A heel spur (or osteophyte) is a small bony growth or collection of bony growths on the back or underside of the heel. They may or may not cause pain, and patients often confuse heel spurs with a related condition known as plantar fasciitis, inflammation of the band of tissue that stretches from the ball of the foot to the heel, forming the arch. Many people have bone spurs without ever knowing it, and about 70 percent of patients with plantar fasciitis who do have discomfort will also be found to have a heel spur when observed via X-ray. It is likely that a bone spur forms as the body tries to repair itself from repeated injury by laying down extra bone at the site of trauma. Plantar fasciitis is typically another result of such trauma. Heel spurs are most often seen in middle-aged men and women, but can be found in all age groups.
One frequent cause of heel spurs is an abnormal motion and mal-alignment of the foot called pronation. For the foot to function properly, a certain degree of pronation is required. This motion is defined as an inward action of the foot, with dropping of the inside arch as one plants the heel and advances the weight distribution to the toes during walking. When foot pronation becomes extreme from the foot turning in and dropping beyond the normal limit, a condition known as excessive pronation creates a mechanical problem in the foot. In some cases the sole or bottom of the foot flattens and becomes unstable because of this excess pronation, especially during critical times of walking and athletic activities. The portion of the plantar fascia attached into the heel bone or calcaneous begins to stretch and pull away from the heel bone.
Pain and discomfort associated with heel spurs does not occur from the spur itself. The bone growth itself has no feeling. However, as you move, this growth digs into sensitive nerves and tissue along the heel of the foot, resulting in severe pain. Pain can also be generated when pushing off with the toes while walking. Swelling along the heel is also common.
A thorough history and physical exam is always necessary for the proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are helpful, as excess bone production will be visible.
Non Surgical Treatment
In some cases, heel spur pain may not be resolved through conservative treatment options. In those cases, cortisone injections may be used to reduce inflammation associated with the condition, helping to reduce discomfort. However, treatment options such as these must be discussed in detail with your physician, since more serious forms of treatment could yield negative side effects, such as atrophy of the heel's fat pad, or the rupture of the plantar fascia ligament. Although such side effects are rare, they are potential problems that could deliver added heel pain.
Have surgery if no other treatments work. Before performing surgery, doctors usually give home treatments and improved footwear about a year to work. When nothing else eases the pain, here's what you need to know about surgical options. Instep plantar fasciotomy. Doctors remove part of the plantar fascia to ease pressure on the nerves in your foot. Endoscopy. This surgery performs the same function as an instep plantar fasciotomy but uses smaller incisions so that you'll heal faster. However, endoscopy has a higher rate of nerve damage, so consider this before you opt for this option. Be prepared to wear a below-the-knee walking cast to ease the pain of surgery and to speed the healing process. These casts, or "boots," usually work better than crutches to speed up your recovery time.