The calcaneal spur, often called a heel spur, is a common orthopedic condition involving a bony growth on the heel bone. This growth frequently develops alongside chronic soft-tissue inflammation in the arch of the foot. While the spur itself is often silent, the associated inflammation can cause sharp, debilitating pain and limit mobility. Understanding the anatomy and pain mechanism is key to effective management.
The Anatomy of a Calcaneal Spur
A calcaneal spur is a calcium deposit that forms a bony protrusion, or osteophyte, extending from the underside of the heel bone (calcaneus). It develops in response to long-term strain and micro-trauma at the insertion point of the plantar fascia, the thick band of tissue connecting the heel to the toes. Repetitive tension causes the body to deposit extra calcium near the attachment site, leading to the gradual formation of the spur. The bony spur itself is not typically the source of pain; approximately 15% of the population has spurs without symptoms. The pain experienced is almost always a result of the accompanying inflammation, known as plantar fasciitis.
Identifying the Associated Pain
The characteristic pain linked to a calcaneal spur is caused by the inflammation of the plantar fascia. Individuals commonly describe the sensation as a sharp, stabbing pain localized to the bottom of the heel, often extending toward the arch. This pain is most intense during the first steps taken in the morning or following any prolonged period of rest. While resting, the plantar fascia tightens and contracts. When weight is suddenly placed on the heel, the contracted tissue is abruptly stretched, causing immediate discomfort. As the person walks and the fascia warms up, the pain often lessens, returning after another period of inactivity.
Non-Surgical and Lifestyle Interventions
Initial Pain Management
The initial approach focuses on reducing inflammation and easing tension on the plantar fascia. Applying ice to the affected heel for 15 to 20 minutes several times a day helps to decrease swelling and relieve localized pain. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can also be used temporarily to manage both pain and inflammation.
Stretching and Support
Stretching exercises are a foundational element of conservative treatment, focusing on the calf muscles and the plantar fascia itself. Simple stretches, like rolling a tennis ball under the arch of the foot, help to lengthen the tight tissues. Wearing night splints while sleeping is also effective, as these devices hold the foot in a slightly flexed position, preventing the fascia from contracting overnight and reducing severe morning pain.
Footwear and Orthotics
Supportive footwear and orthotic devices are important for reducing stress on the heel during weight-bearing activities. Shoes should feature thick soles, extra heel cushioning, and adequate arch support to absorb shock and distribute pressure evenly across the foot. Both off-the-shelf inserts and custom-fitted orthotics provide the necessary support to correct biomechanical imbalances and relieve the constant pulling on the calcaneal insertion point.
Medical Diagnosis and Advanced Care
A professional diagnosis begins with a physical examination and a review of symptoms. An X-ray confirms the presence of the bony calcaneal spur and helps rule out other causes of heel pain, such as a stress fracture. If conservative measures fail to provide sufficient relief after several months, a medical professional may recommend advanced interventions. Corticosteroid injections can be administered directly into the area of inflammation to provide localized pain relief by reducing tissue swelling. Physical therapy is often prescribed for specialized stretching and strengthening routines. Non-invasive treatments like extracorporeal shock wave therapy (ESWT) may also be used to stimulate soft tissue healing. Surgery is only considered as a last resort, typically after nine to twelve months of failed conservative treatment, and often involves a partial release of the plantar fascia.