Heel spur

Ricarda Schwarz studied medicine in Würzburg, where she also completed her doctorate. After a wide range of tasks in practical medical training (PJ) in Flensburg, Hamburg and New Zealand, she is now working in neuroradiology and radiology at the Tübingen University Hospital.

More about the experts All content is checked by medical journalists.

A heel spur (calcaneus spur) is a thorn-like bone growth on the calcaneus. It is caused by small tendon injuries that calcify. The reasons for such injuries are mostly improper and overloading. If you have a calcaneal spur, walking or standing can be very painful. Here you can read what you can do to get rid of the symptoms.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. M77

Heel Spur Quick Overview

Description: thorn-like bone growth, mostly on the lower, front edge of the heel bone
Treatment: shoe insoles, cold therapy, physiotherapy, shock wave therapy, radiation, anti-inflammatory drugs, surgery
Symptoms: sharp pain in the arch of the foot when standing and walking
Causes: Overload (e.g. through sport), misaligned feet, overweight, shortened tendons
Prognosis: Therapy is often protracted, often only shows an effect within weeks or months, but operations are usually not necessary

Heel spur - description

A heel spur (calcaneus spur) is a thorn-like bone outgrowth on the heel. The much more common form is formed from the lower, front edge of the heel bone along the sole of the foot towards the toes (plantar heel spur). The rarer, dorsal heel spur arises at the insertion of the Achilles tendon.

Heel spurs often cause no discomfort and are only discovered by chance during an X-ray. Symptoms usually occur when you put intense pressure on the foot. Because this can cause a small inflammation and swelling at the start of the tendon on the heel bone. It can cause severe, sharp pain when walking or standing.

This is how the lower heel spur is created

Chronic micro-injuries at the tendon plate attachment of the lower heel bone result in calcification that later ossifies.

Heel spur treatment

Heel spur treatment aims to relieve acute pain and prevent future discomfort. Patients need a lot of patience for the therapy: It can take a few weeks or even months for the symptoms to completely disappear. However, surgery is only necessary in rare cases.

discharge

The most important principle of heel spur treatment is relief. The symptoms usually improve quickly when the patient is calm. Therefore, patients should take a break from exercising and walk or stand as little as possible. In addition, it helps to elevate your foot.

Pain medication

Often, however, relief is not enough to alleviate the pain in the heel spur. Then additional pain medication can help. Medicines that also inhibit inflammation (anti-inflammatory drugs) are particularly suitable for this. These include active ingredients such as diclofenac or ibuprofen.

Cold therapy

Cold relieves pain and reduces inflammation. This works with ice, a cryopack or cold spray. The repeated application of cold also increases the blood flow to the inflamed tissue, which accelerates healing. The cold therapy (cryotherapy) should be used for 10 to 15 minutes and repeated several times a day. In order to prevent the skin from freezing, the skin should be protected by a thin layer of fabric.

physiotherapy

In physiotherapeutic therapy, the large tendon plate of the sole of the foot (plantar fascia), the calf muscles and the Achilles tendon are stretched. As a side effect, the activation of the tissue improves blood flow, which also promotes healing. During the treatment, the patient learns special exercises that he can continue to carry out at home.

Infiltration therapy

As part of infiltration therapy, the doctor injects a local anesthetic or a cortisone preparation into the painful area on the foot. The anesthetic relieves acute pain. The cortisone preparation inhibits inflammation. With this procedure, germs can easily get into the tissue. It should therefore be carried out by an experienced doctor.

Heel spur insoles

Anyone prone to heel spurs should generally wear comfortable shoes. In addition, the shoes can be cleverly cushioned. This relieves the foot and prevents further discomfort.

If you have a flat foot, arched foot or arched foot, there is a higher risk of developing a heel spur. However, these foot deformities can be compensated for with orthopedic insoles. This can often prevent a heel spur from developing at all.
If there is already a lower heel spur (under the sole of the foot), insoles with a recess (perforated inserts), which can be individually orthopedically adapted, help. Visco-elastic inserts filled with a kind of gel or wide buffer heels also help. They distribute the pressure over the entire foot and absorb shocks better.
In the case of the rear heel spur (on the Achilles tendon), a heel cushion, pieces of felt or heel wedges can be glued into the rear shoe cap for cushioning.

Shock wave therapy

During shock wave treatment, a special device is used to direct strong pressure waves onto the heel spur. They are supposed to irritate the tissue and stimulate blood circulation and cell metabolism. The inflammation heals faster and the pain is reduced.

To do this, the doctor first marks the painful tender spot on the foot with a pen. Then he places the transducer of the shock wave device on this point. In three to five individual treatments, shock waves are emitted for around 5 to 15 minutes each.

radiotherapy

If other measures have not been able to improve the symptoms sufficiently, heel spurs can also be treated with X-rays. The radiation dose is much lower than, for example, when x-rays of body structures or in cancer therapy. That is why there are no known acute side effects or long-term effects. Within about three weeks, the foot is irradiated a total of six times for a few minutes. Almost all patients are pain-free after this heel spur treatment.

Heel spur operation

Heel spur operations are very rarely performed. They are the last resort when all other therapeutic measures have failed. An operation is only possible if there is a heel spur under the sole of the foot. The surgeon notches the short muscles of the foot and loosens the tendon plate under the sole of the foot from the heel bone. This is supposed to relieve the tendon under the foot.

Heel spur surgery is not always successful and involves risks. Wound healing disorders can occur and increased scar tissue can form. The natural protective fat pad under the heel can also be lost during the operation.

Alternative forms of treatment

Heel spur tapes: Some patients also use so-called tapes to treat a heel spur. This is an elastic adhesive tape. The use of the tape pushes the skin and connective tissue against each other. As a result, the tissue should be better supplied with blood.

