Heel Spurs

Heel spur – short overview

• Description: Spiny outgrowth of bone, usually at the lower, anterior edge of the heel bone
• Treatment: Shoe inserts, cold therapy, physiotherapy, shock wave therapy, radiation, anti-inflammatory drugs, surgery
• symptoms: Stinging pain in the back arch on standing and walking
• Causes: Overload (for example, through sports), foot deformity, obesity, shortened tendons
• Forecast: Therapy often tedious, often only within weeks or months effect, operations but usually not necessary

Heel spur – description

A heel spur (calcaneus spur) is a spine-like outgrowth of the heel. The much more common form is formed from the lower front edge of the heel bone along the sole of the foot towards the toes (plantar heel spur). The rarer, dorsal heel spur arises at the base of the Achilles tendon.

Often a heel spur causes no discomfort and is only accidentally detected by X-rays. Complaints usually occur when the foot is heavily loaded. Because this can cause a small inflammation and swelling in the approach of the tendon on the heel bone. It can cause severe, stinging pain when walking or standing.

Heel spur – treatment

A heel spur treatment aims to relieve acute pain and prevent future discomfort. Patients need a lot of patience for the therapy, because it can take a few weeks or even months before the symptoms disappear completely. Surgery is only necessary in rare cases.

discharge

The most important principle of heel spurs treatment is the discharge. At rest, the symptoms usually improve quickly. Therefore, patients should take a sports break and walk or stand as little as possible. In addition, it helps to elevate the foot.

pain medications

Often, however, relief is not enough to relieve the pain of heel spurs. Then additional pain medications can help. Particularly suitable for this are drugs that also inhibit the inflammation (anti-inflammatory drugs). These include active ingredients such as diclofenac or ibuprofen.

cold therapy

Cold relieves pain and inhibits inflammation. This works with ice, a cryopack or cold spray. The repeated application of cold then also increases the blood flow of the inflamed tissue, which accelerates the healing. Cryotherapy should be used for 10 to 15 minutes and repeated several times a day. To avoid frostbite of the skin, the skin should be protected by a thin layer of fabric.

physiotherapy

In the physiognomic therapy, the great tendon plate of the sole of the foot (plantar fascia), the calf muscles and the Achilles tendon are stretched. As a side effect, the tissue is better perfused by activation, which additionally promotes healing. The patient learns during the treatment special exercises, which he can continue to do at home.

infiltration therapy

As part of an infiltration therapy, the doctor injects a local anesthetic or cortisone preparation into the painful region of the foot. The anesthetic relieves acute pain. The cortisone preparation inhibits the inflammation. In this method, germs can easily enter the tissue. That’s why it should be done by an experienced doctor.

Heel spur deposits

Who tends to a heel spur should always wear comfortable shoes. In addition, you can pad the shoes skillfully. This relieves the foot and prevents new discomfort.

• With flatfoot, kinkfoot or hollowfoot there is a higher risk of heel spur. However, these foot deformities can be well balanced with orthopedic insoles. This often prevents even a heel spur arises.
• If there is already a lower heel spur (under the sole of the foot), inserts with a recess (perforated inserts), which are individually adapted to the orthopedics, help. Also viscoelastic inserts filled with a kind of gel or wide buffer heels help. They distribute the pressure on the entire foot and absorb bumps better.
• In the posterior heel spur (on the Achilles tendon), a heel cushion, felt pieces or heel wedges can be glued into the rear shoe cap for cushioning.

Shock Wave Therapy

Shock wave treatment uses a special device to apply strong pressure waves to the heel spur. They are supposed to irritate the tissue and stimulate blood circulation and cell metabolism. The inflammation heals faster and the pain decreases.

To do this, the doctor first marks the painful area on the foot with a pen. Then he places the transducer of the shockwave device on this spot. In three to five individual treatments shock waves are emitted for about 5 to 15 minutes.

radiotherapy

If other measures can not sufficiently improve the symptoms, a heel spur can also be treated with X-rays. The radiation dose is much lower than, for example, in X-ray of body structures or in cancer therapy. Therefore, there are no known acute side effects or late effects. Within approximately three weeks, the foot is irradiated a total of six times for a few minutes. Almost all patients are pain free after this heel spur treatment.

Heel spur surgery

Heel spurs are rarely performed. They are the last resort if all other therapies have failed. An operation is only possible with a heel spur under the sole of the foot. The surgeon scores the short foot muscles and loosens the tendon plate under the sole of the foot from the heel bone. This should relieve the tendon under the foot.

