A heel spur, known medically as a calcaneal spur, is a calcium deposit that develops over time on the underside of the heel bone, or calcaneus. This bony outgrowth typically forms where the plantar fascia, a long, thick ligament, attaches to the bone. An X-ray provides a clear visual confirmation of this common condition.
Why Imaging Is Essential for Diagnosis
An X-ray is the standard imaging method for evaluating heel pain because it effectively visualizes bone structures. Imaging is used to rule out other, potentially more serious, causes of pain, such as a stress fracture, a bony tumor, or arthritis. The lateral, or side view, radiograph is the most informative projection for viewing a heel spur, providing a clear profile of the heel bone. While an X-ray is excellent for bone, it does not show soft tissues like tendons or ligaments, which is an important consideration in diagnosis.
Interpreting the Heel Spur on X-ray
On a radiograph, a heel spur appears as a distinct, dense white area extending from the calcaneus. Since X-rays capture bone density, the calcium deposit registers as a sharp, bony outgrowth, described by radiologists as a radiopaque density. Heel spurs are classified by their location on the heel bone. The most common type is the inferior or plantar spur, which projects forward along the bottom of the foot, associated with chronic tension on the plantar fascia ligament. Less frequently, a posterior spur can form at the back of the heel where the Achilles tendon attaches. The size and shape of a spur can vary significantly, ranging from a small bump to a large hook.
The Symptom/Image Disconnect
A common misunderstanding is that the size of the heel spur seen on the X-ray directly correlates with the amount of pain a person experiences. Many individuals have noticeable, large heel spurs but report no pain whatsoever; they are completely asymptomatic. When pain is present, it is rarely caused by the rigid, non-moving spur itself. The actual source of discomfort is typically the inflammation of the surrounding soft tissue, specifically the plantar fascia (plantar fasciitis). X-rays only show the bone, meaning they cannot visualize the thickness or swelling of the inflamed plantar fascia. Therefore, a physician relies heavily on a patient’s description of pain and clinical findings to determine the correct diagnosis.
General Management Following Confirmation
Once an X-ray confirms the presence of a heel spur and a clinical exam links it to symptomatic soft tissue inflammation, the initial focus of management is conservative care. The primary goal is to decrease inflammation in the plantar fascia and surrounding tissues, not to remove the spur. This approach typically involves a combination of rest and activity modification to reduce repetitive strain on the heel. Treatment includes stretching exercises designed to lengthen the Achilles tendon and the plantar fascia. Supportive footwear and orthotics are often recommended to provide better arch support and distribute pressure. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to help manage the pain and reduce the local inflammation.