Calcaneal Spurs · What Are They, Signs and Symptoms, Treatment, and More

Calcaneal spurs, or heel spurs, are small bone growths that develop in the calcaneus, which is the bone that makes up the heel. Heel spurs are typically painless, however, they can cause pain when they exert pressure on surrounding nerves or soft tissues, thereby leading to heel pain on standing or walking. 

Most heel spurs develop at the calcaneal tuberosity, a bony growth at the bottom of the heel that serves as the attachment point for the plantar fascia. More rarely, they can develop on the back of the heel, at the site of insertion of the Achilles tendon, where they can be associated with Achilles tendonitis.

Calcaneal spurs develop as the body’s response to inflammation of a tendon or ligament at its attachment point to the bone. In plantar heel spurs, repetitive microtrauma or traction of the plantar fascia can result in an inflammatory reaction that triggers the formation of new bone. In many cases, heel spurs coexist with inflammation of the plantar fascia, or plantar fasciitis, but it is unclear whether spurs cause plantar fasciitis or represent a secondary response to inflammation. 

Risk factors for heel spurs include conditions that put more pressure on the heel, such as obesity, prolonged standing, working on hard surfaces, overtraining, and flat feet. As individuals age, the heel’s protective fat pad becomes thinner and the plantar fascia becomes less flexible, increasing the risk of both heel spurs and plantar fasciitis. Some individuals may have a genetic predisposition to generate heel spurs from levels of stress insufficient to initiate bone growth in others. Finally, individuals with bone and joint disorders such as osteoarthritis, rheumatoid arthritis, gout, and ankylosing spondylitis are also more likely to develop heel spurs. 

Calcaneal spurs do not always cause heel pain, however, when they do, it is usually palpated over the bottom of the heel and the sole of the foot. The symptoms are similar to those of plantar fasciitis, with pain typically being worse in the morning and after prolonged rest, gradually lessening with activity.  The associated pain may also appear at the end of the day or after spending long periods of time on the feet. Additionally, high-impact activities such as running or jumping, or training in bare feet, can often exacerbate the symptoms. 

Calcaneal spurs are diagnosed by X-rays, a CT scan, or other imaging tests of the foot. On a X-ray lateral view of the foot, plantar heel spurs can be seen as small spike-like projections of the calcaneal tuberosity at the bottom of the heel, whereas dorsal heel spurs are located above the insertion of the Achilles tendon.

A thorough clinical history and physical examination of the foot can help differentiate if the heel pain is caused by heel spurs or another condition, such as plantar fasciitis, degeneration of the heel fat pad, or compression of the foot’s nerve structures (e.g., entrapment of the inferior calcaneal nerve, or Baxter neuropathy). 

Treatment of calcaneal spurs is only needed if they cause pain or discomfort. Heel pain can be relieved with anti-inflammatory medications, such as ibuprofen or naproxen. Other measures, such as physical therapy and stretching of the plantar fascia can help decrease the pain. Common exercises that can be completed at home include rolling a tennis ball under the feet, and leaning the body against a wall with one foot in front of the other until a stretch is felt in the back leg. Additionally, supportive shoes with extra cushioning or shoe inserts, such as silicone heel pads, may help reduce pain when standing or walking. 

In cases where conservative treatment is not effective, surgery may be necessary to improve the symptoms. Surgery can be conducted through open or minimally invasive techniques and usually involves removing the heel spur and releasing the plantar fascia from its attachment point to relieve the associated inflammation. 

Calcaneal or heel spurs are bone growths that typically occur at the bottom of the heel bone. They represent the body’s response to inflammation of a tendon or ligament at its attachment point to the bone and are usually associated with plantar fasciitis. Although heel spurs are painless, they can result in heel pain when pressing on surrounding nerves or soft tissues. Diagnosis of heel spurs is done radiologically with X-rays of the foot. Treating heel spurs is only necessary if heel spurs cause symptoms, and consists of medications to relieve the pain, physical therapy, shoe orthotics, and surgery if other conservative measures are not effective.