Heel spurs are a common cause of foot and heel pain in many people… or are they?? It seems only logical, right? You have pain on the bottom surface of your heel. You see a doctor who takes an x-ray of your foot. They show you a piece of bone growing on the bottom of your foot right where you have pain! That’s got to be the cause of the pain, right? Time for surgery to remove that thing…
While extremely large heel spurs can cause some discomfort during strenuous activity, the vast majority of people with heel spurs don’t even realize they have them until they see them on an x-ray. Does that mean we completely ignore a heel spur if we see it on an x-ray? Not necessarily, but the presence of a heel spur is an indicator that something is functionally wrong with the way the foot and ankle are working. Personally, I tend to look at a heel spur as a SIGN of the foot dysfunction/pain and not the root cause.
What is a heel spur?
Heel spurs or calcaneal spurs are bony overgrowths arising from the underside of the calcaneal bone. The overgrowth is a result of constant pulling of the soft tissues of the foot at its insertion site on the calcaneal bone. The most common spot for a heel spur to develop is on the bottom medial surface of the calcaneus; the insertion site of the plantar fascia. You may have heard that plantar fasciitis and heel spurs go hand in hand. That’s because plantar fasciitis is essentially overstretching and inflammation of the plantar fascia. If the problem is not addressed and becomes chronic, the tissue of the plantar fascia will start to change! It becomes thickened and more rigid rather than stretchy and pliable; like a rope compared to a rubber band. That means that instead of the soft tissue stretching as much, there is more tug at the insertion site at the calcaneus. That constant chronic tug of the calcaneus will cause the body to reinforce the area by laying down extra bone to strengthen the attachment site. And alas, a heel spur begins to form and grow!
Does that heel spur need to be removed?
Most times, if a heel spur is present, it DOES NOT need to be removed surgically. Conservative treatment has been shown to be extremely effective for heel and foot pain. Manual therapy and soft tissue therapies can be used to improve the flexibility of the plantar fascia and soft tissues of the foot to reduce the amount of tug on the calcaneus. Chiropractic adjustments of the foot and ankle joints and functional rehab of the intrinsic foot muscles are performed to improve arch function and improve joint mobility to further reduce stress on the plantar fascia and calcaneus. Implementing at home anti-inflammatory strategies like icing, stretching, and adhering to an anti-inflammatory diet will reduce the inflammation associated with this condition as well. Custom-fit orthotics may also be used to help support the arch and foot to further reduce the pull on the calcaneus during strenuous activity or exercise. This multi-faceted approach has been shown to greatly reduce or even completely eliminate the pain of heel spurs and their associated conditions.
If these conservative methods fail, more aggressive therapy may need to be applied. Anti-inflammatory or steroid injections can be used to introduce anti-inflammatory chemicals directly into the problem area. Only after these options fail as well should surgical removal of the heel spur be considered.