The foot pain associated with heel spurs can be agonizing. Some people have described it as a hot poker, or like walking on glass. Others have a more mild experience, like a dull ache whenever their heel strikes the ground.
Whatever your own experience with heel spurs, it’s definitely an inconvenient condition. Whether foot pain makes mobility unpleasant, painful, or impossible, it’s important to find heel spur treatments that will subdue the pain so you can lead a more normal life.
What Are Heel Spurs
A heel spur is an extra area of growth in the heel bone. It is simply a calcium deposit, more like cartilage than hard bone. On X-rays it will look like a very obvious cause of pain, like a spike that digs into the soft tissue of the heel.
This is misleading. Half of patients with heel spurs, in fact, experience no pain at all. “Heel spurs”, in association with foot pain, is simply another way to say you have Plantar Fasciitis (PLAN-ter Fash-ee-EYE-tis).
On the bottom of your foot a large, firm ligament forms a bridge between your toes and your heel. This is the plantar fascia. You can feel an edge of this broad band of tissue if you press your fingers along the bottom inside edge of your flexed foot. Most people are basically aware of this assembly of ligament and muscle, because we all feel a twinge from time to time when we over-extend a foot, as when running, or pushing a heavy object, or climbing stairs.
As strong as this tissue is, it is actually the weak point in a larger system involving the calves, Achilles tendon, and structures of the feet. It is strained repeatedly through our daily movements. The forces supported by our feet day in and day out are enormous, and mostly underestimated by the majority of people. Modern life has done us no favors by putting us at desks for eight hours a day, or forcing us to walk on hard, unyielding surfaces most of the time. Our feet, essentially, have not yet adapted to the rigors of modern life.
We are constantly subjecting this tissue to small tears and other abuse, but normally it can recover in time to fight the next day’s battle. When it can’t (due to more severe injury, degeneration from aging, or other factors), the tears grow, cause inflammation, and lead to the pain normally classified as Plantar Fasciitis.
By now, you’re probably wondering where heel spurs come in. When a ligament like the plantar fascia repetitively yanks or tears or causes trauma at the bone connection point, the body responds by trying to grow more bone at the point of weakness. In the case of trauma where the plantar fascia connects to the heel bone, a heel spur is the end result.
But not all people with Plantar Fasciitis have a heel spur, and not all people with heel spurs have Plantar Fasciitis. The exact relationship between the two is not well understood, but the briefest way to explain current understanding is to say that if you have pain consistent with Plantar Fasciitis, and you also have a heel spur, the spur is a response to the condition—not the source of pain. About 70% of people with Plantar Fasciitis also have heel spurs.
Symptoms of Heel Spurs
You might have been given a diagnosis of “heel spur” because many doctors believe this is easier to understand from the patient’s point of view, when an actual heel spur exists. Since there’s no point confusing the issue by using the two terms interchangeably, this article will continue to refer to Heel Spurs. But remember that if you have pain that sounds like Plantar Fasciitis, that condition is more likely the cause of your discomfort—not any heel spurs that may or may not have developed because of it.
This is not to say your doctor is wrong, and in almost all cases he or she will recommend the correct course of treatment, which is the same whether you are diagnosed with a heel spur or with Plantar Fasciitis. But if a person believes that an apparently sharp piece of misplaced bone is causing their pain, they may be more likely to consider surgery as a corrective action, when there is no evidence that such a risky, expensive procedure will fix the problem.
Symptoms of heel spurs are hard to miss. Most people report that they feel a sharp pain immediately upon getting out of bed, which then diminishes as they slowly perform their daily activities. At some point during the day, whether your job is sedentary or active, the pain might return, even stronger than earlier. This usually happens after a short period of inactivity (such as a lunch break, or a couple hours at your desk), followed by normal activity like walking or climbing stairs.
The injury itself may have been caused by any number of factors. The most common are:
This is probably the greatest single risk factor leading to Plantar Fasciitis. In some rare cases (such as pregnancy), your weight gain cannot be avoided. But in general, overweight people—particularly women—are much more likely to have persistent pain from the condition.
