What Is A Heel Spur?
Table of Contents
Your heel bone is made up of a large structure called the calcaneus. This is connected to the bottom of your foot by durable connective tissue called fascia. If the layers of connective tissue become damaged or begin to degenerate due to wear and tear, plantar fasciitis may develop. Plantar fasciitis is a fairly common condition that often coincides with heel spurs, one doesn’t lead to the other.
Instead, this damage in the connective tissues can lead to an abnormal buildup of calcium on the bone of your heel. Over time, this calcification can protrude into a sort of “spur” shape. As you can see in the following image, an actual build-up of this material is visible on an X-ray.
The excessive accumulation of calcium under the heel of your foot can be extremely painful. Heel spurs usually form under the base of your foot or the back of your heel bone. Spurs that develop underneath the foot may actually visibly protrude through the skin.
Both, plantar fasciitis and heel spurs can lead to chronic pain that persists for three or more months, especially if the sides and base of the heel bone have been affected. A large heel spur can affect your movement, preventing you from walking or even standing properly.
Heel Spurs CausesA heel spur usually develops as a result of wear and tear over time. As noted earlier, this leads to the degeneration of connective tissue called fascia. As the body attempts to repair the damaged tissue by delivering calcium to the affected region, too much calcium can begin to accumulate, leading to pain.
Because of this, some of the more common risk factors for heel spurs include:
- Standing for prolonged periods, as in a job that keeps you on your feet all day
- Wearing shoes that do not provide effective arch support, such as heels
- Gait imbalances
- A high body mass index (BMI), due to the increased pressure on the feet
- Regular vigorous activity, especially new programs that aren’t eased into
- Intensive training routines or sports
- Poorly managed diabetes
- Increasing age
- Flat feet or high arches
These factors can increase your risk of repetitive stress injuries that are associated with the formation of heel spurs.
Degenerative conditions, like arthritis, can also lead to heel spur pain. Arthritis, for example, can lead to chronic inflammation in the tissues surrounding the heel. Ankylosing spondylitis is one particular form of arthritis that frequently develops along with heel spurs. This condition can damage bones all over the body, and can even lead to the fusion of spinal vertebrae.
When a heel spur forms, you’ll experience sharp pain along with the feeling that a part of your heel is trying to burst through the skin. If left untreated, this pain can worsen significantly over time.
Heel Spur TreatmentsWhen it comes to heel spur pain, prevention is the best treatment. You can read more about heel spur prevention in our post “28 Heel Pain Treatments, Home Remedies, And More.” This discusses more of the at-home treatments and correct types of shoes to wear to prevent pain.
Many people with mild to moderate pain can find relief by:
- Avoiding exercise on hard surfaces
- Icing your heel
- Taking over-the-counter medications, like ibuprofen, when pain flares up
- Properly stretching and warming up your feet and calves
- Wearing supportive shoes or orthotic devices
- Using night splints
- Undergoing physical therapy
If you’re suffering from severe heel spur pain that hasn’t responded to these techniques, your doctor will likely need to use interventional approaches to manage your pain.
We feel pain due to the nerves that relay pain signals to the brain. Nerves located in the lower region of the back, called sacral nerves, are responsible for transmitting these pain signals from the foot to your brain.
Because of this, pain specialists can target nerves in that particular region of the back to treat heel spur pain that hasn’t responded to other treatments. These treatments generally include nerve blocks or radiofrequency ablation.
A spinal nerve block is a non-invasive procedure that your doctor may try. With a nerve block, they’ll locate and effectively block the nerve roots that are transmitting your heel pain signals. They’ll locate the problematic nerves with imaging devices, such as an X-ray or magnetic resonance imaging (MRI). After they identify the correct nerves, they’ll insert a catheter and needle into your back next to these nerves.
From there, they’ll administer medication into the area. A steroid is usually injected in order to reduce inflammation, along with lidocaine, which is an anesthetic that blocks pain signal transmission. This can drastically reduce your pain. Some patients may experience pain relief for several months, up to a year or more. As a minimally-invasive, outpatient procedure, this can help some patients avoid surgery while resolving the underlying cause of their heel spur.
Nerve blocks are associated with risks, including adverse events that may be caused by drug interactions, especially due to their signal blocking potential. Common side effects include:
- Possible nerve damage
- A loss of sensation
- Discomfort at the injection site
Additional complications may develop if the medication is injected into the wrong area or if a blood vessel is accidentally injected. By working with a highly-qualified specialist, you can better avoid this risk.
