot condition called plantar fasciitis can develop these spurs, which are often referred to as heel spurs or calcaneal spurs.
• Insertional Achilles tendonitis can be associated with bone spurs at the back of the heel, where the Achilles tendon inserts into the bone.

Two painful heel conditions are associated with the formation of bone spurs. Dorsal spurs are commonly related to insertional Achilles tendonitis, and plantar spurs are normally associated with heel spur syndrome.

Bone spurs that develop with plantar fasciitis or Achilles tendonitis are sometimes called by their medical name, enthesophytes.

See Plantar Fasciitis Diagnosis

Bone spurs are common, and the likelihood of developing them increases with age.

¹
Bone Spur. Reed Group MD Guidelines website. http://www.mdguidelines.com/bone-spur Accessed July 8, 2016.

See What Is a Bone Spur?

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Heel Spur Syndrome

Plantar spurs are hook-like and are normally associated with heel spur syndrome.

Heel spur syndrome is a condition associated with heel spurs, bony protrusions that grow on the bottom of the heel. A heel spur forms where the plantar fascia—band of fibrous tissue stretching along the bottom of the foot—connects to the heel bone. The spur grows in the direction of the plantar fascia and often forms a hook-like shape.

See Is Heel Pain Caused by Heel Spurs or Plantar Fasciitis?

Heel spurs develop as a bone’s response to stress from:

• Straining foot muscles and ligaments
• Over-stretching the plantar fascia
• Repeated tearing of the thin lining of the heel bone

There is good news as it relates to these heel spurs. The vast majority of heel spurs usually do not cause pain. In fact, only 5% of people with heel spurs have foot pain.

²
Plantar Fasciitis and Bone Spurs. American Academy of Orthopedic Surgeons website. http://orthoinfo.aaos.org/topic.cfm?topic=A00149&webid=23D4 Last reviewed June 2010. Accessed July 8, 2016.
Heel spurs often occur in athletes participating in sports involving running and jumping. They are also associated with age, obesity, and osteoarthritis.

See Common Running Injuries: Foot Pain

Insertional Achilles Tendonitis

Dorsal spurs are commonly related to insertional Achilles tendonitis.

Insertional Achilles tendonitis affects the back of the heel, where the Achilles tendon inserts into the heel bone. The bone spur gradually develops around the tendon where it inserts into (attaches to) the bone.

See Achilles Tendonitis and Tendon Injuries

The bone spur can irritate the Achilles tendon, potentially causing more tendon damage and pain. In addition, the inflamed and/or damaged portion of the Achilles tendon can calcify, or harden.

See Causes and Risk Factors for Achilles Tendon Damage

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Insertional Achilles tendonitis is associated with decreased ankle range of motion and increasing age—people who are affected are often in their 40s, 50s, or 60s.

³
Insertional Achilles Tendinitis. American Orthopaedic Foot & Ankle Society.https://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Insertional-Achilles-Tendinitis.aspx Accessed May 6, 2016.
Achilles tendonitis usually develops gradually and is not linked with a single incident or trauma. Jumping and running can exacerbate this condition, along with negotiating stairs, making inflammation and heel pain worse.

See Diagnosing Achilles Pain

Insertional Achilles tendonitis is different than non-insertional Achilles tendonitis, which causes pain in the lower calf, where the Achilles tendon and calf muscle meet.

See Achilles Tendon Conditions Signs and Symptoms

Dr. Phillip Walton, Jr. is an orthopedic surgeon specializing in foot and ankle injuries and general orthopedics. He practices with Resurgens Orthopaedics and has several years of experience performing adult reconstruction of the foot and ankle, as well as total ankle replacement surgery.

• 1
  Bone Spur. Reed Group MD Guidelines website. http://www.mdguidelines.com/bone-spur Accessed July 8, 2016.
• 2
  Plantar Fasciitis and Bone Spurs. American Academy of Orthopedic Surgeons website. http://orthoinfo.aaos.org/topic.cfm?topic=A00149&webid=23D4 Last reviewed June 2010. Accessed July 8, 2016.
• 3
  Insertional Achilles Tendinitis. American Orthopaedic Foot & Ankle Society.https://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Insertional-Achilles-Tendinitis. aspx Accessed May 6, 2016.

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Editor’s Top Picks

• Plantar Fasciitis: Initial Treatment Options

• Treating a Painful Achilles Tendon

• Common Running Injuries: Pain in the Ankle or Back of the Heel

• Plantar Fasciitis: Injections and Prolotherapy

• Injections and Surgery to Treat Achilles Pain

• Nonsurgical, Surgical, and Minimally Invasive Treatment Options for Plantar Fasciitis

When Heel Pain Is Caused by Bone Spurs

Like some other tissues in the body, bones can regenerate themselves and develop new growth. Unfortunately, sometimes the new growth comes in the form of an irregular protrusion on the bone known as a spur.

See What Is a Bone Spur?

