Heel foot pain relief: Heel Pain: Causes, Treatments, and Prevention

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Heel Pain: Causes, Treatments, and Prevention

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Medically reviewed by William Morrison, M. D. — By Darla Burke — Updated on April 21, 2023

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Heel pain. (n.d.).
apma.org/learn/FootHealth.cfm?ItemNumber=985
Mayo Clinic Staff. (2016). Heel pain.
mayoclinic.com/health/heel-pain/MY00081
Weatherford BM. (2017). Heel pain.
orthoinfo.aaos.org/topic.cfm?topic=a00159

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Current Version

Apr 21, 2023

Written By

Darla Burke

Edited By

Heather Hobbs

Dec 18, 2017

Medically Reviewed By

William Morrison, MD

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Medically reviewed by William Morrison, M.D. — By Darla Burke — Updated on April 21, 2023

Heel Spurs: Symptoms, Causes, and Prevention

Overview

A heel spur is a foot condition that’s created by a bony-like growth, called a calcium deposit, that extends between your heel bone and arch.

Heel spurs often start in the front of and underneath your heel. They eventually affect other parts of your foot. They can get up to half an inch in length. They may not necessarily be visible to the naked eye.

Detecting heel spurs can be challenging. Heel spurs don’t always cause pain, and not all heel pain is related to spurs. Keep reading to learn more about these bony growths and what causes them.

Symptoms of heel spurs may include:

pain
inflammation
swelling at the front of your heel

The affected area may also feel warm to the touch. These symptoms may spread to the arch of your foot. Eventually, a small bony protrusion may be visible.

Some heel spurs may cause no symptoms at all. You may also not see any changes in soft tissues or bones surrounding the heel. Heel spurs are often discovered only through X-rays and other tests done for another foot issue.

Heel spurs are directly caused by long-term muscle and ligament strain. Eventually, this excessive strain stresses the heel bone (calcaneus) causing spurs.

Heel spurs develop over time. They don’t suddenly appear after a workout or a sports event. Heel spurs tend to occur when you ignore early symptoms like heel pain.

Repetitive stress from walking, running, or jumping on hard surfaces is a common cause of heel spurs. They may also develop from wearing shoes that don’t support your foot.

Heel spurs may also be caused by:

arthritis
bruising of the heel
excess body weight
poorly fitted shoes
walking gait issues
wearing flip-flops too often
worn-out shoes

Many people who have heel spurs also have plantar fasciitis. This painful condition deals with the tough, fibrous tissue that runs between your heel and toes. Having plantar fasciitis increases your risk for eventually developing heel spurs.

[Q&A WIDGET:

Q: What’s the difference between heel spurs and plantar fasciitis?

A: There’s a distinct difference between a heel spur and plantar fasciitis, but the two are closely related. A heel spur is a bony projection that occurs from the bottom of the heel along the course of the plantar fascia. It will vary in size but is usually not larger than half an inch. A heel spur may have no symptoms associated with it. It’s often discovered on an X-ray.

Plantar fasciitis is a painful condition in which there’s an inflammatory process occurring where the plantar fasciitis attaches to the heel. This occurs because of an abnormal force being placed on it. Excess weight, overuse, or wearing shoes without a supporting arch can cause an abnormal force.

As a general rule, plantar fasciitis will subside on its own over a period of time regardless of the treatment. A heel spur will be there permanently, unless surgery is required. Fortunately, surgery is rarely needed.

— William Morrison, MD

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

]

It’s difficult for you diagnose a heel spur without medical assistance. This is because the symptoms are similar to other forms of heel pain and foot problems.

You’ll need to see a specialist, such as an orthopedic surgeon or a podiatrist, for a proper diagnosis. They can then detect a heel spur through an X-ray. You can book an appointment with an orthopedist in your area using our Healthline FindCare tool.

Bony protrusions aren’t usually visible to the naked eye. That’s why diagnostic imaging tools are essential if you’re experiencing any unknown causes of foot pain and inflammation.

Before ordering imaging tests, your doctor will conduct a physical examination of your foot to look for any signs of redness or inflammation. Your doctor will also check for any noticeable tenderness on the foot. Tenderness is another indication of a heel spur.

Your podiatrist may also have you do physical tests, such as standing on one foot at a time, as well as taking a brief walk.

