Dr Tariq Jagnarine
Family Med, Endocrinology / Diabetes

A heel spur is a foot condition that is caused by a bony-like growth, called a calcium deposit that extends between the heel bone and arch. Heel spurs often start in the front of and underneath the heel. They eventually affect other parts of the foot and can get up to half an inch in length. Detecting heel spurs can be challenging. Heel spurs do not always cause pain, and not all heel pain is related to spurs.

Heel spurs are directly caused by long-term muscle and ligament strain. Eventually, this excessive strain stresses the heel bone (calcaneus) causing spurs. Repetitive stress from walking, running, or jumping on hard surfaces is a common cause of heel spurs. They may also develop from wearing shoes that do not offer support. Heel spurs may also be caused by:
• Arthritis
• Bruising of the heel
• Excess body weight
• Poorly fitted shoes
• Walking gait issues
• Wearing flip-flops too often
• Worn-out shoes
Many people who have heel spurs also have plantar fasciitis. This painful condition deals with the tough, fibrous tissue that runs between the heel and toes. Having plantar fasciitis increases the risk for eventually developing heel spurs.

Symptoms of heel spurs may include:
• Pain
• Inflammation of the heel
• Swelling around the heel
• The affected area may also feel warm to the touch. These symptoms may spread to the arch of the foot.
• Eventually, a small bony protrusion may be visible.
• Some heel spurs may cause no symptoms at all.
• It can cause changes in soft tissues or bones surrounding the heel.
It is difficult to diagnose a heel spur without medical assistance. This is because the symptoms are similar to other forms of heel pain and foot problems. Most spurs are detected through an X-ray. Bony protrusions are not usually visible to the naked eye. That is why diagnostic imaging tools are essential when experiencing any unknown causes of foot pain and inflammation. A physical examination of the foot with any signs of redness or inflammation, noticeable tenderness on the foot.

Heel spur treatment primarily consists of rest and lifestyle changes.
• Cold compresses
Using ice packs or cold compresses for up to 15 minutes at a time may help relieve heel spur pain by temporarily numbing the area. This method also helps reduce swelling. Cold compresses are preferable over heat packs for heel spurs because heat works better for joint and muscle aches.
• Injections of anti-inflammatory medications
For severe pain, doctors may recommend corticosteroid shots. These anti-inflammatory injections help to ease both pain and inflammation throughout the heel and arch of the foot.
• Over-the-counter pain medications
Acute, or short-term, pain may be reduced with the help of over-the-counter (OTC) pain medications. These may include Panadol, aspirin, diclofenac or ibuprofen.
• Physical therapy exercises and stretching exercises
Heel spur exercises consist of stretching the heel and plantar fascia muscles. These can be performed at any time of the day, but stretches can be especially helpful at night before bedtime.
• Rest
Rest is one of the most recommended treatment measures for both plantar fasciitis and heel spurs. Not only does rest help alleviate acute pain, but getting off our feet can also prevent the condition from worsening. It is especially important to rest the feet after long periods of standing and other activities.
• Orthotic shoe inserts
Orthotic shoe inserts, such as heel pads, can help give the arch and heel support needed to reduce pain. Heel pads can also prevent further wear and tear. They should be used in addition to proper footwear for all-around foot protection.
• Surgery for heel spurs
Doctors may recommend surgery when heel spur pain becomes severe and ongoing. This type of surgery involves removing the heel spur. Sometimes it also involves releasing the plantar fascia. Heel spur surgery not only reduces pain, but it is also aimed at boosting mobility in the overall foot. Most people who have this type of surgery also have plantar fasciitis. Due to other forms of treatments and therapies available, surgery is not common for heel spurs alone.
• Exercises for heel spurs
Stretching exercises are good methods of overall body conditioning because they help you work out sore muscles and tight ligaments while also preventing injuries. The same concept applies to heel spur pain management and recovery. Certain types of stretches can help improve pain and inflammation in the heel and calf areas. These include:
• Calf stretches against the wall
• Calf stretches on steps
• Golf/tennis ball foot rolls
• Seated foot flexes
• Towel grabs with toes

• Preventing heel spurs requires an increased attention to the overall foot health. Be mindful of the everyday stresses placed on the feet. Be sure to give them a rest at the end of the day. As a rule of thumb, never push through any heel pain that develops. Continuing to walk, exercise, or wear shoes that cause heel pain can lead to long-term issues such as heel spurs. If experiencing heel pain after any activity, ice the area and give the foot a rest until it gets better.
• Choose the right footwear and replace running shoes as often as possible. Worn shoes, or shoes that are worn very unevenly (the height is different between the heel and the forefoot) make a heel spur more likely.
• Make sure that the surface used to run is not too hard.
• Keep an eye on weight management; being overweight often puts too much pressure on the heels.
• Run barefoot: slowly start to try out barefoot running. It will help to avoid landing with too much weight on our bones and joints, landing instead on the muscles and fascia. This option is especially suited to warmer months, if unable to run on different surfaces. Some of the best options include grass, moss and sand.
• Mobilize and activate the foot muscles regularly.
The long-term outlook is generally good. The inflammation usually responds to conservative, nonsurgical treatments, like anti-inflammatory drugs and orthotics. Infrequently, surgical intervention is necessary.