Plantar fasciitis and heel spur syndrome can both be treated through physical therapy. See Plantar Fasciitis: Initial Treatment Options

Bone spurs are frequently harmless and often go undetected. But if they impinge on nearby soft tissues like tendons or ligaments, they can cause pain and immobility.

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Bone spurs can occur at many sites in the body, but there are two common sites in the heel where spurs can cause pain and interfere with your ability to do activities that involve running and jumping.

See The 2 Common Types of Heel Spurs

This guide explains the causes and symptoms of both types of heel spur:

Pain on the bottom of the heel toward the front (just behind the arch) may be the result of heel spur syndrome. This occurs when a bone spur forms at the spot where the plantar fascia, a fibrous band that runs down the sole of the foot, inserts into the heel bone.

See Is Heel Pain Caused by Heel Spurs or Plantar Fasciitis?

But the heel pain may not be caused by the bone spur. In fact, it’s much more likely the pain is the result of injury or inflammation in the planta fascia itself: plantar fasciitis. Even if imaging results reveal the presence of a bone spur, it’s probably not responsible for the pain.

See Plantar Fasciitis Symptoms

But whether the pain was caused by bone spur syndrome or plantar fasciitis, both have similar initial treatment recommendations: resting, changing footwear, and stretching the calf and plantar fascia.

See Plantar Fasciitis: Initial Treatment Options

Pain on the back of the heel

Another spot that’s susceptible to the growth of bone spurs is at the top and back of the heel, where the heel bone connects with the Achilles tendon.

See Achilles Tendon Conditions Signs and Symptoms

A bone spur in this location can irritate the Achilles tendon, causing pain and inflammation—this is known as insertional Achilles tendonitis. It usually develops over time and is more likely to affect people in their 40s, 50s, or 60s.

See Common Running Injuries: Pain in the Ankle or Back of the Heel

Insertional Achilles tendonitis is different than regular Achilles tendonitis, which causes pain higher up, at the bottom of the calf.

See Diagnosing Achilles Pain

Bone spurs can be treated nonsurgically and surgically, but the first step is to treat the inflamed structure (like the plantar fascia or Achilles tendon) that triggered the spur in the first place.

Learn more:

Achilles Tendonitis and Tendon Injuries

Plantar Fasciitis Risk Factors

Carrie DeVries worked as the content marketing manager at Veritas Health. Carrie combined a background of writing and editing, marketing, and patient education to best serve the consumers, patients, and physicians who rely the Veritas Health sites for information.

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Editor’s Top Picks

• What Is a Bone Spur?

• Achilles Tendon Conditions Signs and Symptoms

• What Is Plantar Fasciitis?

• Is Heel Pain Caused by Heel Spurs or Plantar Fasciitis?

• Treating a Painful Achilles Tendon

• Diagnosing Achilles Pain

Posterior Calcaneal Spur / Insertional Tendylopathy / Bursitis – MD Erich H.

Rembeck

	Achilles tendon rupture Achilles Tendon Sprain tendinosis Rear heel spur Partial Achilles tendon rupture / chronic tenosynovitis / tendinosis General A particular form of chronic microtrauma to the Achilles tendon is the posterior heel spur, often referred to as Haglund’s deformity. In this case, the bony growth on the back of the heel bone presses on the Achilles tendon and on the bursa (retrocalcaneal bursa), resulting in inflammation of both the tendon itself (tendinitis) and the bursa (retrocalneal bursitis). If the disease is in its initial form, then it is advisable to start with conservative ones, i.e. non-surgical measures, eg. with physiotherapy. The main objective of these activities is to relieve pain by unloading the problem area and relieving inflammation. In more severe cases, due to the pressure of the growth on the bag and tendon, their inflammation and swelling occurs, which later leads to gluing at the point of attachment of the Achilles tendon to the calcaneal tuberosity. The disease develops due to constant friction between the mucous bag and the calcaneus, which in turn leads to a visible increase in the heel and deterioration of the deformity process. In the final stage of the disease, the growth on the bone presses on the tendon and on the bag and leads to their swelling, so that walking without pain becomes simply impossible. Only surgical treatment can help in this case. Surgical treatment In very complex cases, it is necessary to resort to a surgical intervention that includes several stages. First, the altered cicatricial transformations of the tissues around the tendon are removed, then the inflamed mucous bag is excised and the calcaneus is reduced, causing internal overpressure. In case of significant changes in the Achilles tendon at the place of attachment to the calcaneus, in isolated cases, the removal of the tendon is required and then its reattachment / fixation with a special screw-anchor with the formation of a suture. If the tendon is not completely removed, then postoperative treatment includes a period of immobilization of up to 2 weeks by applying a plaster splint to the lower leg in a position of slight plantar flexion at an angle of about 15 °. Then the position of the foot is changed up to 0°. After this period, you can switch from wearing a plaster splint to wearing a removable orthosis (Vacuped boots) for a period of about 4 weeks, with which an increase in motor activity with partial load up to 20 kg is allowed. Participation in sports activities is recommended no earlier than 12 weeks after the operation. If fixation of the tendon in the bone was to be performed using double thread anchors, then postoperative treatment is carried out by analogy with that recommended after a complete rupture of the Achilles tendon. International Specialized Center for Orthopedic Surgery, arthroscopy, sports traumatology and rehabilitation Arabellastr. 17 D-81925 Munich Germany Tel: +49. 89. 92 333 94-0 Fax: +49. 89. 92 333 94-29 Diese E-Mail Address ist gegen Spam-Bots geschützt, Sie müssen Javascript aktivieren, damit Sie sie sehen können. RUSSIAN PATIENT OFFICE: Mail: Diese E-Mail-Adresse ist gegen Spam-Bots geschützt, Sie müssen Javascript aktivieren, damit Sie sie sehen können. Dr. Erich. H. Rembek Impressions from the ER Sports Orthopedics Center in Arabellapark >> to the photo gallery Dr. med. Erich H. Rembeck Orthopäden in München
	© 2021 – Dr. med. Erich H. Rembeck – Zentrum für Orthopädie, Sportmedizin und Rehabilitation – Imprint