Inflexible Calf Muscles
This probably ranks equal with weight as a risk factor, but overweight people tend to be inactive physically. And an inactive lifestyle is likely to contribute to calf muscles that are tight or too short. There are also some people who simply have short calves.
Sudden Change In Activity
This risk factor can apply both to inactive people and active people. If you’re inactive, your calf muscles and plantar fascia are probably not conditioned for the additional stretching that occurs when you suddenly begin to perform activities, even relatively mild ones like walking.
Sports and Hard Activity
Sports that require lunging, jumping, or repetitive hard steps are particularly hard on the plantar fascia, especially when they take place on hard surfaces. Tennis, basketball, running, step aerobics, and volleyball are all examples. There is a real possibility of tearing the fascia away from the heel in activities like this, especially in competitive situations.
People in some occupations are more likely to develop Plantar Fasciitis. Waitresses, nurses, mail carriers, and teachers are all people who spend too much time on their feet each day.
What makes a “bad shoe”? One that is stiff, inflexible, and with too little arch support. Look for shoes where the toe bends back easily, and with plenty of cushioning inside.
Some people are subject to overpronation, where the ankle rolls inward slightly when walking or standing. This puts more weight on the insides of the feet, and may contribute to the development of Plantar Fasciitis. People with flat feet may experience overpronation more often.
The opposite is underpronation, and can also cause problems by rolling the feet outward. This occurs more often in people with high arches.
Some medications have a side effect or risk of weakening ligamentous tissue. Whether or not these medications actually cause Plantar Fasciitis is not proven, but there is some support for the possibility that quinolone antibiotics are a contributing factor.
This is a risk factor that obviously can’t be controlled, but if you simply can’t think of how you might have injured your foot, realize that older tendons and tissues are more susceptible to rips and tears.
Heel Spur Treatments
As mentioned earlier, a conservative approach to treatment is recommended. This means starting with the easiest, least expensive remedies, and advancing through them alone and in combination to realize pain reduction and eventual healing.
Remember that treatments for heel spurs are identical to treatments for Plantar Fasciitis—just because you have been given a diagnosis of “heel spurs” is no reason to jump ahead to surgery, which should be the very last option for any patient.
Ninety percent of patients will be “cured” of heel pain within a year of following the treatments described below—assuming they also make the lifestyle or activity adjustments that prevent further damage to the plantar fascia.
Ice and Rest
Heel spurs and the associated pain are considered a soft-tissue problem, and the first line of defense for these types of injuries is always ice (to reduce inflammation) and rest (to allow damaged tissue to heal).
It’s up to your schedule to determine when and how long to apply cold to the source of pain. If your work allows it, bring a gelpack to work in a cooler and use it whenever you have a few minutes off your feet. If you can’t manage that, then reserve a couple of slots after the day’s activities to apply ice for 5-8 minutes at a time. Remember that you just want to chill the bottom of your foot, not freeze it. Always use some kind of barrier between your skin and the ice.
Simple stretches can work wonders as far as limbering up the muscles and tendons that make your lets and feet work together smoothly. Of course, you’ll have to take care to stretch very slowly and gingerly at first, because energetic stretches will only damage your foot further.
But incorporate a few simple exercises into your daily routine:
- Balance on your toes at the edge of a stair or ledge. Slowly lower your heels until you can feel a pull. Repeat 10 or 12 times.
- Extend your legs each morning before getting out of bed, first with your feet pointed straight ahead, then with the toes pulled up toward the shin as much as is not painful. Gently hold for a few counts, and repeat until your feet feel “loosened”.
There are several products designed to help you massage and stretch your foot. In addition to making it easier to perform these actions, they feel great. A couple to look at are:
- A massage ball based on acupuncture techniques. Easy to use at home or at the office under your desk.
- The tried-and-true wooden foot roller.
Ibuprofen, aspirin and Aleve will give you some relief during periods of sharpest pain and will also reduce some of the inflammation that arises from Plantar Fasciitis.
