A heel spur is a calcium deposit that forms a bony protrusion on the underside of the heel bone (calcaneus). While the term suggests the spur is the source of discomfort, the pain experienced usually results from inflammation in the surrounding soft tissues, most commonly the plantar fascia. Although surgical removal is possible, it is rarely the initial treatment recommended. Most patients find success with non-surgical methods aimed at addressing the associated inflammation and strain.
Understanding Heel Spur Formation and Symptoms
The underlying cause of a heel spur is chronic, repetitive strain on the foot’s muscles and ligaments, particularly where the plantar fascia attaches to the heel bone. This prolonged stress is often linked to factors such as abnormal walking patterns, unsupportive footwear, or excessive body weight. These factors place increased tension on the heel structure. In response to this mechanical stress, the body attempts to repair the damaged site by laying down new bone tissue, which eventually calcifies into the spur.
Heel spurs are frequently seen with plantar fasciitis, which is inflammation of the plantar fascia ligament. The pain is typically sharp and stabbing, often described as a pin or knife-like sensation, especially when taking the first steps in the morning or after rest. This intense pain usually lessens as the foot warms up with movement, but a dull ache may return after extended activity or standing. Diagnosis is confirmed via an X-ray, though the presence of a spur does not always correlate with the severity of the pain.
Non-Surgical Approaches to Pain Relief
Because the pain is primarily caused by inflammation rather than the spur itself, conservative, non-surgical treatment is the standard first line of defense. The goal is to reduce inflammation, alleviate strain on the plantar fascia, and modify activities that aggravate the condition. Initial steps involve rest and activity modification, such as switching from high-impact activities like running to low-impact exercises like swimming or cycling.
Applying ice to the affected area for short periods several times a day can help reduce inflammation and pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are commonly recommended for short courses to manage pain and decrease swelling in the tissue. These medications work by blocking the production of chemicals that cause inflammation.
Physical therapy is a major component of conservative treatment, focusing on specific stretching exercises for the plantar fascia and the calf muscles. Tight calf muscles, particularly the gastrocnemius, can increase tension on the Achilles tendon and, subsequently, the plantar fascia. A physical therapist can also recommend modalities like taping or strapping the foot to provide temporary support and reduce stress on the stressed tendons and muscles.
Supportive footwear and orthotic devices are effective tools for managing heel spur pain. Custom or over-the-counter shoe inserts, such as soft silicone heel pads, provide cushioning and slightly elevate the heel, reducing tension on the plantar fascia. For persistent morning pain, a night splint may be used; this device holds the foot in a slightly flexed position overnight to gently stretch the plantar fascia and calf. If pain persists despite these measures, a corticosteroid injection may be administered directly into the inflamed area for an anti-inflammatory effect.
Surgical Removal: Criteria and Procedure
Non-surgical methods successfully resolve symptoms for over 90% of patients. Surgical intervention is considered when severe pain persists after a minimum of six to twelve months of consistent conservative treatment. Surgery is viewed as a last resort because it carries risks, including nerve pain, infection, and recurrent heel pain. The decision to operate is based on the failure of the pain to resolve, not simply the presence or size of the bony spur.
When surgery is performed, the primary focus is often not solely on removing the heel spur, but on addressing the tension on the plantar fascia. The most common procedure is a plantar fasciotomy, where a portion of the plantar fascia ligament is released or cut from its attachment to the heel bone to relieve tension. The surgeon may also perform a calcaneal osteotomy, which is the removal or shaving of the bony spur itself, but this is secondary to the fasciotomy.
The procedure can be performed using an open technique, which involves a larger incision, or an endoscopic technique, which utilizes smaller “keyhole” incisions and specialized instruments. Endoscopic surgery is associated with a faster recovery time. Post-operative recovery involves a period of non-weight bearing or limited weight bearing, often requiring a surgical boot or cast. This is followed by physical therapy to regain strength and mobility. Most individuals see significant improvement within three to six months.