In this way, heel spur treatment often has positive effects on pain receptors, muscle and tendon attachments. For treatment, the tape is stuck from the Achilles tendon to the middle of the sole of the foot with a heel spur.

Heel spurs homeopathy: The remedy Hekla lava D4 is used for the homeopathic treatment of heel spurs.

Schüssler salts: Schüssler salts such as Calcium Fluoratum D12, Calcium phosphoricum D6 and Silicea D12 are said to be good for bones and tendons.

Heel spur treatment: what you can do by yourself

Anyone who has symptoms from a heel spur can improve them with various exercises or prevent them from reappearing. The aim is to correct malpositions of the feet, to strengthen the foot and to stretch the tendons and ligaments.

Foot muscle training

Well-trained foot muscles can better absorb loads and shocks and thus relieve the tendons. Suitable exercises are, for example, walking on uneven ground such as a meadow or on the beach or picking up paper with your toes and tearing it up.

Stretching exercises for heel spurs

The plantar tendon under the foot can be rotated through various exercises. To do this, place a tennis ball under the sole of your foot and roll it back and forth with strong pressure.

Another exercise in heel spurs is to stand on a step with the balls of your feet only, then let your heels sink down until you feel a slight stretching pain in the soles of your feet.

A heel spur can also form due to increased tension on the Achilles tendon. Regular stretching of the calves counteracts this.

Heel spur - surgery is very rare

Three questions for

Prof. Dr. habil. Peter Diehl,
Specialist in orthopedics and trauma surgery
1
Can I prevent heel spurs from developing?

Prof. Dr. habil. Peter Diehl
Anything that takes the strain off the feet helps. Avoid being overweight. Shoes with cushioning cushions are important, especially when doing sports that place high loads on the feet. Correct running technique also plays a role. And get clarified in good time whether you suffer from a foot deformity. A flat or arched foot can promote the development of a heel spur.
2
Surgery is now very rare. How do you treat today?

Prof. Dr. habil. Peter Diehl
In addition to physiotherapy, custom-made shoe insoles have proven their worth. Methods that can reduce the inflammation and thus the pain in the heel spur area are also helpful. There is, for example, shock wave therapy or the injection of growth factors. Surgery is only performed if conservative treatment no longer helps.
3
What helps with acute complaints?

Prof. Dr. habil. Peter Diehl
In acute pain, the best way to protect your feet is to put them up and cool them. Wear proper shoes with good insoles, i.e. with a heel support and cushioning pads. Cortisone injections are only a temporary solution. The anti-inflammatory does reduce pain. However, it can cause permanent tissue changes on the soles of the feet and thereby exacerbate the pain.
Prof. Dr. habil. Peter Diehl,
Specialist in orthopedics and trauma surgery
Chief physician of minimally invasive shoulder and knee joint surgery at the Orthopedic Center Munich East, expert in cartilage and stem cell therapy

Heel spur: symptoms

Even if you can see a heel spur on the X-ray, it does not necessarily have to cause discomfort. Conversely, pain can also occur if you do not see any changes in the X-ray image.

Most of the time, the patients feel severe, stabbing pain in the area of the heel or the sole of the foot. These increase as the patient leaves. They can even be so pronounced that he can only walk on tiptoe. As soon as he sits, lies down or rests the leg, the pain usually disappears again.

However, the heel spur complaints are often more pronounced after a period of rest, for example when getting up in the morning. Often pain can also be triggered by pressing on the appropriate point on the heel.

A plantar (lower) heel spur causes pain on the inner front edge of the heel sole. In the case of the dorsal heel spur, the pressure point is in the area of the rear shoe cap or at the slightly higher-lying Achilles tendon attachment (achillodynia).

Heel spur: causes and risk factors

The calcaneus spur is caused by overstressing the foot. This leads to small injuries and tears in the areas where the footplate tendon or the Achilles tendon have grown together with the heel bone.

The micro-injuries can cause inflammation that attracts inflammatory cells. They repair the tissue by remodeling it. This results in small calcifications and finally a heel spur.

There are a few factors that increase your risk of developing calcaneus spur:

Overweight: The heel is more heavily loaded with every step.
Professions in which you have to walk or stand a lot
Foot malpositions such as flat feet or flat feet
Disposition
Insufficient warm-up before exercise: calf muscles, tendons and ligaments are then more tense and exert greater force on the tendon attachment at the heel.
Older age: As you get older, the fat pad under your heel shrinks. The tendons and bones are then less padded and therefore more stressed.

If a heel spur is already present, it will be aggravated by every additional load. If the symptoms last longer, the heel spur should definitely be treated.

Heel spur: examinations and diagnosis

Most of the time, the typical heel spur pain suggests the diagnosis. This suspicion is confirmed when pressure on the front edge of the heel sole, in the area of the rear shoe cap or at the insertion of the Achilles tendon causes or increases pain. The painful area is usually neither visibly swollen nor reddened.

The side of the foot can be x-rayed to confirm the diagnosis. Most of the time, the ossification can already be clearly seen on the X-ray. A large calcaneus spur does not necessarily have to cause more discomfort than a small one.

The heel spur on the x-ray

Heel spur: disease course and prognosis

A heel spur does not resolve on its own. This is not a problem in itself, because the symptoms are caused by the inflammatory reaction and not by the bone growth itself.

The inflammation can be reduced by appropriate treatment, for example with medication or physiotherapy or medication. Then the symptoms will go away too. Most of the time, even simple relief measures such as suitable footwear, shoe insoles against heel spurs or stretching exercises help.

For more severe symptoms, there are also other treatment options. Surgery for heel spurs is very rarely necessary.