Heel Spur

Medically reviewed by Oluseun Olufade, MD

A heel spur, or calcaneal spur, is a bony growth of calcium deposits on the back or bottom of the heel bone that often has a hooked, pointy, or shelf-like shape.

Heel spurs develop when strain or pressure damages the foot over long periods causing an inflamed tendon or ligament to attach to the heel bone. Having a heel spur doesn't always cause symptoms, but many people experience sharp pain, especially when walking or standing.

Heel spurs affect about 15% of the general population and are most common in older adults, people with plantar fasciitis (inflammation in the tissue in the heel of your foot), and people living with obesity.

Fortunately, treatment can help reduce symptoms. At-home measures like getting adequate rest, ice therapy, stretching, and wearing supportive footwear may help manage the pain. Medical treatments like cortisone injections, shockwave therapy, and laser therapy are also available for more painful heel spurs. Surgery can remove heel spurs when other treatment methods are ineffective.

Types

Healthcare providers categorize heel spurs based on where they form near your heel bone.

Plantar Heel Spur

A plantar heel spur forms on the bottom of the heel, where the plantar fascia ligament attaches to the heel bone. Inflammation of the plantar fascia (medically known as plantar fasciitis) can cause calcium deposits to build up on the bottom of your heel and form a plantar heel spur.

Dorsal Heel Spur

A dorsal heel spur appears on the back of the heel, near the point where the Achilles tendon connects to the heel bone. Inflammation of the Achilles tendon can cause calcium deposits to build up on the back of the heel.

Heel Spur Symptoms

Not all heel spurs cause noticeable symptoms. When symptoms do occur, they often stem from the inflammation of the surrounding tissues on your foot, rather than the spur itself. Sometimes, inflamed tissues put pressure on the nerve that runs through the heel, causing numbness, burning, or tingling sensations.

The primary symptom of a heel spur is heel pain, which may feel like a sharp, stabbing sensation at the bottom or back of the heel. Pain may be more intense when taking your first steps in the morning and after physical activity or prolonged periods of rest.

What Causes A Heel Spur?

Repeated stress and strain on your heel from physical activity and walking or running on hard surfaces for long periods can damage the ligaments and tendons in your feet. Inflammation can occur when your body attempts to heal the damaged tissue. Over time, the irritation you feel occurs due to excess calcium buildup at the site of the microtears (small tears).

Risk Factors

Anyone can develop a heel spur, but certain factors can increase your risk, including:

• Intense physical activity: Physical activities that place extra demands on your feet, such as running, jumping, dancing, and high-impact sports can put stress on your heels.

• Occupation: Working a job that requires prolonged standing on hard surfaces, such as nursing and teaching causes prolonged stress on your feet.

• Obesity: Excess body weight can put extra demand on your feet that causes microtears in the ligaments and tendons.

• Footwear: Wearing poorly fitting shoes or shoes with little arch support or heel cushioning (e.g., high heels) can aggravate symptoms.

• Foot structure: Having flat feet or high arches may also increase the risk of heel spurs

• Age: Heel spurs most often affect middle-aged and older adults.

• Underlying conditions: Certain types of arthritis, including rheumatoid arthritis (RA), ankylosing spondylitis and spondyloarthritis (spinal and joint inflammation), osteoarthritis, and Reiter's disease (caused by infection), can co-occur with heel spurs.
  

Diagnosis

Healthcare providers aim to identify the underlying cause of heel pain, confirm the presence of a heel spur, and rule out other conditions with similar symptoms during the diagnostic process.

During diagnosis, you can expect your healthcare provider to perform or order the following tests:

• Medical history: Review past medical history, underlying health conditions, current medications, and symptoms you’re experiencing

• Physical exam: Check for signs of swelling, pain, and tenderness around your feet and heels and assess your feet’s range of motion

• X-ray: Take detailed images of the bones in your foot to detect the presence of a heel spur and confirm a diagnosis

• Magnetic resonance imaging (MRI): Take detailed images of the soft tissues and nerves in your foot to assess the extent of soft tissue damage and nerve inflammation

Treatment

Heel spurs only require treatment if they are causing pain and discomfort. In many cases, at-home remedies are enough to relieve pain associated with a heel spur. The goal of treatment is to improve symptoms and reduce inflammation.

