What are the two common types of heel spurs. How do heel spurs form and what causes them. Who is at risk for developing heel spurs. What are the symptoms of heel spurs and how are they diagnosed. What treatments are available for heel spurs.

The Two Main Types of Heel Spurs: Plantar and Dorsal

Heel spurs are bony growths that can develop on the heel bone, often causing pain and discomfort. There are two primary types of heel spurs:

1. Plantar spurs (heel spur syndrome)
2. Dorsal spurs (associated with insertional Achilles tendonitis)

Understanding the differences between these two types is crucial for proper diagnosis and treatment. Let’s explore each type in detail.

Plantar Spurs: The Culprit Behind Heel Spur Syndrome

Plantar spurs, also known as calcaneal spurs, are bony protrusions that grow on the bottom of the heel. They are often associated with a condition called heel spur syndrome.

Formation and Characteristics of Plantar Spurs

Plantar spurs typically form where the plantar fascia, a band of fibrous tissue along the bottom of the foot, connects to the heel bone. These spurs often develop a hook-like shape and grow in the direction of the plantar fascia.

Causes of Plantar Spurs

Plantar spurs develop as the body’s response to stress on the heel. Common causes include:

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

Who is at Risk for Plantar Spurs?

Certain factors can increase the likelihood of developing plantar spurs:

• Athletes participating in running and jumping sports
• Advancing age
• Obesity
• Osteoarthritis

Do plantar spurs always cause pain? Interestingly, only about 5% of people with heel spurs experience foot pain. This means that many individuals may have heel spurs without even realizing it.

Dorsal Spurs: Understanding Insertional Achilles Tendonitis

Dorsal spurs are bone growths that develop at the back of the heel, where the Achilles tendon inserts into the heel bone. These spurs are commonly associated with a condition called insertional Achilles tendonitis.

Formation and Characteristics of Dorsal Spurs

Dorsal spurs gradually develop around the Achilles tendon’s insertion point on the heel bone. As the spur grows, it can irritate the tendon, potentially causing more damage and pain.

Causes of Dorsal Spurs

The development of dorsal spurs is often linked to:

• Decreased ankle range of motion
• Advancing age (most common in people in their 40s, 50s, or 60s)
• Repetitive stress on the Achilles tendon

Symptoms of Insertional Achilles Tendonitis

Unlike acute injuries, insertional Achilles tendonitis usually develops gradually. Common symptoms include:

• Pain at the back of the heel
• Discomfort when walking or running
• Increased pain when climbing stairs
• Stiffness in the heel area

The Connection Between Heel Spurs and Other Foot Conditions

Heel spurs often develop in conjunction with other foot conditions. Understanding these relationships can help in proper diagnosis and treatment.

Plantar Fasciitis and Heel Spurs

Plantar fasciitis, a common cause of heel pain, is frequently associated with the development of heel spurs. However, it’s important to note that the pain is typically caused by the inflammation of the plantar fascia rather than the spur itself.

Achilles Tendonitis and Dorsal Spurs

Insertional Achilles tendonitis can lead to the formation of dorsal spurs. As the tendon becomes inflamed or damaged, it may calcify or harden, contributing to spur formation.

Are heel spurs always associated with these conditions? While there is a strong correlation, it’s possible to have heel spurs without experiencing plantar fasciitis or Achilles tendonitis, and vice versa.

Diagnosis of Heel Spurs: Identifying the Root Cause

Proper diagnosis of heel spurs is crucial for effective treatment. Healthcare providers use various methods to identify and assess heel spurs.

Physical Examination

A thorough physical examination is the first step in diagnosing heel spurs. The doctor will:

• Examine the foot for signs of swelling or tenderness
• Test the range of motion in the ankle and foot
• Assess the patient’s gait and posture

Imaging Tests

To confirm the presence of heel spurs and rule out other conditions, imaging tests may be ordered:

• X-rays: Can clearly show the presence and size of heel spurs
• MRI: Provides detailed images of soft tissues, helpful in diagnosing associated conditions like plantar fasciitis
• Ultrasound: Can reveal inflammation in the plantar fascia or Achilles tendon

How accurate are these diagnostic methods? While imaging tests are highly accurate in identifying heel spurs, it’s important to correlate these findings with the patient’s symptoms, as not all heel spurs cause pain or require treatment.

Treatment Options for Heel Spurs: From Conservative to Surgical

Treatment for heel spurs aims to alleviate pain and address the underlying causes. Options range from conservative approaches to surgical interventions.

