Heel spurs: treatment, symptoms and causes

quick overview

Definition: A thorn-like, bony outgrowth forms on the heel bone (calcaneus) in the heel spur.

Symptoms: Pain in the heel that can radiate into the calf muscles.

Diagnose: A heel spur can often be felt from the outside; in cases of doubt, an X-ray image can help.

Treatment: Relief and insoles help many of those affected, and radiotherapy and shock wave therapy are also possible.

Article content at a glance:

What is a heel spur?

A thorn-like, bony outgrowth forms on the heel bone in the heel spur (calcaneus spur). Bone outgrowth itself is painless, so it rarely needs treatment. Only when an additional inflammation develops does pain occur that requires treatment. About ten percent of the German population is affected at least once in their lives, most commonly between the ages of 40 and 60.

There are two types of heel spurs:

• dorsal or cranial heel spur: Irritation of the Achilles tendon leads to inflammation, which in turn leads to the formation of roughened bony calcifications. The upper heel spur is rather rare. People who do a lot of sport are often affected.

• plantar or medial heel spur: The heel spur on the underside of the heel bone is far more common. It is usually caused by overloading a connective tissue plate in the sole of the foot.

Inflammation of the tendon plate of the sole of the foot (plantar fascia) is also called plantar fasciitis.

Heel spur treatment with relief and insoles

In 80 to 90 percent of cases of heel spurs, the symptoms disappear on their own within a year, even without treatment. The focus of the treatment is not the removal of the spur, but the alleviation of the pain.

Short-term help: Self-measures for heel spurs

Those affected can do a few things themselves to relieve heel pain:

• Discharge: The most important therapeutic measure is rest to give the inflamed tissue the opportunity to recover. In addition, the foot can be relieved by being elevated. A heel pad can also protect the affected area on the sole of the foot.

• Pain medication: Pain-relieving and anti-inflammatory drugs can help make the symptoms more bearable.

• Cold therapy (cryotherapy): If you have tissue inflammation, cooling can help reduce pain and inflammation. The temperature of the affected tissue should be lowered several times a day for about 10 minutes using cold packs or ice.

Conservative measures for heel spurs

In addition, the following non-surgical measures can help to reduce the symptoms.

• Physical therapy: A targeted and gentle stretching of the muscles and ligaments involved stimulates blood circulation, which promotes recovery. Physiotherapists can show those affected exercises that they can do on their own at home.

• Medical insoles: Well-padded insoles, ideally with holes cut out, reduce the pressure on the heel and promote the healing of inflammation. The insole should have a soft heel bedding. The costs are usually covered by the statutory health insurance companies.

• Infiltrationstherapie: Most of time A combination of local anesthetic (anaesthetic) and cortisone is injected into the heel. Injections with botulinum toxin are also considered a promising treatment option. The active ingredient relaxes the thickened tendon and pain can be relieved.

• shock wave therapy (also called extracorporeal shock wave therapy or ESWT): With the help of high-energy shock waves, the muscles are loosened and hardening is removed. In addition, trigger points for the perception of pain can be addressed directly. Some health insurance companies cover the therapy if other conservative measures have not achieved any improvement over a longer period of time.

• Radiotherapy: X-ray stimulus radiation has an anti-inflammatory effect and reduces heel pain. According to the German Society for Radiation Oncology (DEGRO), the chances of success of radiotherapy for heel spurs are high. Due to the low radiation dose, practically no side effects or long-term effects are to be expected.

Surgical therapy for heel spurs

Surgical intervention is only considered if conservative measures are not effective in the long term. In a heel spur operation, for example, the bony outgrowths are removed in a minimally invasive manner. In addition, the tendon plate under the sole of the foot can be detached from the heel bone in order to relieve the tendon under the foot. It is important to know that no surgical method can eliminate the pain with certainty.

Causes: How does a heel spur develop?

Heel spurs are degenerative, i.e. caused by wear and tear. It is usually caused by excessive or incorrect strain on the foot. As a result, small injuries occur at the base of the Achilles tendon or footplate tendon, which are reproduced as ossification in the course of the repair measures. As a result, there is a bone outgrowth at the tendon attachment of the heel, which is also somewhat roughened. The surrounding tissue can then easily become inflamed and painful.

There are some risk factors that increase the risk of developing a heel spur. This includes:

• ill-fitting and, above all, too tight shoes without a cushioning effect

• Excessive physical activity or excessive sports in an untrained state (especially with repetitive loads, such as running and jumping)

• standing for a long time, for example at work

• heavy physical work

• overweight and obesity

• congenital deformity of the heel bone

• Foot malpositions, for example pes cavus, skewed foot or flat foot

Symptoms: This is how you can recognize the heel spur

A heel spur often causes no symptoms. However, severe stinging can occur if the surrounding tissue, such as the plantar tendon (plantar fasciitis), becomes inflamed. The pain is most severe after periods of rest and in the morning immediately after getting up. They can be so severe that those affected can hardly walk, but usually pass relatively quickly as soon as the affected area is relieved. Pain in the calf muscles is also possible.

Heel spur: This is how the diagnosis works

Sometimes a heel spur can already be felt. This is the case when it has already reached a certain size. However, because the growth does not always cause symptoms, it often goes undetected.

The clear diagnosis of heel spurs can be made with the help of X-rays. Then the one to five millimeter long bony outgrowth on the heel bone (calcaneus) can be seen on the X-ray image. to recognize. In addition, diseases such as rheumatism, Bechterew’s disease or gout must be ruled out.

Preventing heel spurs: preventive measures

A heel spur and the associated complaints can be prevented by avoiding overloading or incorrect loading of the foot. The most important measure is suitable footwear with a cushioning, cushioning effect. The shoes must not be too tight and put pressure on the Achilles tendon. Shoe inserts that are individually adapted to the soles of the feet and the gait can also be used preventively against heel spurs. The relief of the heel region also benefits above all overweight people, whose risk is increased due to the additional strain.

In order to prevent the calcaneus spur through sport, you should not only wear suitable shoes, but also ensure sufficient warm-up and stretching exercises before and after training and avoid overloading.