What is a heel spur?
A heel spur is an inflammatory condition of the thick band of connective tissue that runs across the bottom of the foot and connects to the heel, causing severe pain in the heel. The band of connective tissue is also called ‘plantar fascia’, it runs form the underside of the heel bone all the way to the toes. Plantar fascia is especially vulnerable to overload and stress on the heel bone, which can result in inflammation. Heel spurs are one of the most common causes of pain in the heel and can occur in all ages. However, it is most common in people around the age of 40, especially in runners and military personnel.
What are the symptoms of a heel spur?
A heel spur can cause the following symptoms:
- Increasing pain under the heel, approximately 5 cm from the back of the heel and most pronounced at the heel’s inward side
- Pain is trigged when putting pressure on the foot
- Initially, the pain is only present during physical activity. Later, the pain can also be felt during rest
- The pain can radiate through the foot
- The pain is often worst in the morning and eases during the day. If the condition is severe enough and causes pain during rest, the pain will frequently be worst in the evening
- The pain can increase in intensity if the toes are stretched upward
What are the causes of a heel spur?
The pain connected to heel spurs occur due to inflammation of the plantar fascia. The inflammation can be the result of different conditions affecting the band of connective tissue. Thus, it can manifest as a consequence of a range of factors, like malpositions and muscle tensions, combined with external factors affecting the patient’s heel, such as bad footwear, load from daily activities, and some forms of physical activity. These factors affect the band of connective tissue and provoke the inflammatory reaction. Physical activity associated with increase risk of heel spurs are, sports involving jumping, running long distances on a hard surface in bad footwear, and prolonged periods of standing on a hard surface. Malpositions such as flatfoot and hollow stand can also increase the risk.
What are the treatment options for a heel spur?
One can attempt to ease the pain, relieve the inflammation, avoid future discomfort, and exacerbating the condition through various techniques. Frequently, treatment of a heel spur can be conservative, i.e. avoid straining the foot, alternative training, and appropriate footwear with proper support. It is possible to purchase shock absorbing shoe inlays, supporting the arch the foot, relieving some pressure form the heel. It is also possible to purchase a night splint for the foot. Furthermore, is it important to avoid prolonged periods of standing and walking/running on a hard surface. It is also beneficial to stretch the plantar fascia, since this can relieve some of the pain. One method of stretching the planar fascia is by placing the foot on stairstep, so that the heel isn’t on the stairstep and raising and lower the heel so that it is, respectively, above and below the level of the stairstep.
The pain can also be temporarily treated with creams containing the painkiller NSAID, e.g. Voltaren®, or by injecting steroids directly into the affected area. If the above does not have any effect, if the condition is chronic, or if the physician suspects the plantar fascia has torn from the heel, surgery might be required. A surgeon can disconnect the plantar fascia from the heel bone.
If one keeps up with the treatment, the pain will often subside after 1-2 years. If the pain returns, it is important to react immediately and avoid applying too much pressure to the heel, and that way the symptoms can subside quickly.
