What are the two common types of heel spurs. How do heel spurs develop and affect foot health. What are the symptoms and risk factors associated with heel spurs. How can heel spurs be diagnosed and treated effectively.

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

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

Heel Spur Syndrome: Understanding Plantar Spurs

Heel spur syndrome is a condition characterized by the formation of a bone spur on the bottom of the heel. These spurs, also known as plantar spurs or calcaneal spurs, typically develop where the plantar fascia connects to the heel bone.

What causes plantar spurs to form?

Plantar spurs develop as the body’s response to 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 plantar spurs cause pain. In fact, only about 5% of people with heel spurs experience foot pain related to the spur itself.

Who is at risk for developing plantar spurs?

Several factors can increase the likelihood of developing plantar spurs:

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

Insertional Achilles Tendonitis: The Role of Dorsal Spurs

Dorsal spurs are commonly associated with insertional Achilles tendonitis, a condition affecting the back of the heel where the Achilles tendon attaches to the heel bone.

How do dorsal spurs develop?

Dorsal spurs gradually form around the Achilles tendon insertion point. As the spur grows, it can irritate the tendon, potentially leading to further damage and pain. In some cases, the inflamed or damaged portion of the Achilles tendon may calcify, exacerbating the problem.

What are the risk factors for insertional Achilles tendonitis?

Several factors can contribute to the development of insertional Achilles tendonitis and associated dorsal spurs:

• Decreased ankle range of motion
• Advancing age (typically affecting people in their 40s, 50s, or 60s)
• Repetitive jumping and running activities
• Frequent stair climbing

Unlike acute injuries, insertional Achilles tendonitis usually develops gradually over time.

Diagnosing Heel Spurs: Symptoms and Medical Evaluation

Proper diagnosis of heel spurs is essential for effective treatment. While the presence of a heel spur doesn’t always correlate with pain, certain symptoms may indicate the need for medical evaluation.

What are the common symptoms of heel spurs?

Symptoms can vary depending on the type and location of the heel spur:

• Sharp pain in the heel, especially when first standing up in the morning
• Dull ache or throbbing in the heel throughout the day
• Pain that worsens with activity or prolonged standing
• Tenderness and swelling at the back of the heel (for dorsal spurs)

How are heel spurs diagnosed?

Diagnosis typically involves a combination of methods:

1. Physical examination: A doctor will assess the foot’s structure and function.
2. Medical history: Information about symptoms, activity levels, and past injuries is collected.
3. Imaging tests: X-rays or MRI scans may be used to confirm the presence of heel spurs and assess associated soft tissue damage.

Treatment Options for Heel Spurs: Conservative and Surgical Approaches

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

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

Conservative treatments are often the first line of defense:

• Rest and ice: Reducing activity and applying ice can help manage pain and inflammation.
• Stretching exercises: Targeted stretches can improve flexibility and reduce tension on affected tissues.
• Orthotic devices: Custom or over-the-counter shoe inserts can provide support and redistribute pressure.
• Physical therapy: Specialized exercises and techniques can strengthen muscles and improve foot mechanics.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may be prescribed to manage pain and inflammation.

When is surgery considered for heel spurs?

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

• Plantar fascia release: Partially detaching the plantar fascia from the heel bone to relieve tension.
• Heel spur removal: Surgically removing the bony growth.
• Gastrocnemius recession: Lengthening the calf muscle to reduce tension on the Achilles tendon (for dorsal spurs).

It’s important to note that surgery is typically considered a last resort and carries its own risks and recovery period.

Preventing Heel Spurs: Proactive Measures for Foot Health

While not all heel spurs can be prevented, certain measures can reduce the risk of development or recurrence.

How can you reduce the risk of developing heel spurs?

Consider implementing these preventive strategies:

• Maintain a healthy weight to reduce stress on your feet
• Wear properly fitting, supportive shoes
• Replace athletic shoes regularly, especially if you’re a runner
• Warm up and stretch before exercise
• Gradually increase the intensity and duration of physical activities
• Use shock-absorbing insoles or orthotics if recommended by a healthcare professional

Living with Heel Spurs: Managing Pain and Maintaining Mobility

For those diagnosed with heel spurs, learning to manage the condition is key to maintaining quality of life and staying active.

