Heel Spurs: Symptoms, Causes, and Prevention

A Heel spur, or also known as a calcaneal spur, occurs when a bony outgrowth forms on the heel bone. Calcaneal spurs can be located at the back of the heel (dorsal heel spur) or under the sole (plantar heel spur).
The dorsal spurs are often associated with achilles Tendinopathy, while spurs under the sole are associated with Plantar fasciitis.
The apex of the spur lies either within the origin of the planter fascia (on the medial tubercle of the calcaneus) or superior to it (in the origin of the flexor digitorum brevis muscle).
The relationship between spur formation, the medial tubercle of the calcaneus and intrinsic heel musculature results in a constant pulling effect on the plantar fascia resulting in an inflammatory response.

Pathophysiology

Countinued overstrain of the plantar fascia results in stripping of the periosteun from its origin at the calcaneus.the gap thus form is filled up by proliferation of bone,resulting in formation of bony spur to securethe detached attachment.
occsionally bursa forms over the bony spur which may get inflamed resulting in pain.thus calcaneal spur is late sequele of plantar fascitis.the calcaneal spur may not always be painful.once formed this spur is permanent and attempt to rempve it results in its recurrenece.

The painful heel is a relatively common foot problem, but calcaneal spurs are not considered as a primary cause of heel pain. A calcaneal spur is caused by long-term stress on the plantar fascia and foot muscles and may develop as a reaction to plantar fasciitis.
The pain, mostly localised in the area of the medial process of the calcaneal tuberosity, is caused by pressure in the region of the plantar aponeurosis attachment to the calcaneal bone. The condition may exist without producing symptoms, or it may become very painful, even disabling.
Most heel pain patients are middle-aged adults. Obesity may be considered a risk factor. Not all heel spurs cause symptoms and are often painless, but when they do cause symptoms people often experience more pain during weight-bearing activities, in the morning or after a period of rest.

Peroneal tendonitis
Haglund’s deformity (with or without bursitis)
Sever’s disease (calcaneal apophysitis): inflammation of the calcaneal apophysis due to overloading
Traumatic Influences
Calcaneal fractures (and stress fractures): fractures as a consequence of repetitive load to the heel
Baxter nerve entrapment: (chronic compression of the first branch of the lateral plantar nerve)
Tarsal tunnel syndrome (sinus tarsi): Impingement of the posterior tibial nerve
Clinical (Tinel’s sign, dorsiflexion-eversion test)
Heel fat pad syndrome: Atrophy or inflammation of the shock-absorbing fatty pad or corpus adiposum
Chronic lateral ankle pain with other cause.

A diagnosis is based on the patient’s history and on the results of the physical examination. Diagnosis is usually confirmed by X-ray, but other diagnostic adjuncts are also used.
Radiology may show calcaneal spur formation or calcification at either the insertion of the Achilles tendon or the origin of the plantar fascia.Rarely is an MRI required.

Heel Spurs

ULTRASOUND THERAPY: UltraSound is therapeutic modalities that generate ultrasound causes deep heat, provide micro-massage to soft tissue, increase flexibility, promotes healing of tissue as well improve localized blood supply to area.and ultimately pain relief.
Cold therapy used to relieve inflammation and reduce pain, Ice Massage- Ice on the area of inflammation for anti-inflammatory effects. Use ice in a paper or Styrofoam cup (peeled away) for 5-7 minutes, make sure to avoid frostbite.
Heat therapy to loosen tense muscles and promote oxygen and blood flow to the affected area. Thermotherapy might be useful for the reduction of pain during exercises.

Heel Spurs

Paraffin wax bath therapy is an application of te molten wax on the body parts. It acts like a form of heat therapy and can help increase blood flow, relax muscles, and decrease joint stiffness. Paraffin wax can also minimise muscle spasms and inflammation as well as treat sprains.

CONTRAST BATH:

Heel Spurs

Contrast bath work works on the principle of the combined effect of heat and cold the part alternatively immersed in the hot and cold temperature of hot water ranges from 36c-45c and cold water from 15c -20c.
treatment begins with hot water and should end with cold water. treatment time varies between 15 to 30 minutes, with immersion in hot water around 3 minutes and in cold water around 1 minute.it relieves the pain.
Low-level laser therapy: laser therapy is found to be an effective method for treating heel spurs.

FARADIC FOOT BATH:

Faradic foot bath with voluntary intrinsic exercise: low-frequency current used to re-educate lumbricals , plantar interossei,abductor hallucis.

Night Splints:A conservative treatment in combination with the use of a night splint that keeps the ankle in 5-degree of dorsiflexion for eight weeks; Patients without previous treatments for plantar fasciitisobtain significant relief of heel pain in the short term with the use of a nightsplint incorporated into conservative methods; however, this application does not have a significant effect on prevention of recurrences after a two-year follow-up.

Heel pad

Heel Spurs

Heel inserts or Heel spur pads should relieve heel spur pressure and inflammation and catch shock forces and distribute them evenly throughout the heel reducing stress.
However, Chia suggested that Heel spur pads were ineffective in reducing rearfoot pressure and increased rearfoot peak forces while orthotics and customized orthotics reduced rearfoot peak forces on both sides. Pre-fabricated and customized orthotics are therefore useful in distributing pressure uniformly over the rearfoot region.

Footwear Modification
Footlogics: provide relief from Plantar Fasciitis (heel pain and heel spurs), Achilles Tendinopathy, and also forefoot pain. Aims to correct over-pronation, fallen arches, and flat feet.
Insoles: Patients with heel pain, diagnosed as Sever’s injury, wore insoles with no other treatments added and all patients maintained their high level of physical activity throughout the study period. Significant pain reduction during physical activity when using insoles was found.

Heel Spurs

Sit in a straight-backed chair with feet flat on the floor.
Lay a towel on the floor in front of the leg so the short end is at your feet.
Put the toes of one foot on the end of the towel, and scrunch toes and pull the towel toward you.
Repeat 10 times.

Heel Spurs

Sit in a straight-backed chair with feet flat on the floor.
Place 20 marbles and a small bowl on the floor in front of the leg.
Pick up one marble at a time with toes and place it in the bowl. Use one foot to pick up all 20 marbles.