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 bone spurs. How are heel bone spurs diagnosed and treated effectively.

Understanding Heel Bone Spurs: Plantar and Achilles Varieties

Heel bone spurs are bony protrusions that can develop on the heel bone, often causing pain and discomfort for those affected. There are two primary types of heel bone spurs, each associated with different conditions and areas of the foot:

• Plantar heel spurs (heel spur syndrome)
• Achilles heel spurs (insertional Achilles tendonitis)

These bone growths, medically known as enthesophytes, typically form as the body’s response to ongoing stress or strain on the affected area. While bone spurs can develop on various bones throughout the body, heel spurs are particularly common and can significantly impact a person’s mobility and quality of life.

Plantar Heel Spurs: Causes and Characteristics

Plantar heel spurs, also referred to as heel spur syndrome, involve the formation of a bone spur at the bottom of the heel, on the sole of the foot. These spurs are often associated with plantar fasciitis, a common foot condition characterized by inflammation of the plantar fascia.

What causes plantar heel spurs to develop?

Plantar heel spurs typically form due to:

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

The spur grows in the direction of the plantar fascia, often forming a distinctive hook-like shape. Interestingly, while heel spurs are common, they don’t always cause pain. In fact, studies suggest that only about 5% of people with heel spurs experience foot pain directly related to the spur.

Who is at risk for developing plantar heel spurs?

Several factors can increase the likelihood of developing plantar heel spurs:

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

Achilles Heel Spurs: Understanding Insertional Achilles Tendonitis

Achilles heel spurs, often associated with insertional Achilles tendonitis, affect the back of the heel where the Achilles tendon attaches to the heel bone. Unlike plantar heel spurs, these bone growths develop around the tendon insertion point.

How do Achilles heel spurs form and cause pain?

The formation of Achilles heel spurs is a gradual process:

1. The bone spur develops slowly around the tendon insertion point
2. The spur can irritate the Achilles tendon, potentially leading to further damage
3. Inflammation and damage to the Achilles tendon may cause the affected portion to calcify or harden

This condition typically develops over time and is not usually linked to a single traumatic event. Activities such as jumping, running, and climbing stairs can exacerbate the condition, intensifying inflammation and heel pain.

What are the risk factors for insertional Achilles tendonitis?

Several factors contribute to the development of insertional Achilles tendonitis:

• Decreased ankle range of motion
• Advancing age (most common in individuals in their 40s, 50s, or 60s)
• Repetitive high-impact activities

Differentiating Between Types of Achilles Tendonitis

It’s important to distinguish between insertional Achilles tendonitis and non-insertional Achilles tendonitis:

• Insertional Achilles tendonitis affects the point where the tendon attaches to the heel bone
• Non-insertional Achilles tendonitis causes pain in the lower calf, where the Achilles tendon and calf muscle meet

Understanding this distinction is crucial for accurate diagnosis and effective treatment.

Diagnosis and Evaluation of Heel Bone Spurs

Proper diagnosis of heel bone spurs is essential for developing an effective treatment plan. Healthcare providers typically use a combination of methods to diagnose heel spurs and associated conditions:

How are heel bone spurs diagnosed?

1. Physical examination: The doctor will inspect the foot and ankle, checking for areas of tenderness, swelling, and reduced range of motion.
2. Patient history: Information about symptoms, activity levels, and previous injuries can provide valuable context.
3. Imaging studies: X-rays are commonly used to visualize bone spurs. In some cases, MRI or ultrasound may be employed for a more detailed view of soft tissues.

It’s worth noting that the presence of a bone spur on an X-ray doesn’t necessarily indicate that it’s the source of pain. Many people have asymptomatic bone spurs, so correlation with clinical symptoms is crucial.

Treatment Options for Heel Bone Spurs

Treatment for heel bone spurs often focuses on addressing the underlying condition (plantar fasciitis or Achilles tendonitis) rather than the spur itself. Conservative treatments are typically the first line of defense:

What are the non-surgical treatments for heel bone spurs?

• Rest and activity modification
• Ice therapy to reduce inflammation
• Stretching exercises for the plantar fascia and Achilles tendon
• Orthotic devices or supportive footwear
• Physical therapy
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroid injections (used judiciously due to potential side effects)

In most cases, these conservative measures are sufficient to alleviate symptoms and improve function.

When is surgery considered for heel bone spurs?

Surgical intervention is typically reserved for cases where conservative treatments have failed to provide relief after several months. Surgical options may include:

• Plantar fascia release
• Removal of the bone spur
• Repair or reconstruction of the Achilles tendon

The specific surgical approach will depend on the individual case and the surgeon’s recommendation.

Prevention Strategies for Heel Bone Spurs

While it’s not always possible to prevent heel bone spurs, certain strategies can help reduce the risk of developing these painful conditions:

How can one reduce the risk of developing heel bone spurs?

• Maintain a healthy weight to reduce stress on the feet
• Choose supportive, well-fitting footwear
• Gradually increase intensity when starting new exercise routines
• Incorporate regular stretching exercises for the feet and ankles
• Use proper technique during high-impact activities
• Address any biomechanical issues with orthotics or physical therapy

By implementing these preventive measures, individuals can potentially reduce their risk of developing painful heel bone spurs and associated conditions.

Living with Heel Bone Spurs: Management and Adaptation

For those diagnosed with heel bone spurs, learning to manage the condition effectively is key to maintaining quality of life and staying active. Here are some strategies for living with heel bone spurs:

How can individuals effectively manage heel bone spur pain?

• Adhere to prescribed treatment plans and follow-up with healthcare providers
• Modify activities to reduce stress on the affected area
• Use cushioned insoles or orthotic devices to provide support
• Perform regular stretching and strengthening exercises as recommended
• Apply ice after activities to reduce inflammation
• Consider low-impact exercises like swimming or cycling to maintain fitness

With proper management and adaptation, many individuals with heel bone spurs can continue to lead active, fulfilling lives while minimizing pain and discomfort.

The Role of Podiatrists and Orthopedic Specialists

When dealing with heel bone spurs and associated conditions, seeking care from a qualified healthcare professional is crucial. Podiatrists and orthopedic specialists play a vital role in diagnosing, treating, and managing these conditions.

Why is specialized care important for heel bone spurs?

Specialized care offers several advantages:

• Accurate diagnosis through expertise and advanced imaging techniques
• Customized treatment plans tailored to individual needs
• Access to the latest treatment options and technologies
• Comprehensive approach addressing both symptoms and underlying causes
• Guidance on prevention and long-term management strategies

By working closely with a podiatrist or orthopedic specialist, patients can ensure they receive the most appropriate and effective care for their heel bone spurs.

Understanding the types, causes, and treatment options for heel bone spurs is essential for anyone experiencing heel pain or at risk of developing these conditions. By recognizing the symptoms early and seeking appropriate care, individuals can take proactive steps to manage their foot health and maintain an active lifestyle. Remember, while heel bone spurs can be painful and frustrating, with proper diagnosis and treatment, most people can find relief and return to their normal activities.

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.