Heel spur treatment primarily consists of rest and lifestyle changes. Talk to your doctor about the following treatment options for heel spurs.

Cold compresses

Using ice packs or cold compresses for up to 15 minutes at a time may help relieve heel spur pain by temporarily numbing the area. This method also helps reduce swelling. Cold compresses are preferable over heat packs for heel spurs because heat works better for joint and muscle aches.

Injections of anti-inflammatory medications

For severe pain, your podiatrist may recommend corticosteroid shots. These anti-inflammatory injections help to ease both pain and inflammation throughout the heel and arch of the foot.

Over-the-counter pain medications

Acute, or short-term, pain may be reduced with the help of over-the-counter (OTC) pain medications. These may include acetaminophen (Tylenol), aspirin, or ibuprofen (Advil, Motrin).

Tell your doctor if you’re taking any other medications, such as blood thinners, or if you have any preexisting liver or kidney problems that could prevent you from taking OTC pain relievers.

Physical therapy exercises and stretching exercises

Your podiatrist may recommend physical therapy as a way to learn and practice exercises to prevent long-term pain, especially since anti-inflammatory medications can only be safely taken for a short amount of time.

Heel spur exercises consist of stretching the heel and plantar fascia muscles. Your physical therapist can show you how to do some of the exercises at home. These can be performed at any time of the day, but stretches can be especially helpful at night before bedtime.

Rest

Rest is one of the most recommended treatment measures for both plantar fasciitis and heel spurs.

Not only does rest help alleviate acute pain, but getting off your feet can also prevent your condition from worsening. It’s especially important to rest the feet after long periods of standing and other activities.

In the case of acute pain from a heel spur, your podiatrist may ask you to rest your foot until your symptoms subside. Putting weight on your heel while it’s in pain will likely worsen your condition. It could also lengthen your recovery time.

Orthotic shoe inserts

Orthotic shoe inserts, such as heel pads, can help give you the arch and heel support needed to reduce pain. Heel pads can also prevent further wear and tear. They should be used in addition to proper footwear for all-around foot protection.

Your doctor may recommend surgery when heel spur pain becomes severe and ongoing. This type of surgery involves removing the heel spur. Sometimes it also involves releasing the plantar fascia.

Heel spur surgery not only reduces pain, but it’s also aimed at boosting mobility in the overall foot. Most people who have this type of surgery also have plantar fasciitis. Due to other forms of treatments and therapies available, surgery is not common for heel spurs alone.

Before recommending heel spur surgery, your doctor will determine if you’re a proper candidate by conducting final imaging tests via X-rays and EKGs, as well as blood flow tests to the foot.

It will also take time for you to fully recover from heel spur surgery so that you’re able to put weight on your foot again. The recovery process might include:

resting your foot and using ice
compression
supportive gear

Stretching exercises are good methods of overall body conditioning because they help you work out sore muscles and tight ligaments while also preventing injuries. The same concept applies to heel spur pain management and recovery.

Certain types of stretches can help improve pain and inflammation in your heel and calf areas. These include:

calf stretches against the wall
calf stretches on steps
golf/tennis ball foot rolls
seated foot flexes
towel grabs with your toes

Try these eight exercises to ease pain from heel spurs.

Certain essential oils may act as natural anti-inflammatories to reduce both pain and swelling. They may also be massaged into your heels for further relief.

Some of the most notable anti-inflammatory essential oils include:

bergamot oil
eucalyptus oil
fennel oil
lavender oil
orange oil
rosemary oil
sesame oil
thyme oil

While studies are still being done to evaluate their anti-inflammatory effects, there’s no concrete evidence yet available that proves essential oils work to cure heel spurs.

It’s also important to keep in mind that these oils have medicinal properties. When used incorrectly, they can cause side effects. Always combine a few drops of an essential oil with at least three times the amount of a carrier oil and conduct a patch test prior to application..

Preventing heel spurs requires an increased attention to your overall foot health. Be mindful of the everyday stresses you place on your feet. Be sure to give them a rest at the end of the day.

As a rule of thumb, you should never push through any heel pain that develops.

Continuing to walk, exercise, or wear shoes that cause heel pain can lead to long-term issues such as heel spurs. If you experience heel pain after any activity, ice the area and give your foot a rest until it gets better.

