What are the two common types of heel bone spurs. How do heel spurs develop and cause pain. What are the symptoms and risk factors for heel spur syndrome and insertional Achilles tendonitis. What treatment options are available for heel bone spurs.

Understanding Heel Bone Spurs: Plantar and Dorsal Types

Heel bone spurs are bony protrusions that can develop on the heel bone, causing pain and discomfort for many individuals. There are two main types of heel spurs:

• Plantar spurs (associated with heel spur syndrome)
• Dorsal spurs (associated with insertional Achilles tendonitis)

These bony growths, also known as enthesophytes, form in response to stress and strain on the foot. While bone spurs can develop on various bones in the body, they are particularly common in the heel area due to the constant pressure and impact experienced during daily activities.

Heel Spur Syndrome: Causes and Symptoms

Heel spur syndrome is characterized by the formation of a bone spur at the bottom of the heel, on the sole of the foot. This condition is closely related to plantar fasciitis, a common foot ailment affecting the plantar fascia—a band of fibrous tissue that runs along the bottom of the foot.

What causes heel spur syndrome?

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

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

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. This suggests that the pain associated with heel spur syndrome may be more closely linked to the underlying plantar fasciitis rather than the spur itself.

Who is at risk for developing heel spurs?

Several factors can increase the likelihood of developing heel spurs:

• Age (risk increases with advancing years)
• Obesity
• Osteoarthritis
• Participation in high-impact sports (especially running and jumping)

Insertional Achilles Tendonitis: When Dorsal Spurs Cause Problems

Insertional Achilles tendonitis affects the back of the heel, where the Achilles tendon attaches to the heel bone. This condition is often associated with the development of dorsal spurs, which can irritate the Achilles tendon and potentially cause further damage and pain.

How does insertional Achilles tendonitis develop?

Unlike acute injuries, insertional Achilles tendonitis typically develops gradually over time. It is not usually linked to a single incident or trauma. The condition can be exacerbated by activities that put stress on the Achilles tendon, such as:

• Jumping
• Running
• Climbing stairs

As the condition progresses, the inflamed or damaged portion of the Achilles tendon may calcify or harden, further contributing to pain and reduced mobility.

Who is most at risk for insertional Achilles tendonitis?

This condition is most commonly seen in:

• Individuals in their 40s, 50s, or 60s
• People with decreased ankle range of motion
• Athletes participating in high-impact sports

Diagnosis and Differentiation of Heel Spur Conditions

Accurately diagnosing heel spur syndrome and insertional Achilles tendonitis is crucial for effective treatment. While both conditions involve bone spurs, they affect different areas of the heel and require distinct approaches to management.

How are heel spurs diagnosed?

Diagnosis typically involves:

1. Physical examination
2. Patient history
3. Imaging studies (X-rays, MRI)

X-rays can reveal the presence and size of bone spurs, while MRI scans can provide detailed images of soft tissue damage, such as plantar fascia inflammation or Achilles tendon degeneration.

What distinguishes insertional Achilles tendonitis from other forms of Achilles tendon pain?

It’s important to differentiate insertional Achilles tendonitis from non-insertional Achilles tendonitis, which affects the tendon higher up in the lower calf. The key differences include:

• Location of pain (back of heel vs. lower calf)
• Presence of bone spurs at the tendon insertion point
• Age of onset (typically older for insertional tendonitis)

Treatment Options for Heel Bone Spurs

Treatment for heel bone spurs aims to address both the bony protrusion and the underlying soft tissue inflammation. The approach may vary depending on whether the condition is heel spur syndrome or insertional Achilles tendonitis.

What are the non-surgical treatment options for heel spurs?

Conservative treatments are often the first line of defense and may include:

• Rest and activity modification
• Ice therapy to reduce inflammation
• Stretching exercises for the plantar fascia and Achilles tendon
• Orthotic devices or shoe inserts to provide support
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Physical therapy
• Extracorporeal shock wave therapy (ESWT)

When is surgery considered for heel bone spurs?

Surgical intervention may be recommended if conservative treatments fail to provide relief after several months. Surgical options can include:

• Removal of the bone spur
• Plantar fascia release (for heel spur syndrome)
• Achilles tendon debridement or repair (for insertional Achilles tendonitis)

It’s important to note that surgery is typically considered a last resort due to potential complications and extended recovery time.

Prevention Strategies for Heel Bone Spurs

While it’s not always possible to prevent heel bone spurs, certain measures can reduce the risk of their development or minimize associated pain.

How can you reduce the risk of developing heel spurs?

Preventive strategies include:

• Maintaining a healthy weight to reduce stress on feet
• Wearing properly fitting, supportive shoes
• Gradually increasing intensity in exercise routines
• Performing regular stretching exercises for feet and calves
• Using shock-absorbing insoles or orthotics
• Avoiding prolonged periods of standing on hard surfaces

What role does footwear play in preventing heel spurs?

Proper footwear is crucial in preventing heel spurs and managing associated conditions. Key features to look for in shoes include:

• Adequate arch support
• Cushioned heel area
• Proper fit with enough room in the toe box
• Shock-absorbing soles

For those with existing heel spurs, custom orthotics or specialized shoes may be recommended by a podiatrist or orthopedic specialist.

Living with Heel Bone Spurs: Lifestyle Adjustments and Management

For individuals diagnosed with heel bone spurs, making certain lifestyle adjustments can significantly improve comfort and mobility.

What daily habits can help manage heel spur pain?

Incorporating the following practices into your routine can help alleviate discomfort:

• Performing foot and calf stretches upon waking and throughout the day
• Using a frozen water bottle to roll under the foot for pain relief
• Taking breaks during prolonged standing or walking
• Maintaining good posture to distribute weight evenly
• Avoiding walking barefoot, especially on hard surfaces

How can exercise routines be modified for those with heel spurs?

Adapting your exercise regimen is crucial for managing heel spur pain while staying active:

• Opt for low-impact activities like swimming or cycling
• Use proper warm-up and cool-down techniques
• Gradually increase exercise intensity and duration
• Incorporate strength training for foot and ankle muscles
• Consider working with a physical therapist to develop a tailored exercise plan

By making these adjustments, many individuals with heel bone spurs can maintain an active lifestyle while minimizing pain and discomfort.

Advanced Treatments and Future Directions in Heel Spur Management

As medical science advances, new treatments for heel bone spurs continue to emerge, offering hope for those who have not found relief through traditional methods.

What innovative treatments are being explored for heel spurs?

Cutting-edge therapies currently under investigation or in limited use include:

• Platelet-rich plasma (PRP) injections
• Stem cell therapy
• Low-level laser therapy
• Ultrasound-guided percutaneous needle tenotomy
• Minimally invasive surgical techniques

While these treatments show promise, more research is needed to fully establish their efficacy and long-term outcomes.

How might future developments impact heel spur treatment?

Ongoing research in biomechanics, materials science, and regenerative medicine may lead to:

• Advanced imaging techniques for earlier detection and more precise treatment
• Personalized orthotics using 3D printing technology
• Targeted drug delivery systems to reduce inflammation
• Gene therapy to promote tendon and ligament healing

As our understanding of heel spur formation and associated conditions improves, treatment approaches are likely to become more tailored and effective, potentially reducing the need for invasive interventions.

In conclusion, heel bone spurs, whether associated with heel spur syndrome or insertional Achilles tendonitis, can significantly impact quality of life. However, with proper diagnosis, a range of treatment options, and ongoing research, many individuals can find relief and maintain an active lifestyle. If you’re experiencing persistent heel pain, consult with a healthcare professional to determine the best course of action for your specific situation.

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.