A calcaneal enthesophyte is the medical name for a heel spur, a small bony outgrowth on the heel bone where a tendon or ligament attaches.1Best Foot Doc. What Are Calcaneal Enthesophytes and What Causes Them? It is the body slowly laying down bone in response to long-term stress at that attachment, not the result of a sudden injury.2Best Foot Doc. What Are Calcaneal Enthesophytes and What Causes Them? Heel spurs become more common with age, and many people who have one never feel it.3PubMed. Evidence for a distinctive pattern of bone formation in enthesophytes
Where Heel Spurs Form and What They Look Like
“Calcaneal” refers to the calcaneus, the heel bone. An enthesis is the spot where a tendon or ligament anchors into bone, and an enthesophyte is bone growing at that attachment point.4Best Foot Doc. What Are Calcaneal Enthesophytes and What Causes Them? It is not the same as the bone spur that forms inside a joint with osteoarthritis.5Best Foot Doc. What Are Calcaneal Enthesophytes and What Causes Them?
There are two common sites. A plantar spur sits under the heel, where the plantar fascia attaches; the plantar fascia is the tough band running along the sole.6PubMed Central. The age dependent change in the incidence of calcaneal spur A posterior (or dorsal) spur sits at the back of the heel, where the Achilles tendon attaches.7PubMed Central. The age dependent change in the incidence of calcaneal spur On X-ray, both kinds look like bony points that are narrow at the base and bulky at the tip, and the tip points in the direction of the tendon or fascia attached there.8PubMed Central. Why heel spurs are traction spurs after all
The site named in your report tells you where a soft-tissue problem might be: the underside for the plantar fascia, the back for the Achilles tendon. Having a spur at one site says nothing about the other.9PubMed Central. Changes in prevalence of calcaneal spurs in men & women: a random population from a trauma clinic
The spur is usually a few millimetres long, not the large claw people tend to imagine. The finding describes the shape of the bone, not what is causing pain.
What Causes Calcaneal Enthesophytes to Form
Spurs form where the attachment is most fibrous.10PubMed. Evidence for a distinctive pattern of bone formation in enthesophytes Tendons and ligaments reach bone through a transition zone that moves from soft fibre to tougher fibrous tissue to bone, and spurs arise in the toughest part. That zone takes the concentrated force of every step, so long-term load can change the tissue there. The change is a gradual remodelling, not a tear that fails to heal.
A thick layer of hardened, cartilage-like tissue appears first, and small knots of bone then develop inside it.11PubMed. Evidence for a distinctive pattern of bone formation in enthesophytes Over time those islands grow and join the heel bone, leaving a visible bony point on X-ray. Because it starts as tissue rather than bone, an early spur may not show on an X-ray at all. That build-up takes months to years. Spurs are rare and small before about age 40, and finding one does not date a recent injury.
At the Achilles, spurs can form without any earlier small tears or inflammation.12Arthritis & Rheumatism. The mechanism of formation of bony spurs (enthesophytes) in the Achilles tendon So a spur is not necessarily a sign that you injured the tendon.
The old explanation is that the fascia or tendon tugs on the bone until it grows a spur.13PubMed Central. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? But spurs under the heel do not grow inside the plantar fascia itself, which argues against simple pulling there.14PubMed. Heel spur formation and the subcalcaneal enthesis of the plantar fascia They may instead follow wear-and-tear changes at the fascia’s attachment.15PubMed. Heel spur formation and the subcalcaneal enthesis of the plantar fascia In older adults, flat or rolled-in feet were not linked to spurs, which points to the weight pressing down on the heel more than pulling.16PubMed Central. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? Other researchers still find the spur’s shape consistent with pulling at both sites.17PubMed Central. Why heel spurs are traction spurs after all
The two sites may form spurs in different ways, and pulling and pressing may both contribute. Either way, long-term load appears to play a central role.
Who Is Most Likely to Develop a Heel Spur
Spurs become more common as people age.18PubMed. Evidence for a distinctive pattern of bone formation in enthesophytes Large spurs were seen mainly between ages 40 and 79, and there were no large plantar spurs under 40.19PubMed Central. Changes in prevalence of calcaneal spurs in men & women: a random population from a trauma clinic Under age 50, women had spurs more often than men.20PubMed Central. Changes in prevalence of calcaneal spurs in men & women: a random population from a trauma clinic In a large X-ray review, 12.4% of patients had spurs, more often women and older people.21PubMed. The conundrum of calcaneal spurs: do they matter? The reasons for the pattern in women are not settled, so it is no rule for any individual.
Weight, arthritis-type conditions, and foot position are all linked to spurs under the heel.22PubMed Central. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations The heel takes your body weight with every step, so more weight means more load on the attachment points. It is one of several linked factors, though, and many lighter people have spurs.
People with type 2 diabetes had spurs more often in one clinic group, 77% compared with 57% of people without diabetes.23Endocrine Abstracts. Calcaneal spur incidence is increased in patients with type 2 diabetes mellitus Among people with diabetes, those with spurs were older, heavier, and more likely to have nerve damage in the feet.24Turkish Journal of Physical Medicine and Rehabilitation. Increased Calcaneal Spur Frequency in Patients with Obesity and Type-2 Diabetes Mellitus That shows an association, not that diabetes directly grows spurs, and age and weight may explain part of the link. Nerve damage can dull feeling, so foot problems in people with diabetes are worth having checked rather than ignored.
