Introduction
The heel spur is a bony extension of the heel bone (calcaneus). The spur is often located at the bottom of the sole of the foot (plantar heel spur) as an ossification at the base of a tendon plate running there. More rarely is the posterior heel spur, which is located at the rear edge of the calcaneus at the base of the Achilles tendon.
Symptoms and causes
Not every patient with a heel spur also shows symptoms. These are typically load-dependent pain in the heel area. A characteristic feature is an early morning pain immediately after getting up in the morning, which initially improves after a few steps.
Whether the pain occurs permanently during the day or only after a longer period of stress (walking distance) depends on how advanced the disease is. Those affected describe the pain as bright and sharp, with possible radiation into the entire rear foot or down to the calf. The heel spur develops on the floor of a degenerative wear of the heel bone, which is why its occurrence in the population increases with age.
The heel spur is a very common disease, so that approximately every second elderly person is affected by a heel spur. A heel spur develops due to increased pressure and strain on the tendon attachments of the calcaneus. This permanent stimulus causes the tendon fibers to rebuild bones, resulting in a spur-like bone formation at the tendon attachment.
This often leads to an inflammatory reaction in the surrounding tissue. Apart from age, overweight and unsuitable footwear are the main suspected risk factors. Various foot malformations (especially a flat-foot kink) also contribute to the development of a heel spur.
Diagnosis
If the doctor suspects a heel spur on the basis of the patient’s medical history, he can try to trigger a pressure pain over the corresponding area. For confirmation, an x-ray is used, which shows a heel spur well. In early stages, the x-ray can be inconspicuous despite the onset of symptoms. In such cases, MRI or ultrasound can be helpful in assessing the onset of ossification of the tendon structures.