Treatment Heel “spur” – Orthopedics Ruslana Sergienko

A heel spur is the result of plantar fasciitis, the main symptom of which is pain in the heel that occurs or worsens with exercise. In most cases, the pain syndrome is caused by inflammatory and degenerative changes in the plantar (plantar) fascia.

Plantar fascia is a tough tendon plate, woven from a huge amount of microfibers, which is attached to the calcaneus and metatarsal heads, creating a kind of protective cover for the plantar surface of the foot.

As can be seen from the figure, the plantar fascia is stretched like a bowstring between the bones, the so-called arch of the foot. Imagine that with every step this kind of bowstring is pulled, holding this arch, preventing the bones of the foot from “parting”.

Constant load of body weight, overload during hard work, changes in posture due to diseases of the back lead to the appearance of microdamages in the places of attachment of the plantar fascia to the bones. As can be seen from the figure, the place of attachment of the “string” to the metatarsal bones is divided into five points, while on the heel there is only one point of attachment. The load is 5 times more on the heel, so the disease starts from the heel.

There is a microdamage (tear or rupture) of one of the many thin fibers of the plantar fascia. The body reacts in a standard way – inflammation develops. Inflammation leads to the formation of edema, abnormal germination of microvessels and small nerve branches into the damaged fascia, and pain occurs. The pain is especially severe after a night’s sleep and rest, the so-called “starting pain”.

The fibers of the plantar fascia that have remained intact begin to work instead of the broken ones, experiencing an increased load, and are also damaged.

Inflammation and pain progress, forcing to reduce the load. Human activity is reduced, new fibers are not damaged. The inflammatory process subsides, scars form at the site of the damaged fibers, and then bone growths that are visible on the x-ray and have a characteristic “spur” appearance.

That is why this disease is called “heel spur”, although the “spur” itself is already the result of long-term plantar fasciitis.

Who is more likely to suffer from heel spurs?

Heel spurs mainly affect people over 40 years of age, and women are more predisposed to this disease. The likelihood of developing heel spurs is increased by excess weight, problems with the spine, arthritis, flat feet, diseases of the large joints of the legs, injuries of the calcaneus, gout, circulatory disorders in the legs. Also, the heel spur is found in athletes with prolonged loads in the heel area.

What are the symptoms of a heel spur?

The leading symptom of heel spurs (plantar fasciitis) is pain in the heel region that occurs or worsens with exercise. Pain is more pronounced in the morning. In most cases, the diagnosis of plantar fasciitis is sufficient to analyze the patient’s complaints, physical examination and X-ray, which reveal the presence of a heel spur. The absence of radiological signs of a heel spur in combination with heel pain requires a differential diagnosis with systemic inflammatory diseases (rheumatoid arthritis, Reiter’s syndrome, etc.), which can also debut with heel pain. In this case, the diagnosis of plantar fasciitis can be established using an ultrasound examination.

What is the treatment for heel spurs?

First, get rid of overloads.

This does not mean completely abandoning any movement. This means that a painless range of motion should be performed. For example, you have noticed that it is worth standing for 2 hours, the pain increases. Try to stand for 2 hours with breaks, for example 15 minutes. Or you walk 4 kilometers and experience pain. Try to walk 2 kilometers or the same 4 kilometers, but at a slow pace. Sports doctors have proven that continuing exercise in a “sparing mode” has a greater effect on the result of treatment than refusing to exercise at all.

Stretching and strengthening.

The stretching and strengthening program plays an important role in the treatment of the disease, as it can effectively relax cramped calf muscles or strengthen weak foot muscles. Why stretching or “stretching” is effective? It loosens the tension and reduces the risk of breaking the “bowstring”. A less taut plantar fascia is not damaged as much. Do these exercises at home.
The easiest way to stretch is using a support wall: Or steps: Another effective stretching method is to use footrests that can be used in the workplace, such as under a desk or in the kitchen, thus increasing the time for such “on-the-job” activities. The use of “rocking chairs”, widely used to prevent salt deposits, is a type of “dynamic stretching” of the plantar fascia. For the same purpose, you can use a tennis ball or an iron can: Before getting out of bed, it is useful to perform a massage in the sole area to reduce pain:
or stretching with a towel: Strengthening the small muscles of the foot.
By performing 2 simple exercises, you can achieve a significant increase in strength in the small muscles of the foot, which will lead to unloading of the plantar fascia.