Pressure on the heel at work is thought to contribute.25Endocrine Abstracts. Calcaneal spur incidence is increased in patients with type 2 diabetes mellitus In assembly-plant workers, long hours standing on hard floors and walking raised the risk of heel pain from plantar fasciitis.26PubMed. Risk factors for plantar fasciitis among assembly plant workers
Some types of inflammatory arthritis, known as spondyloarthritis, inflame attachment points directly.27PubMed Central. MRI of enthesitis of the appendicular skeleton in spondyloarthritis Heel spurs or heel pain alongside back pain may be worth mentioning to a doctor.
Does a Heel Spur Cause Heel Pain
People with heel pain under the foot are almost 5 times more likely to have a spur on X-ray.28PubMed Central. Medical imaging for plantar heel pain: a systematic review and meta-analysis Yet in older adults, 61% of people with spurs had no heel pain.29PubMed Central. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? A spur alone does not explain the pain.
The usual source of this pain is plantar fasciitis, irritation of the band under the foot.30PubMed Central. The age dependent change in the incidence of calcaneal spur It often occurs with a spur, which is one reason the two get confused, but it can occur without one, and treatment is aimed at the fascia. The X-ray shows bone, not the irritated soft tissue that usually hurts, so the better question is whether your symptoms match plantar fasciitis. Typically that means sharp pain with the first steps in the morning, easing with walking and returning after rest, with tenderness on the underside of the heel.
The spur itself may still contribute in some people. Spurs longer than about 5.3 mm, and obesity, each roughly doubled the odds that a spur was painful.31PubMed Central. Association of Obesity and Plantar Fasciitis in Patients With Plantar Heel Spurs That is a statistical association, not a test for any one person. Pain may be worse when the spur’s angle brings it into contact with the plantar fascia.32PubMed Central. The Relationship between Calcaneal Spur Type and Plantar Fasciitis in Chinese Population People with spurs also reported more foot pain even when plantar fasciitis was ruled out.33PubMed. The conundrum of calcaneal spurs: do they matter?
How Heel Spur Pain Is Treated
First steps usually include stretching, supportive shoes or inserts, rest from long standing, and weight loss where relevant. Before standing in the morning, pull your toes up toward your shin with your hand and hold briefly, which stretches the sole. Stretch the calf by leaning toward a wall with the back leg straight and the heel down. Repeating these daily helps more than occasional long sessions.
For footwear, cushioned, supportive shoes with a small heel spread pressure better than thin, flat soles. In a computer model, a 4 cm heel lowered peak heel pressure by about 22% compared with a flatter shoe.34EDP Sciences (MATEC Web of Conferences). Effects of Different Heel Heights on Heel Pressure Distribution for Calcaneal Spur Patients during Standing: Finite Element Analysis So a small heel rather than flat soles may ease pressure. Avoid walking barefoot on hard floors, even at home, and cut back on long stretches of standing where your work allows. Heel-cushioning inserts are a reasonable first step.
Expect weeks to months of steady care, not days. Stopping once the pain eases can let it return, so many people keep stretching for longer. If nothing improves after a few months, ask about other options.
Shockwave therapy is an option when other care fails.35PubMed Central. Is extracorporeal shockwave therapy an effective treatment for calcaneal spur? A literature review After five sessions, two thirds of people were pain-free and about 16% had their pain halved.36PubMed. Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes The spurs themselves barely changed.37PubMed. Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes
Surgery is less straightforward. Removing the spur alone gave good results in fewer than half of people in older reports.38Podiatry Today. Plantar Calcaneal Spurs: Is Surgery Necessary? Partly releasing the fascia without removing the spur gave excellent results in most people.39Podiatry Today. Plantar Calcaneal Spurs: Is Surgery Necessary? Removing the spur during fascia surgery delayed pain relief and the return to walking in shoes.40PubMed. The effect of plantar calcaneal spur excision on plantar fascia surgery outcomes The spur did not regrow within 12 months when it was removed in keyhole surgery.41PubMed Central. Comparison of Short-Term efficacy between medial and lateral dual incision approach and medial dual incision approach for endoscopic spur resection combined with plantar fascia release in the treatment of heel pain syndrome
Other Causes of Heel Pain to Rule Out
A trapped nerve in the heel, sometimes called Baxter’s neuropathy, can cause numbness, tingling, or pain along the nerve’s path.42PubMed Central. Plantar Fasciitis with Chronic Baxter’s Neuropathy Causing Hindfoot Pain – A Case Report Pain spread along a path rather than at one tender spot can hint at a nerve source. It can coexist with plantar fasciitis, so a clinician may need to separate the two.
Pain at the back of the heel can come from the Achilles tendon.43PubMed Central. The age dependent change in the incidence of calcaneal spur Even with a spur there, the tendon rather than the bone may be the source. It is felt where the tendon meets the heel, so location is a clue to which tissue is involved.
In children and young teens, heel pain is often Sever’s disease, strain at the heel’s growth plate, rather than a spur.44PubMed Central. Imaging in Pediatric Spondyloarthritis It tends to track with activity and often settles with rest and activity changes.
See a doctor for numbness or tingling in the foot, pain at night, pain that does not improve after a couple of months, swelling, redness, or several joints hurting at once. Heel pain in a child or teenager also warrants a visit.
A visit usually involves pressing on the foot to find the sore spot and an X-ray to show any spur. An ultrasound or MRI may follow if the soft tissues need a closer look.