Heel spur, causes, symptoms, treatment

Heel spur is a bony growth in the plantar surface of the calcaneus. Its appearance is associated with constant irritation of the place of attachment to the heel bone of the plantar aponeurosis. This irritation usually occurs with increased physical exertion on the foot.

The main cause of the formation of bone outgrowth in the area of ​​the calcaneus is the constant irritation of the place of attachment to the bone of the tendons or ligaments, in particular, the plantar aponeurosis. As a result of constant irritation in this area, inflammation occurs. That is what is causing the pain. Gradually, the place of attachment of the inflamed ligament or aponeurosis undergoes “calcification” – that is, as if “impregnated” with calcium salts. In this period, when radiography of the foot, you can see the shadow of the bone growth – osteophyte .

Major risk factors for heel spurs :

• Age over 40 years.
• Comorbidities in the joints of the foot, such as osteoarthritis or rheumatoid arthritis.
• Violation of blood microcirculation in the foot.
• Other degenerative diseases.

Symptoms of a heel spur

Symptoms of a heel spur do not appear immediately after the formation of a bone growth. Due to the proximity of the tendons, a heel spur can cause constant pain in the foot. Heel spur pain is described as similar to toothache.

It should be noted that the pain of a heel spur is not due to the pressure of body weight on the spur itself, but due to inflammation of the soft tissues around the spur. The pressure of these inflamed tissues, for example, when stepping on the heel, leads to sharp pains. Usually, pain most often occurs at the very beginning of walking. This is explained as follows. At rest, the nerves and capillaries in the area of ​​the inflamed tissue, as it were, adapt to the rest of the foot. However, with a sharp start of movement, the vessels and nerves do not have time to adapt to new conditions. As a result, pain occurs.

Diagnosis

Performed by routine inspection and feel of the sole and heel. At the same time, the most painful point is located. The spur itself is usually not palpable, however, due to chronic inflammation of the soft tissues, their compaction can develop, which can be felt.

X-ray of the foot allows to clarify the diagnosis. In this case, the bone growth is visible on the x-ray.

Heel spur treatment

Treatment of a heel spur often is carried out conservatively and is aimed at three main points:

• Elimination of inflammation of the soft tissues around the spur;
• Prevention of inflammation;
• Elimination of the heel spur itself.

Patients come to the Orthopedics and Sports Injury Clinic of the Zaporozhye Regional Hospital with different problems, but with the same goal – to move freely again without pain and enjoy life. Natalya Borisovna from the Tokmak region was deprived of this happiness by a heel spur.

A woman says that she has suffered from heel spurs for years. I tried to defeat inflammation with the help of physiotherapy, all kinds of medicines and folk remedies, but they did not solve the problem, but only dulled the pain in the joint. Own house in the village, household, work – it became more and more difficult to live in the same rhythm. One day, Natalia Borisovna was suggested to go to Orthopedics and Sports Injury Clinic , one of the best in Ukraine.

After consultation, the diagnosis of heel spur » was confirmed – the bone growth was clearly visible on the x-ray. At the appointment, the specialists of the clinic explained to the woman that the methods she had hoped for were effective only at the very beginning of the disease. And since Natalya Borisovna’s heel spur has been preventing her from living a normal life for years, the operation was the only right decision. Moreover, it was by no means impossible to delay the intervention.

“The patient needed to have her spur removed as soon as possible. She was at high risk of tearing her Achilles tendon where it attaches to her calcaneus. If we had not carried out the treatment, the growths would have become more and more. Therefore, in order to prevent a complex and risky operation to restore the Achilles tendon, we decided not to waste time and remove the spur,” comments Ivan Zabelin, head of the Orthopedics and Sports Injury Clinic.

Rengen-pred to surgery an X-ray of the foot after surgery

during the intervention of the orthopedist of the clinic using low-traumatic techniques removed the resulting growth, so now nothing will prevent Natalia Borisovna from moving normally. The patient is now feeling much better and is already planning treatment for a heel spur on her second leg.