The heel spur is a persistent and, in the vast majority of cases, burdensome disease that, also like hallux valgus (bunion), contributes to more or less severe restrictions on walking and affects more and more people. Because of the painfulness and the impairment of the functionality of the foot, the heel spur forces patients to limit walking to an increasing extent.
What is heel spur?
Calcaneal spur, often colloquially referred to as heel spur and more commonly known by that name, is based on abnormal growths of bone substance. A heel spur is an irregular, deformed increase of bone tissue, which can be characterized as a so-called bone outgrowth. The heel spur manifests itself on the foot, on the heel bone. There is the origin for a muscle of the calcaneus. The heel spur is known in medical diagnostics as plantar heel spur and as Haglund’s heel spur or Haglund’s exostosis.
Causes
Various factors are named as the cause of the formation of the heel spur. Basically, it can be mechanical triggers that exist in the form of constant exertion of pressure and traction on the heel bone. For these overloads, which favor a heel spur, incorrect postures or misalignments of the foot skeleton as well as unsuitable footwear are responsible. The external causes, which can often be influenced by those affected themselves, are excessive body weight and, in particular, extreme obesity, malpositions of the feet such as flat, flat or splay feet and the constant exercise of very heavy physical activities. In addition, the development of heel spurs can be promoted by patients wearing poorly fitting or pressure-applying footwear and by excessive exercise without having been sufficiently trained beforehand. Genetic predispositions are also possible triggers for heel spurs. The cause of Haglundexostosis as a heel spur is a mechanical irritation of the Achilles tendon insertion by the heel-side edge on the shoe.
Symptoms, complaints and signs
Typical symptoms of heel spur are pain at the tendon insertions. Here, there is mainly a stabbing pain on the soles of the feet. Most often, this pain occurs in the early morning, when the first steps out of bed. But also after longer resting of the feet strong stabbing pains occur again. The heel spur usually forms over the course of several weeks or even months, and therefore slowly suggests itself with increasingly severe discomfort and pain. Only after some time, when it is more pronounced, it is also palpable or visible to the naked eye from the outside of the affected area. A bulge is perceived at the point of emergence of the heel. The bulge is hard and yields a little under pressure, but this is associated with pain. Increasingly severe pain is also perceived during walking and normal treading. In the case of the upper heel spur, on the other hand, there is pressure pain in the area of the Achilles tendon. Here, too, pain on exertion can occur during walking. In addition, skin redness is occasionally found in the affected areas. The heel spur is often caused by too much strain or incorrect loading, also incorrect footwear can be its cause. Thus, it is one of the very common sports injuries and often occurs in runners, boxers and footballers. It is often accompanied by plantar fasciitis, in which the tendon running along the bottom of the foot is overloaded. Overuse of the Achilles tendon can also lead to a heel spur, as can the reverse. In rarer cases, the heel spur also occurs at the back of the heel rather than the tread. Typically, a heel spur announces itself with a longer lead time, so it may well be that the symptoms are sometimes more and sometimes less pronounced when it occurs. Often, the symptoms will also go away during this early phase.
Course
There is an overuse at the tendon of the sole of the foot, which is called plantar fascia, in a heel spur and minimal tears begin at first. Due to the irritation of periosteum and other tissues, small foci of inflammation form, resulting in pain of the lower heel region in heel spur. The heel spur becomes pronounced due to the removal of calcium substances for the repair of the tears. This always runs directly next to the tendon cord.If the foot is subject to excessive stress from traction at the base of the foot, which is typical in a deformity known as a bent-lower foot, then this can lead to tendon ossification in the presence of a lower heel spur.
Complications
If a heel spur is not treated by a doctor for a long period of time, there is a fear of an increase in inflammation of the surrounding soft tissue. Intense irritation often increases the complications of the heel spur. Sometimes this can even cause a fatigue fracture of the calcaneus because the load on the bone is increased and there is no longer any tension on the tendon plate. This discomfort makes later surgery inevitable due to non-treatment. After surgery, it cannot be ruled out that the condition may manifest itself through wound healing disorders, infections or through problematic scars. In addition, nerve injuries with local numbness may occur. Furthermore, complications in the form of thrombosis or pulmonary embolism may occur despite treatment. In rare cases, a treated heel spur can also result in a bone infection (osteomyelitis). Regardless of whether treatment of the heel spur is conservative with medication or surgical, there is a risk that the complications will recur and the pain will return. Early treatment of heel spurs is also important to avoid risking long-term damage. These could otherwise cause changes in foot statics or develop a chronic course of pain.
When should you see a doctor?