At-Home Treatments

Your healthcare provider may recommend trying the following remedies to treat your heel spur at home:

• Get rest or take a break from activities that require you to be on your feet

• Apply ice packs to your heels for up to 20 minutes at a time to reduce inflammation

• Use over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) for pain relief

• Stretch the plantar fascia and calf muscle to improve flexibility and reduce stress on your heels

• Choose shoes with good arch support or use orthotics to provide extra cushioning for your feet

Medical Treatments

When at-home treatments are ineffective and symptoms last longer than nine months, your healthcare provider may recommend one or more of the following treatments:

• Cortisone injections in your heels to reduce pain and inflammation

• A cast or walking boot to limit movement in your feet

• Extracorporeal shock wave therapy (ESWT), which delivers high-energy shockwaves to damaged tissues, such as ligaments and tendons, to stimulate healing and tissue repair

• Radiofrequency thermal ablation (RFA), which applies a high-frequency, high-temperature electric current to the damaged tissues in your heel to reduce inflammation
  

Surgery

Calcaneal spur excision is a surgical procedure that removes a heel spur. Healthcare providers will usually only recommend surgery if your symptoms are extremely severe and other treatments haven’t worked and you have been experiencing pain has lasted for nine months or longer.

Depending on the location of the heel spur, your healthcare provider may perform one of two surgeries:

• Inferior heel spur excision: Involves removing a heel spur on the bottom of the heel. Because plantar fasciitis often causes this type of heel spur, healthcare providers may perform a plantar fasciotomy (cutting the connecting tissue in the foot) at the same time they remove your heel spur.

• Retrocalcaneal heel spur excision: Removes a heel spur on the back of the heel. If a heel spur grows into the Achilles tendon, healthcare providers may need to detach your tendon altogether to access and remove the spur and reattach the tendon before completing the surgery.

How To Prevent Heel Spurs

It’s not always possible to prevent a heel spur. However, prevention strategies often look similar to at-home treatment options. To reduce your risk of developing heel spurs:

• Stretch your calf muscles and plantar fascia regularly

• Wear supportive footwear

• Warm up before you exercise

• Massage your feet, especially if you are on your feet for long periods

Related Conditions

Plantar fasciitis and Achilles tendinitis are the most common conditions that cause heel spurs. However, these conditions may also increase your risk of developing a heel spur:

• Gout: A form of inflammatory arthritis that affects the Achilles tendon and heel

• Tarsal tunnel syndrome (TTS): Compression of the tibial nerve (located near the tibia, the bone that runs down the leg to the ankle)

• Rheumatoid arthritis (RA): An autoimmune disease that causes your immune system to attack the synovium (the lining that covers your joints)

• Osteoarthritis (OA): An age-related form of arthritis that causes the cartilage in joints to break down from normal "wear and tear”

A Quick Review

Heel spurs are bony growths that can develop on the back or underside of the heel bone. Not everyone experiences symptoms with a heel spur, but this condition can cause pain and inflammation around your heels and feet.

Fortunately, at-home remedies and medications can help keep symptoms at bay. If you develop a heel spur, try your best to stay off of the injured foot as much as possible and look into supportive footwear options—so you can get back on your feet soon.

Frequently Asked Questions

What's the difference between a heel spur and plantar fasciitis?

Plantar fasciitis is inflammation of the plantar fascia ligament, while a heel spur sticks out on the heel bone in response to inflammation or injury of the ligaments and tissues in the foot. Plantar fasciitis is one of the most common causes of heel spurs.

What happens if a heel spur goes untreated?

Untreated heel spurs can lead to chronic pain that can limit mobility and affect daily life. A heel spur can also irritate the soft tissues surrounding the bony growth, causing further inflammation and pain.

Is walking good for heel spurs?

Taking your first steps in the morning may be painful with a heel spur, especially one that develops due to plantar fasciitis.

Walking while wearing supportive shoes with heel cushioning may help reduce your pain. Avoid activities that aggravate your pain or place heavy demands on your foot, and opt for low-impact exercises like swimming or cycling if walking is too uncomfortable.

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