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Heel spur

A heel spur (med. calcaneal spur) is a bony growth on the heel bone (heel bone, med. calcaneus). It often forms on the underside of the heel in the area where the plantar fascia attaches (plantar fasciitis), but can also occur on the upper edge of the heel. Although a heel spur can remain asymptomatic for a long time, if it becomes irritated or inflamed, it causes pain and restrictions when walking for many people.

Causes and development

1. Mechanical overload: Prolonged or recurring strain, for example from running, standing or walking on hard floors, favors the development.
2. Foot malpositions: With flat feet, hollow feet or unstable foot statics, the heel bone is subjected to increased and sustained stress.
3. Overweight: Increases the pressure on the feet and heels.
4. Shortened tendons and muscles: Inflexible calf muscles or Achilles tendons can increase the strain on the heel base.

All of these factors can lead to micro-injuries to tendon insertions and fascia over a long period of time. The body often reacts to this with a bony extension that becomes visible as a "heel spur".

Symptoms

• Sharp heel pain when walking, especially in the morning or after periods of rest ("start-up pain").
• Improvement of the pain when relieved (e.g. sitting or lying down), renewed pain on exertion.
• Sometimes you can feel a small, hard protrusion or feel pressure pain when touching the heel.

Diagnosis

• Clinical examination: Orthopaedists or podiatrists check the foot statics, palpate the heel and look for pressure pain points.
• Imaging: X-rays often show the typical bony outgrowth on the lower or back of the calcaneus.

Treatment

1. Conservative therapy:

   • Pain and inflammation relief: Through cooling, anti-inflammatory medication or ointments.
   • Relief: Special insoles (e.g. heel pads) or shoe adjustments reduce the pressure on the painful area.
   • Stretching exercises: Regular stretching of the calf muscles and plantar fascia relieves tension and reduces the pull on the heel.
   • Physiotherapy: Strengthens muscles, optimizes foot statics and can relieve pain using manual techniques.
   • Shock wave therapy: Stimulates blood circulation and supports the healing of damaged tissue.

2. Surgical intervention:

   • Is only considered in rare cases when conservative measures do not help sufficiently. During surgery, the bony protrusion is removed and excessive tension in the fascia is reduced.

Prevention

• Movement and stretching: Regular exercise, especially for the calf muscles and Achilles tendon, to keep the foot stable and supple.
• Suitable footwear: Sufficient space in the toe area, good cushioning and, if necessary, customized insoles.
• Weight reduction: If you are overweight, even a moderate reduction in weight will reduce the pressure on the heel.
• Foot exercises: Strengthens foot muscles and can prevent incorrect loading.

Conclusion: A heel spur itself is usually not the main problem. Rather, it is the surrounding irritated tendon insertions or inflamed soft tissue that lead to pain. With a combination of rest, targeted exercises and relief measures, the strain on the heel can be sustainably reduced and the pain can be significantly alleviated. If pain persists despite consistent therapy, a medical examination should be carried out in order to plan further treatment steps.