What lifestyle modifications can help manage heel spur pain?

Consider incorporating these strategies into your daily routine:

• Practice regular foot and calf stretches, especially before getting out of bed in the morning
• Use a frozen water bottle to roll under your foot for pain relief
• Avoid walking barefoot, especially on hard surfaces
• Choose low-impact exercises like swimming or cycling to maintain fitness
• Apply kinesiology tape to support the arch and heel

When should you seek professional help for heel pain?

While many cases of heel pain can be managed at home, certain situations warrant medical attention:

• Severe pain that interferes with daily activities
• Pain that persists for more than a few weeks despite home treatment
• Swelling or redness in the heel area
• Difficulty walking or bearing weight on the affected foot

Early intervention can prevent the condition from worsening and improve treatment outcomes.

The Role of Biomechanics in Heel Spur Development

Understanding the biomechanical factors that contribute to heel spur formation can help in developing effective prevention and treatment strategies.

How do foot mechanics influence heel spur development?

Several biomechanical factors can increase the risk of heel spur formation:

• Overpronation: Excessive inward rolling of the foot during walking or running
• High arches: Rigid foot structure that doesn’t absorb shock well
• Leg length discrepancy: Uneven leg lengths that alter gait and weight distribution
• Tight calf muscles: Reduced ankle flexibility that increases strain on the plantar fascia

Addressing these underlying biomechanical issues through proper footwear, orthotics, and targeted exercises can help prevent and manage heel spurs.

Can gait analysis help in preventing heel spurs?

Gait analysis can be a valuable tool in identifying biomechanical abnormalities that may contribute to heel spur formation. This assessment typically involves:

1. Visual observation of walking and running patterns
2. Use of force plates to measure ground reaction forces
3. Video analysis to examine joint angles and movement patterns
4. Pressure mapping to identify areas of high stress on the foot

By identifying these issues early, interventions can be implemented to correct abnormal mechanics and reduce the risk of heel spur development.

Emerging Treatments for Heel Spurs: Exploring New Options

As medical research advances, new treatments for heel spurs are being developed and refined. These innovative approaches offer hope for those who haven’t found relief through traditional methods.

What are some of the latest treatments for heel spurs?

Emerging treatment options include:

• Extracorporeal shock wave therapy (ESWT): Using high-energy sound waves to stimulate healing
• Platelet-rich plasma (PRP) injections: Utilizing the body’s own healing factors to promote tissue repair
• Low-level laser therapy: Applying specific wavelengths of light to reduce pain and inflammation
• Regenerative medicine techniques: Exploring the use of stem cells to promote tissue regeneration

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

How do these new treatments compare to traditional methods?

Emerging treatments offer several potential advantages:

• Non-invasive or minimally invasive procedures
• Reduced recovery time compared to surgical interventions
• Potential for long-lasting pain relief
• Ability to target the underlying causes of heel spurs, not just symptoms

However, it’s important to note that these treatments may not be suitable for everyone and should be discussed with a healthcare professional.

The Impact of Heel Spurs on Athletic Performance

For athletes, heel spurs can be particularly problematic, affecting performance and potentially sidelining them from their sport.

How do heel spurs affect different types of athletes?

The impact of heel spurs can vary depending on the sport and the specific demands placed on the feet:

• Runners: May experience increased pain and reduced endurance during long-distance events
• Basketball players: Jumping and quick direction changes can exacerbate heel spur pain
• Dancers: Precision and balance may be compromised, affecting performance quality
• Soccer players: Cleats and uneven playing surfaces can increase discomfort

What strategies can athletes use to manage heel spurs?

Athletes dealing with heel spurs can adopt several strategies to maintain their performance:

• Implement a proper warm-up routine focusing on foot and ankle flexibility
• Use sport-specific orthotics designed for high-impact activities
• Incorporate cross-training with low-impact activities to maintain fitness
• Work with a sports medicine specialist to develop a tailored treatment plan
• Gradually return to full activity levels following a rehabilitation program

By taking a proactive approach, many athletes can continue to participate in their chosen sports while managing heel spur symptoms effectively.

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.