If there is painful swelling of the foot or heel, a doctor should be consulted promptly. A noticeable heel spur is best examined and treated by a specialist. If inflammation of the foot occurs, medical advice is also required. Otherwise, a fatigue fracture of the calcaneus may occur and need to be treated in a hospital. Chronic pain and symptoms of a circulatory disorder should also be clarified by a doctor. If serious complications such as thrombosis or pulmonary embolism occur, the emergency physician must be called. First aiders must administer first aid and check the pulse and breathing of the affected person. In most cases, however, a heel spur does not present any problems. A visit to the doctor is nevertheless necessary to rule out secondary symptoms and, if necessary, to remove the ossification. In addition to the family doctor, the orthopedist or a chiropractor can be consulted, depending on any accompanying symptoms and the previous course of the disease. If a deformity in the feet is causative, this must be treated concomitantly by a foot surgeon or orthopedist.
Treatment and therapy
The heel spur is a deformity that does not always manifest itself in painful symptoms. If the heel spur is not too severe an impairment, then usually no therapy is performed. Only when the affected person can hardly walk and pain occurs, different types of therapy can be implemented. These initially consist of the initial conservative treatments and any surgical measures that may be required. In some cases, treatment for a heel spur is already successful and the pain goes away when the affected areas of the foot are relieved. In the case of a plantar or lower heel spur, orthopedic aids such as a so-called heel cushion with a hole insert are recommended. In addition, hole insoles supplement the treatment. If it is a Haglundexostosis as a heel spur, then shoes made of soft materials and lower back edges on the shoe than the heel spur are beneficial. Other forms of therapy for heel spur include heat and cold and ultrasound treatments. The use of shock wave technology is also effective for heel spurs. Alongside this, pain-relieving and anti-inflammatory ointments are often prescribed. Surgical intervention involves gradual removal of the heel spur by abrasion, and some portion of the tendon cord is separated out.
Outlook and prognosis
Provided there has been no damage to the skeletal system, heel spurs have a good prognosis if medical care is sought. Regression of the symptoms without active countermeasures is not expected. Since the cause is an inflammatory process, it must be cured by the administration of medication. Spontaneous healing is not to be expected.If self-responsible measures are taken in support of the prescribed medicine, the complaints are reduced and the healing process is shortened. Wearing healthy footwear and regular stretching exercises improve well-being and promote recovery. Despite the good prognosis, the heel spur can recur throughout life. The prospects for cure remain favorable if the condition recurs. The re-formation of the heel spur depends on factors that can be influenced by the affected person. Overexertion and obesity should be avoided for long-term healing. In addition, wearing shoes with high heels or in an incorrect shoe size should be avoided. If the self-help tips are followed, there is a good chance of a permanent cure. If permanent impairments to the skeletal system have already developed as a result of the bone outgrowth, the prospect of complete freedom from symptoms worsens. Depending on the extent of the damage, there may be lifelong restrictions or disturbances in mobility.
Prevention
To avoid the formation of a heel spur, it is advisable to avoid tight, pressing and rubbing footwear. If there are deformities of the feet, then appropriate orthopedic measures ensure that prevention of heel spur can be guaranteed. A reduction of body weight, the avoidance of overloading and overstressing of the feet, even through long periods of standing, is also considered prophylaxis against heel spur.
Aftercare
Doctors advise avoiding surgery at first because it can cause persistent pain. Therefore, prevention is considered the best aftercare. This usually falls under the patient’s responsibility. The attending physician provides information about suitable measures. In addition, physiotherapy can be ordered. If the symptoms are due to inflammation, medication can also help. As a general rule, patients should take care of the tendons in the soles of their feet. They can achieve this by choosing comfortable footwear. Under no circumstances should they be too tight. Sufficient stretching is important before sporting activities. Short posture exercises can bring about relief. Strengthening the foot muscles by long walks on uneven terrain is advisable. Shoes can be cushioned with the help of insoles. This relieves the feet in everyday life. Furthermore, severe overweight puts a strain on the heel – with every step. A diet can provide relief and significantly reduce the discomfort. If the typical signs of heel spurs are permanently present, scheduled check-ups become necessary. In addition to a superficial examination, the doctor usually has an X-ray taken. This clearly shows the degree of ossification. The progress is clearly documented. Surgical intervention can also be discussed as a result.
What you can do yourself
Usually, a pronounced heel spur announces itself with stabbing pain every morning with the first steps after getting up. A less pronounced heel spur, on the other hand, usually causes no discomfort at all, so it usually goes unnoticed. Since many different causes can trigger the development of a lower or an upper heel spur, it is advisable to find out possible reasons when the first signs appear. These can be, for example, poorly fitting footwear, constant incorrect stress in sports or simply overloading of the foot as a result of extreme overweight. In many cases, other footwear that is better adapted to the anatomy of the foot can already help as a self-help measure. For athletes who have problems with a heel spur, it is advisable not only to think about changing shoes, but also to seek advice from an experienced physiotherapist about the footwear and about certain movement sequences in order to possibly train a different, less stressful movement sequence. If the heel spur is essentially caused by an acquired or congenital foot malposition, custom-made insoles usually help; they help to gradually reduce the incorrect load on the foot, which can curb the inflammation on the foot tendons that causes pain. It is recommended to have the insoles made by an experienced orthopedic shoemaker. The insoles can be permanently installed or loosely inserted so that they can be used for other shoes.