Conservative Treatments

Most cases of heel spurs respond well to non-invasive treatments, including:

• Rest and ice therapy
• Stretching exercises for the plantar fascia and Achilles tendon
• Orthotic devices or shoe inserts
• Physical therapy
• Anti-inflammatory medications
• Corticosteroid injections

Advanced Treatments

For persistent cases, more advanced treatments may be considered:

• Extracorporeal shock wave therapy (ESWT)
• Platelet-rich plasma (PRP) injections
• Stem cell therapy

Surgical Options

Surgery is typically considered only when conservative treatments fail to provide relief. Surgical procedures may include:

• Plantar fascia release
• Heel spur removal
• Gastrocnemius recession (for tight calf muscles)

What is the success rate of heel spur treatments? Conservative treatments are effective in about 90% of cases. For those requiring surgery, success rates are generally high, with most patients experiencing significant pain relief and improved function.

Prevention Strategies: Keeping Heel Spurs at Bay

While not all heel spurs can be prevented, certain strategies can reduce the risk of developing them or minimize their impact.

Proper Footwear

Wearing appropriate shoes is crucial in preventing heel spurs:

• Choose shoes with good arch support and cushioning
• Replace worn-out shoes regularly
• Use orthotics or custom insoles if recommended by a healthcare provider

Maintaining a Healthy Weight

Excess weight puts additional stress on the feet. Maintaining a healthy weight can reduce the risk of developing heel spurs and alleviate symptoms if they do occur.

Regular Stretching and Exercise

Incorporating foot and calf stretches into your daily routine can help prevent heel spurs by:

• Improving flexibility in the plantar fascia and Achilles tendon
• Strengthening the muscles that support the foot and ankle
• Promoting better overall foot health

How effective are these prevention strategies? While they can significantly reduce the risk of developing heel spurs, it’s important to remember that some factors, such as age and certain medical conditions, are beyond our control.

Living with Heel Spurs: Management and Lifestyle Adjustments

For individuals diagnosed with heel spurs, making certain lifestyle adjustments can help manage symptoms and improve quality of life.

Activity Modification

Adapting your activities can help minimize stress on the affected heel:

• Reduce high-impact activities like running or jumping
• Opt for low-impact exercises such as swimming or cycling
• Use proper warm-up and cool-down techniques when exercising

Pain Management Techniques

In addition to medical treatments, various at-home techniques can help manage heel spur pain:

• Apply ice to the affected area for 15-20 minutes several times a day
• Use over-the-counter pain relievers as directed by a healthcare provider
• Practice gentle foot and calf stretches to alleviate tension

Long-term Care and Monitoring

Managing heel spurs often requires ongoing care and attention:

• Regular check-ups with a podiatrist or orthopedic specialist
• Consistent use of prescribed orthotics or supportive footwear
• Monitoring for changes in symptoms or the development of related conditions

Can heel spurs be completely cured? While heel spurs themselves cannot be reversed without surgery, their symptoms can often be effectively managed with proper treatment and lifestyle adjustments, allowing many individuals to live pain-free.

The Role of Technology in Heel Spur Treatment and Management

Advancements in medical technology have expanded the options for diagnosing, treating, and managing heel spurs.

3D Printing for Custom Orthotics

3D printing technology allows for the creation of highly customized orthotic devices:

• Precise fit based on individual foot scans
• Targeted support for specific areas of the foot
• Potential for faster production and lower costs

Wearable Devices for Gait Analysis

Smart insoles and other wearable devices can provide valuable data on foot mechanics:

• Real-time feedback on pressure distribution
• Identification of gait abnormalities that may contribute to heel spur formation
• Tracking of progress during treatment and rehabilitation

Telemedicine for Ongoing Care

Telemedicine platforms offer new ways for patients to access care and support:

• Remote consultations with foot and ankle specialists
• Virtual physical therapy sessions
• Easy access to educational resources and support groups

How are these technological advancements changing the landscape of heel spur treatment? By providing more personalized, data-driven approaches to care, these innovations are helping to improve treatment outcomes and patient experiences.

Understanding the Economic Impact of Heel Spurs

Heel spurs and related foot conditions can have significant economic implications, both for individuals and society as a whole.

Direct Medical Costs

The treatment of heel spurs involves various direct medical expenses:

• Doctor visits and specialist consultations
• Diagnostic tests such as X-rays and MRIs
• Medications and injections
• Physical therapy sessions
• Surgical procedures in severe cases

Indirect Costs

Beyond medical expenses, heel spurs can lead to indirect costs:

• Lost productivity due to missed work days
• Reduced work efficiency due to pain and discomfort
• Potential career limitations in physically demanding jobs

Long-term Economic Considerations

The long-term economic impact of heel spurs can be substantial:

• Ongoing expenses for orthotics and supportive footwear
• Potential need for lifestyle modifications or career changes
• Costs associated with managing related conditions like plantar fasciitis

What is the overall economic burden of heel spurs and related foot conditions? While exact figures vary, studies suggest that foot and ankle conditions, including heel spurs, contribute significantly to healthcare costs and lost productivity, highlighting the importance of effective prevention and treatment strategies.

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.