If you can find this kind of medication in cream form, you can apply it directly to the site of pain for fastest, most effective action. One such anti-inflammatory ointment is called Traumeel; another is called Pentrex.
You’ll find lots of choices when it comes to products that isolate or immobilize at-risk areas of your foot. These items aim to reduce pain and further injury by keeping the plantar fascia safe from overextension. Some are meant to be used in your footwear to increase comfort while performing normal activities, while others are therapeutic.
- Pedifix’s Arch Bandage is a soft elastic bandage that gently squeezes the arch of your foot to provide support and extra stability.
- Dr. Leonard’s Plantar Fasciitis supports does double duty, with a night splint and also a daytime arch support. The night splint holds your foot in a gently extended position while you sleep, with the goal of keeping the plantar fascia from tightening up overnight and causing pain in the morning. Night splints in general seem to help a lot of people, and there are more specialized units available, such as the Bird & Cronin splint. You can find many more models online with different features to address your unique problems.
- Pro-Tec Athletics Arch Supports offers support in a more compact package, basically just a strap that wraps around the middle of the foot to relieve pain and stabilize the arch while you’re walking.
- Heel cups can provide great relief for the pain of heel spurs. There are many varieties and materials available—check out the HTP Heel Seats, shoe inserts that apply accupressure to the tender heel area.
- Mass-produced shoe inserts can be a helpful component for people seeking to alleviate pain and prevent further injury. These can be found at any drugstore, or look online for products like the Powerstep Pinnacle insert.
Another option is to use specialty athletic tape to achieve some of the same benefits as the products above. You can find detailed taping instructions online, or your doctor or physical therapist can help you find the best taping regimen for your individual problem.
Get a referral from your primary care physician to see a podiatrist for a more thorough exam of your problem. Whether the podiatrist fashions orthotics (shoe inserts) for you, or sends your prescription to a laboratory for manufacture, the quality and effectiveness of the devices will be vastly greater than anything your doctor can supply. It is not unheard of for an over-the-counter or mass-produced orthotic to hurt more than help a case of heel spurs, so if you’ve moved on to this step, invest in a quality product. Again, if the orthotic causes you more pain or does not relieve your pain, let the podiatrist know as soon as possible for another evaluation.
Although it may provide relief from pain, if you are still exploring less aggressive options to cure heel spurs this treatment might be ill-advised. If you totally mask your pain you will not be as able to tell whether other treatments are working.
Discuss this option thoroughly with your physician, therapist, and any other professionals you are consulting. Long-term use of steroids can actually start to have a weakening effect on tendons and cartilage—an effect that can exacerbate the heel spur syndrome you already have, and lead to more extensive problems.
There is not much research showing acupuncture to be a cure for heel spur pain, but some people have found relief using the method—similar to the cortisone injections, but less likely to cause additional problems.
Several points on the foot, ankle and leg may be selected for stimulation, some of it supplemented with tiny electrical pulses. The idea is that the acupuncture needles, inserted in specific areas of the body, release endorphins as anti-inflammatory agents. Most acupuncturists treating heel spurs will also include a massage of the calf and foot, and provide instruction on beneficial stretches to use between treatments.
Extracorporeal Shock Wave Therapy (ESWT)
Moving on to one of the more expensive options for treatment, ESWT should not be considered until the therapies above have been exhausted. The FDA requires that the condition be chronically painful for at least six months with less aggressive treatment before ESWT can be attempted.
The therapy sends shock waves into the foot using a device similar to an ultrasound. Perhaps it stimulates new blood flow to the injured area, promoting healing; perhaps it “reminds” the brain that there’s something wrong there and healing activities should begin again. Either way, for patients who have found no solutions thus far, and are not willing to take the extreme and most dangerous step to surgery, this might be an attractive option.
There are countless surgeries that an orthopedic specialist might perform in an effort to relieve the pain of chronic heel spurs. Very careful consideration of the risks should be taken before resorting to this step. Many patients have found that surgery cured their heel spur pain—but many have also found no relief or, in some cases, worse pain and more problems following surgery.