The bone deposit (bony outgrowth) that appears on the heel bone is commonly called a "heel spur." Heel spurs develop where tendons and ligaments attach to the calcaneus. On the plantar side of the heel, it is the ligaments supporting the arch, while posteriorly it is the attachment of the Achilles tendon. The outgrowth and increased bone formation can be triggered by chronic inflammation. The posterior heel spur under the Achilles tendon is common in regular runners, while the plantar spur can appear in anyone. The pain caused by a heel spur is very unpleasant, long-lasting, and difficult to alleviate.
The Development of a Heel Spur
Calcaneal bone spurs develop where the bone and the muscles attaching to it are close together and rub. If these points are repeatedly subjected to pressure (for example, increased body weight, long-distance running, or wearing shoes without proper heel cushioning on hard surfaces), the excessive stress causes inflammation around the attachment sites. With persistent inflammation, bone deposits form over time on the bone. This then increases the pressure on the tendons and further intensifies the symptoms.
The best solution for healing would be complete rest. However, being immobilized for weeks is only possible for few. During walking both the Achilles tendon and the plantar side of the heel move. Thus walking worsens the symptoms and hinders healing. That is why heel spurs cause prolonged, agonizing symptoms that can make daily life miserable for those affected.
Diagnosing a Heel Spur
The diagnosis of a heel spur is usually not too complicated. The patient's reported symptoms and a physical examination are generally sufficient. Of course, an X-ray can easily confirm the presence of the bony outgrowth. In the image above, the significant bony spur on the plantar side of the heel bone is clearly visible. Rarely is more testing necessary. It is important to note that the spur formation develops slowly, so despite the characteristic pain, a bony outgrowth may not yet be detectable. You can expect it only after a longer period of painful inflammation.
From a treatment strategy perspective, whether the spur has appeared is almost irrelevant. Reducing inflammation and pain is the primary goal.
Treatment of Heel Spur
Medical Treatments
Primarily refers to locally administered steroid and non-steroidal anti-inflammatory drugs. They can be applied as ointments or by injection directly into the inflamed area.
X-ray irradiation of the heel bone is a commonly used method, although there is no convincing data regarding its beneficial effect. One thing is certain: we should receive as little radioactive radiation as possible.
The shockwave therapy is a very effective physiotherapy method; however, a few treatments in the clinic rarely completely eliminate heel spur complaints. There are no home shockwave devices yet.
In cases of persistent symptoms, various surgical options are possible. During these procedures, the tendons (fascia) are detached from the bone, the excess bone is shaved off, and the ligaments are then reattached. The "reattachment" of the tendons is a long process, so the limb cannot bear any load for weeks.
Home Physiotherapy Treatments
There are several methods. Each is effective on its own, but combined they lead to the best results.
Cushioning the heel with a simple insole or heel pad relieves walking-related complaints and distributes the pressure on the inflamed area.
Night splinting: applying a dorsiflexed position splint to the ankle at night for eight weeks. This commonly used method is quite uncomfortable for the patient and can disrupt sleep. Nonetheless, it ensures rapid pain relief in the first days.
Pain-relieving TENS treatment: TENS is an effective symptomatic therapy in musculoskeletal disorders. It quickly reduces pain but has no curative effect. TENS treatment can be repeated as needed and certainly causes no side effects.
Cold-warm therapy: alternating cooling and heating stimulates blood circulation and thus the healing processes that reduce inflammation. It is worth trying the Thermedic Foot device, specifically developed for foot treatment, in mild cases.
Ultrasound treatment: ultrasound is a mechanical energy that, when absorbed in tissues, stimulates blood circulation and thus healing processes. Ultrasound cannot be administered indefinitely! One must know several rules regarding how long and at what intensity to treat. You can learn more about this in this article.
Soft laser treatment: nowadays soft lasers are considered perhaps the most effective for musculoskeletal disorders. This includes heel spurs as well. The light (laser) radiated into the tissues triggers several beneficial effects. Although it also has some heat-generating and circulation-enhancing effects, the curative effect occurs at the cellular level. The microcurrents generated by the laser radiation restore the membrane potential of the damaged, inflamed cells in the tissues, thus catalyzing cellular processes. Healing accelerates, inflammation decreases, and eventually ceases.
Combined treatment: in physiotherapeutic practice, applying the above methods in combination is recommended. The treatment consists of cooling-heating, ultrasound, soft laser treatments, and regular performance of special stretching exercises.
However, despite the coordinated treatment, a heel spur still causes a very stubborn inflammation. Since walking always opposes healing, persistent and often months-long treatment is necessary to "eliminate" the symptoms.