Pull up towel. The patient sits on a chair, the towel lies on the smooth floor in front of him. The patient puts his toes on the towel and, without taking his heel off the floor, bending his toes, pulls the towel towards him.
Finger up. The patient sits on a chair, the foot is placed on the floor, the toes are raised up. First, the thumb is placed on the floor, and the rest remain raised. Then the thumb is raised and remains in this position, and the rest are lowered and placed on the floor.

About 35% of patients achieve regression of symptoms only with the help of stretching and muscle strengthening.

Shoes.

It is not uncommon for plantar fasciitis to develop after wearing uncomfortable, especially tight shoes or shoes with excessively hard soles. People who suffer from plantar fasciitis may find that wearing sneaker-type shoes with soft, springy soles and an insole that hugs the arch of the foot significantly reduces pain. This is not surprising. The springy outsole absorbs impact when walking, while the arch-fitting insole supports it and transfers the load directly to the bones, bypassing the plantar fascia.

It should also be noted that over time, the properties of the polymeric materials from which shoes are made change, so such shoes need to be changed in a timely manner.

Insoles.

As far as insoles are concerned, it can be said that only custom-made devices, made on the basis of modern equipment based on the footprint, can help in the treatment of fasciitis. The insoles do not act on the fasciitis itself, but by correcting violations of the arch of the foot, for example, with flat feet. Incorrectly selected insoles can worsen the patient’s condition.

Night immobilizing dressings.

The purpose of immobilization bandages is to keep the ankle joint in a neutral position. It is noted that the vast majority of people sleep with outstretched socks. In this position, the places of attachment of the plantar fascia to the bones come together, which causes it to shorten over time. This is what causes morning pain in the foot. The person spent the whole night with outstretched socks, and in the morning he gets on his feet, sharply stretching the inflamed plantar fascia. The immobilizing bandage keeps the bones from coming together, and the plantar fascia does not contract overnight, which reduces morning pain.

An overnight immobilizing dressing can be made from plaster or polymeric bandages, or you can buy ready-made ones from those sold in a pharmacy.
An example of a nightly immobilizing bandage: Of course, sleeping in a cast is not very comfortable, but studies have shown that this method is effective in 80% of patients. Night immobilizing dressings are especially effective in patients with a long period of the disease (about 12 months or more).

Anti-inflammatory treatment of heel spurs.

Anti-inflammatory treatment of heel spurs includes ice, NSAIDs, electrophoresis and hormonal injections.

Ice is used in the form of ice massages, ice baths or ice packs.
Ice massage: the patient takes an ice cube, places it over the area of pain and performs circular movements with slight pressure for 5 to 10 minutes.

Ice bath: fill a shallow container with ice water, place only the heel in it and hold for 10 to 15 minutes. Do not lower other parts of the foot into the water to avoid hypothermia.

Ice pack: Place crushed ice in a plastic bag, wrap in a towel and apply to the heel for 15 to 20 minutes. Instead of crushed ice, you can use a bag of frozen food.

Ice is applied after completion of exercise or after a working day.

Non-steroidal anti-inflammatory drugs (eg diclofenac or nimesulide).

Non-steroidal anti-inflammatory drugs have been studied for plantar fasciitis with conflicting results. Therefore, they are recommended only in case of increased pain, given the side effects of these drugs, which include gastrointestinal bleeding, gastritis, damage to kidney tissue.

Electrophoresis.

Electrophoresis is a physiotherapy procedure that uses the properties of low voltage electrical impulses to deliver corticosteroid (hormonal) drugs deep into tissues. Studies of the effectiveness of this treatment method showed that within 2-3 weeks after the end of the procedure, the therapeutic effect decreases.

Corticosteroid injections.

Corticosteroid injections are effective in up to 70% of patients, but are known to rupture the plantar fascia in up to 10% of patients. It is known that the introduction of corticosteroids into any tissue leads to its death at the injection site. Therefore, this method of treatment should be used with extreme caution.

Shock wave therapy is a highly effective non-surgical method of treating heel spurs, approved by the equivalent of the US Department of Health as the main one for this particular disease, based on the action of acoustic shock waves. The method of shock wave therapy has been used for a long time to crush stones in the urinary tract. This is the so-called intracorporeal (conducted inside the body) shock wave therapy. Unlike devices for crushing kidney stones (lithotripters), in devices for extracorporeal (used on the surface of the body) shock wave therapy, the acoustic wave is much less powerful. Its action is based on the stimulation of regenerative processes in areas of chronic tendon inflammation and nonunion fractures.

