Heel Spur
What is a heel spur? A heel spur is a calcium deposit under the heel, at the point where the tendon running to the forefoot attaches. A heel spur doesn't have to cause any complaints, but under overload it can trigger inflammation in the plantar fascia. This inflammation causes intense, persistent pain under the foot, at the heel.
Complaints and symptoms of a heel spur
The symptoms of a heel spur are typically as follows:
- Pain under the heel, especially first thing in the morning or after sitting still for a while. The pain is often felt at the front of the heel, though sometimes the entire sole of the foot feels bruised. Walking and warming up usually helps, though the improvement only becomes noticeable after some time. When the nerves and blood vessels have been at rest, they become stressed as soon as you stand up. After walking for a bit, the nerves adjust again and the heel pain eases somewhat. In more severe cases of heel spur, however, that improvement doesn't occur.
- Standing still for long periods is painful, which is a particular problem for people whose job involves a lot of standing.
- Driving is uncomfortable. Heel pain while driving is a typical heel spur symptom, caused by the unnatural position of the foot.
The longer a heel spur goes untreated, the harder it becomes to resolve.
How common is a heel spur, and who gets it?
Around 30 to 75% of the Dutch population has a heel spur, though far from everyone notices it – only about 10% develop pain. It's a particularly common injury among runners. People under 45 rarely experience heel spur symptoms. Children can experience similar symptoms, but these are then classified under Sever's disease, which usually resolves on its own once the load on the foot is adjusted.
Factors that increase the risk of a heel spur include overload from sport, poor footwear, hiking in mountainous terrain, excess body weight, and standing for long periods. A tight calf muscle, flat feet or high arches, a pinched nerve, thin fat padding under the heel (particularly in older people), or a stiff sole (for example, if a shoe doesn't roll properly through the step) can also contribute.
What can I do myself?
A heel spur almost never disappears on its own, but it responds well to treatment. Make sure you recognise the symptoms in time and get enough rest. Try to avoid walking, running and standing as much as possible at first. An insole can sometimes help, since it improves pressure distribution in the foot and takes some of the load off the plantar fascia. A podiatrist can advise you on this.
Treatment
Physiotherapy aims to strengthen your tendons, bones and muscles, using a range of different methods.
The physiotherapist can help you find ways to relieve pressure on the heel. A gel insole can help reduce the structural load during walking.
They can also give you stretching exercises, help strengthen the relevant muscles, and stimulate blood flow – and therefore recovery – in the tendon with deep massage techniques or dry needling.
If needed, they will refer you, in consultation with you and your GP, to a podiatrist.
The combination of rest and physiotherapy often gives good results, though it can sometimes take a fair amount of time. For that reason, a number of alternative treatments are also available in some cases, and your physiotherapist can advise you. Depending on how early you address it, the rest you take and the exercises you do, the pain typically disappears after anywhere from a few weeks to several months.