A heel spur surgery is not always successful and involves risks. Wound healing disorders can occur and scar tissue can increasingly form. Also, the natural protective fat pad under the heel may be lost during surgery.

Alternative forms of treatment

Heel spur-taping: Some patients also used so-called tapes to treat heel spurs. It is an elastic tape. Skin and connective tissue are shifted against each other by the use of the tape. This is intended to better blood circulation to the tissue.

In heel spur treatment, positive effects on pain receptors, muscle and tendon approaches are often achieved in this way. For the treatment stick the tape from the Achilles tendon to the middle of the sole with heel spur.

Heel spur Homeopathy: For the homeopathic treatment of heel spurs, the remedy Hekla lava D4 is used.

Cell salts: Schüssler salts such as Calcium Fluoratum D12, Calcium Phosphoric D6 and Silicea D12 are said to be good for bones and tendons.

Heel spur treatment: What you can do yourself

If you have a heel problem, you can use various exercises to improve it or prevent it from reappearing. The aim is to correct foot deformities, strengthen the foot and stretch the tendons and ligaments.

Fußmuskeltraining

Well-trained foot muscles are better able to absorb loads and impacts and thus relieve the tendons. For example, suitable exercises are to run on uneven ground such as a meadow or on the beach or to pick up and tear paper with your toes.

Stretching exercises on heel spurs

The plantar tendon under the foot can be rotated through various exercises. Place a tennis ball under the sole of the foot and roll it back and forth with vigorous pressure.

Another heel spurs exercise is to stand on a step with just ball of your feet, then lower your heels down until you feel a slight stretching pain in the sole of your foot.

A heel spur can also be formed by an increased pull on the Achilles tendon. This is counteracted by regular stretching of the calves.

Heel spur: symptoms

Even if you can see a heel spur on the radiograph, it does not necessarily cause discomfort. Conversely, pain can occur even if you do not see any changes in the X-ray image.

Most patients experience severe, stabbing pain around the heel or sole of the foot. These increase as the patient leaves. They can even be so pronounced that he can only walk on tiptoe. As soon as he is sitting, lying or resting his leg, the pain usually disappears.

However, the heel spurs complaints after a rest period, for example, in the morning when getting up often even more pronounced. Often a pain can be triggered by pressing on the corresponding spot on the heel.

A plantar (lower) heel spur causes pain at the inner front edge of the heel. In the dorsal heel spur, the pressure point is in the area of ​​the posterior shoe cap or at the somewhat higher Achilles tendon insertion (achillodynia).

Heel Spur: Causes and Risk Factors

The Kalkaneusporn arises by an overload of the foot. This leads to minor injuries and tears in the areas where the footplate tendon or the Achilles tendon are fused with the heel bone.

The micro injuries can cause an inflammation that attracts inflammatory cells. They repair the tissue by rebuilding it. This results in small calcifications and finally a heel spur.

There are several factors that increase the risk of calcaneal spur:

• Overweight: The heel is more heavily loaded with each step.
• Occupations in which one has to walk or stand a lot
• Foot misalignments such as kink-lowering foot or flat foot
• predisposition
• Inadequate warm-up before exercise: calf muscles, tendons and ligaments are then more taut and exert more force on the tendon insertion at the heel.
• Older age: As you get older, the fat pad shrinks under the heel. The tendons and bones are then less padded and are therefore more stressed.

If there is already a heel spur, it is reinforced by any further load. If the symptoms last longer, you should treat the heel spur in any case.

Heel spur: examinations and diagnosis

Most of the typical heel spurs already suggest the diagnosis. This suspicion is confirmed when pressure on the leading edge of the heel, around the back of the shoe or on the Achilles tendon causes pain or increased pain. The painful area is usually neither visibly swollen nor reddened.

To ensure the diagnosis, one can X-ray the foot laterally. In most cases, the ossification can already be clearly recognized on the x-ray. A large calcaneus spur does not necessarily cause more discomfort than a smaller one.

Heel spur: disease course and prognosis

A heel spur does not reform on its own. This is not a problem in itself, because the symptoms are caused by the inflammatory response and not by the bone outgrowth itself.

The inflammation can be abated by a suitable treatment, for example with medication or physiotherapy or medication. Then the symptoms disappear too. In most cases even simple relief measures such as suitable footwear, shoe inserts against heel spurs or stretching exercises help.

For stronger complaints, there are also other treatment options. An operation on heel spurs is only rarely necessary.

Additional information

Books:

• Good on foot for a lifetime: Exercise instead of surgery: the best exercises in Spiral Dynamics® by Christian Larsen, TRIAS (2013)