Shock wave therapy does not break up heel spurs as is commonly believed. It sharply enhances regeneration at the site of damage to the plantar fascia, stops long-term inflammation, thereby, on the contrary, preventing the development of heel spurs. The shock wave in orthopedics does not destroy, but restores.

The effectiveness of shock wave therapy is comparable to surgical treatment, since more than 93% of patients report a pronounced and persistent clinical effect. However, unlike surgical treatment, shock wave therapy is a painless method of treatment that does not require anesthesia and the patient’s stay in the hospital.
Shock wave therapy is a safe method of treating heel spurs, it has a complex effect and eliminates the cause of the heel spur.
Effects of shock wave therapy:

reduction of pain and inflammation
improvement of blood circulation and nutrition of damaged tissues
destruction of calcifications, bone “growths”
accelerate the healing of damaged tissues
increased mobility in the injured area of the body
increasing the resistance of tendons, ligaments and muscles to physical stress and injury

Advantages of shock wave therapy:

high clinical efficiency – up to 93% of patients have a clinical effect
rapid onset of clinical effect – reduction of pain, swelling, improvement of mobility
stable clinical effect of the course lasts up to 1 year
patient safety – no complications or side effects
convenience of treatment for the patient – the session lasts 5-10 minutes, the frequency of the procedure is 1 time per week, 5-7 sessions are enough for a complete recovery
reduction in the need for drugs or complete elimination of them
is an optimal replacement for surgery and injections.

It is recommended to support the effect of shock wave with stretching and muscle strengthening exercises, anti-inflammatory treatment in the form of ice and electrophoresis, as well as modification of the load regimen.

TRUST YOUR HEALTH CARE TO REAL PROFESSIONALS!

Pain in the heel. Shock wave treatment

Department of Physiotherapy

Articles

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Pain in the heel. Shock wave treatment

Heel pain can be caused by a number of conditions. Most often, heel pain is a symptom of plantar fasciitis, or heel spurs. This disease is a bony spike-like outgrowth on the heel bone that causes burning, stabbing pain when stepping on the heel.

In addition, heel pain can be caused by trauma, degenerative-dystrophic or inflammatory disease in the area of the Achilles tendon and the joint under the talus.

Shock wave therapy effectively treats heel pain in all of these conditions.

The growing popularity of this procedure is due to the rapid analgesic and anti-inflammatory effect and the stability of the treatment results.

What conditions are treated with shock wave therapy?

Shock wave therapy shows very good results in heel pain caused by

plantar fasciitis (heel spur).
Achilles bursitis,
gout,
rheumatoid arthritis.
Arthritis,
Ankylosing spondylitis,
Sprain or rupture of the tendon,
Contusion of the calcaneus,
Fracture of the calcaneus,
Epiphysitis of the calcaneus (Sever’s disease), 900 42
osteochondropathy of the calcaneal tuber (Gaglund-Shinz disease),
Achilles tendinitis,
calcaneal paratendinitis,
calcaneal enthesopathy,

Each of these diseases is characterized by characteristic symptoms and has certain causes and developmental features. Regardless of this, shock wave therapy for all these diseases has a rapid and effective analgesic effect. The powerful therapeutic effect of the procedure is explained by its complex effect.

Shock wave treatment results for heel pain

The effect of shock wave therapy is based on the action of acoustic waves, which freely penetrate soft tissues, reach the focus of pain and, encountering the resistance of dense tissues – ligaments, tendons, bones – are partially reflected. This creates the effect of internal impulse massage, which has a number of unique properties.

Firstly, shock wave therapy significantly improves local blood circulation, blood supply and tissue nutrition, activating metabolic processes and promoting tissue repair.

Secondly, the infrasonic waves destroy calcium salt deposits, after which they are removed naturally.

Third, by acting on the nerve endings, UVT has a powerful analgesic effect.

Fourthly, shock wave therapy improves lymph flow, which achieves a pronounced anti-edematous effect simultaneously with an increase in local immunity.

Thanks to this, the treatment of heel pain with shock wave therapy allows not only to quickly and permanently eliminate pain, but also to relieve inflammation, swelling, restore range of motion in the joint and calcaneal tendon.