Note that those nerve block that contain steroids may also come with additional risks. Steroid injections may cause side effects such as an increased incidence of arthritis, stomach ulcers, and immune system deficiencies, as well as weight gain. Some individuals also experience headaches after undergoing a nerve block, but this is usually temporary.
Another treatment method that may help with heel spurs is called radiofrequency ablation. This procedure utilizes heat-producing radio waves to damage targeted nerves. Electrical pulses transmit heat to that area in order to temporarily impair nerve function or completely destroy nerve tissue.
Before the treatment begins, your doctor will place a microelectrode into your lower back near the sacral nerves. A mild electrical pulse is delivered during the placement of the electrode. This initial pulse produces tingling. This tingling will help your physician assess whether or not the electrical stimulation is reaching the appropriate nerves.
After the electrode is correctly placed, your doctor will administer a stronger electrical current to the nerves that are contributing to your heel pain.
There are two types of ablation: a continuous approach or a pulsed approach. The continuous method entails raising the temperature gradually to approximately 122°F. The targeted nerves are exposed to this temperature for 90 seconds, which is the amount of time that it usually takes for the heat to block the transmission of the pain signals.
The pulsed approach involves exposing the targeted nerves to a lower temperature of 104°F for a brief 20 millisecond period followed by 480 milliseconds in which the nerves can cool down. The occurrence of side effects and tissue damage is generally lower with the pulsed approach.
Like nerve blocks, this is a minimally-invasive treatment approach that can be done on an outpatient basis. You can learn more about this treatment approach in the following video.
Heel spur surgery
The vast majority of patients with heel spurs–even painful ones–won’t need to undergo surgery. However, if lifestyle changes or minimally-invasive treatments haven’t helped with your heel pain, surgery may be necessary.
During surgery, your surgeon will remove the bony accumulation in your heel. They’ll advise you on the best ways to care for your feet after the operation, including how long to rest or which types of orthotic devices to use while healing.
ConclusionHeel spurs refer to an abnormal accumulation of calcium deposits on the heel of your foot. Many people suffer from these spurs, but only a percentage of people experience pain.
Vigorous, repetitive movements often result in the formation of heel spurs, but inflammatory diseases (e.g., arthritis) may also increase the occurrence of painful heel spurs. Likewise, certain people may be more at risk for developing this condition.
There are treatments that can help, though prevention is the best approach. Treatments may include lifestyle changes, physical therapy, steroid injections, or radiofrequency ablation. However, a bone spur that begins to protrude excessively may need surgical removal.
To get help with your heel spur pain, you may want to talk to a pain specialist. They can help diagnose the cause of your pain and suggest treatments that work for your lifestyle. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.
- Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur: Fact or fiction? Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons. 2012;18(1):39-41.
- El Shazly O, El Beltagy A. Endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal for management of painful heel syndrome. Foot (Edinburgh, Scotland). 2010;20(4):121-125.
- Yi TI, Lee GE, Seo IS, Huh WS, Yoon TH, Kim BR. Clinical characteristics of the causes of plantar heel pain. Annals of rehabilitation medicine. 2011;35(4):507-513.
- Barrett SJ, O’Malley R. Plantar fasciitis and other causes of heel pain. American family physician. 1999;59(8):2200-2206.
- Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B. Plantar fasciitis. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences. 2012;17(8):799-804.
- Filippou DK, Kalliakmanis A, Triga A, Rizos S, Grigoriadis E, Shipkov CD. Sport related plantar fasciitis. Current diagnostic and therapeutic advances. Folia medica. 2004;46(3):56-60.
- Irving DB, Cook JL, Young MA, Menz HB. Impact of chronic plantar heel pain on health-related quality of life. Journal of the American Podiatric Medical Association. 2008;98(4):283-289.
- Meier PM, Zurakowski D, Berde CB, Sethna NF. Lumbar sympathetic blockade in children with complex regional pain syndromes: a double blind placebo-controlled crossover trial. 2009;111(2):372-380.
- Nagda JV, Davis CW, Bajwa ZH, Simopoulos TT. Retrospective review of the efficacy and safety of repeated pulsed and continuous radiofrequency lesioning of the dorsal root ganglion/segmental nerve for lumbar radicular pain. Pain physician. 2011;14(4):371-376.