Heel pain and calcaneal spurs

Reviewed by Dr Stephen Collins, GP

What is a calcaneal spur?

A calcaneal spur is a small bony projection that is formed on the calcaneus or heel bone. It is caused by putting too much pressure on the sinew on the soles of the feet, usually over a long period of time.

What causes heel pain and calcaneal spurs?

Every time you take a step, one of your heels has to support the whole weight of your body. As you move, the load is equal to 20 times your own body weight. The load is softened by a pillow of fat under the heel and a large sinew under the sole of the foot.

If an athlete does not warm up properly or a person with a sedentary job exercises heavily during the weekends, they might overload the muscles of the calf or the Achilles tendon. These are also fixed on the heel bone. When the muscles of the calf or Achilles tendon are overloaded there will be extra strain on the sinew and muscles in the soles of the foot. The overload can cause inflammation and even small cracks in the sinew.

Every time you sit down, sleep or otherwise rest your legs, the muscles of the sole of the foot will contract in an attempt to protect the damaged sinew. The pain in the heel will then no longer be felt. But when you get up again the pain will return and when you move again, the sinew will crack even more.

To compensate for the repeated damage to the sinew, the body will try and repair it in the same way that it would attempt to repair a broken bone, namely, by wrapping it up in bone. The result is a small bony projection on the heel bone called a calcaneal spur.

But it is not the spur itself that causes the pain. The spur is the result of a prolonged overload of the sinew at the sole of the foot.

What are the symptoms of an overloaded sinew or calcaneal spur?

A sharp, stabbing pain under or on the inside of the heel.

The pain is typically relieved during rest, but is worse after getting up again.

As a rule of thumb, it is most painful first thing in the morning.

The pain is made worse by walking on a hard surface or carrying something heavy, such as a suitcase.

The pain can become so severe that it becomes difficult to continue your daily work.

Special risk groups

Most sufferers are people who are overweight and middle-aged. This is due to the shock-absorbing fat pillow under the foot shrinking over the years and becoming less effective.

Weekend athletes.

People who have feet that are pronated and not corrected. Pronated means that the foot tends to roll inwards when a person walks or runs.

Foot care advice

Take time to warm up and stretch before taking part in sport or exercise and cool down afterwards.

If you run or jog, it is better to run a short distance several times a week than one long run once a week.

Do not overestimate your abilities. If necessary, seek advice about creating a suitable running schedule that will give your body time to adapt.

If you experience pain in the heel, you may be overloading your tendons.

To help the healing process, follow the RICE principle, which stands for Rest, Ice, Compression and Elevation.

Rest the foot and do not run until it is completely healed. Apply an ice pack, such as a packet of frozen peas that has first been wrapped in a towel or cloth. An elasticated support bandage will compress and support the foot. It should be firm, but not so tight that it affects the circulation of blood. Elevate the foot by resting it on a chair or a pillow.

Invest in suitable shoes.

The heel can be supported with a small cushioned insole inside the shoe.

Arch supports that fit inside shoes will prevent feet from pronating.

If you are overweight, losing weight can help prevent foot problems.

How does the doctor make the diagnosis?

Calcaneal spurs are usually diagnosed by the symptoms revealed during a clinical examination.

To eventually confirm the diagnosis and exclude other possible causes of heel pain like arthritis, the doctor may order other investigations such as X-rays.

Prognosis

Once a calcaneal spur develops it can be a difficult condition to treat. However, many cases involve only minor ligament damage, which is relieved in a matter of weeks or months.

Prevention by taking early corrective measures against any predisposing factors will improve the long-term prognosis.

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