Heel Spur: What Is a Heel Spur and Where Does the Pain Come From

A heel spur is often mentioned when the heel hurts, but the connection between them is not as direct as it seems. A spur is a bony outgrowth at the calcaneal tuberosity that is visible on an X-ray, and by itself it does not explain the pain. Below — what is known about the formation itself, about the causes of heel pain, and about how the diagnosis is confirmed.

What a heel spur is

A heel spur is a bony outgrowth, an osteophyte, at the calcaneal tuberosity. It appears as a compensatory reaction against the background of plantar fasciitis — inflammatory and degenerative changes of the plantar fascia. This fascia is dense tissue on the sole; it connects the calcaneus to the toes and forms the arch of the foot.

Plantar fasciitis is the most common cause of heel pain. It was previously thought to be caused by a spur, but studies have shown the opposite: on X-rays, spurs are visible both in people with fasciitis and without it. “Spur disease” is an inaccurate name: the outgrowth itself does not explain the pain.

What a heel spur looks like

On an image, it is a marginal bony outgrowth (osteophyte) at the calcaneal tuberosity, visible on an X-ray.

The calcaneus is the attachment site not only of the plantar fascia: the Achilles tendon runs to it from behind. Pain in the back of the heel, in the ankle and lower leg is associated with Achilles tendinitis.

Why a spur appears and who is at risk

In an upright position, approximately half of body mass presses on the plantar fascia, and the greatest tension falls on the attachment site at the calcaneal tuberosity. Constant load causes microtears: they usually heal on their own, but with repeated microtrauma, chronic aseptic inflammation with pain develops, and against its background — bony outgrowths.

Risk factors: shortening of the calf muscles and plantar fascia, a sedentary lifestyle, sedentary work, excess weight, prolonged standing or walking on a hard surface, high heels, shoes with poor arch support, flat feet and a very high arch. Fasciitis is more common in runners, dancers, people with arthritis, gout and calcaneal injuries. Spurs are predominantly found after age 40, more often in women.

How pain in the calcaneus manifests

The main symptom is pain in the heel area that occurs or intensifies with load. It is worse in the morning, with the first steps, after prolonged standing or sitting, when climbing stairs, during running and jumping. The pain may be dull or sharp, the sole may ache or burn, sensations radiate along the inner edge of the fascia, and sometimes the arch and ankle hurt.

Similar sensations are caused by other conditions: with a calcaneal fracture or Achilles tendon rupture, the pain is sharp, swelling appears, there may be a pop at the moment of injury, and walking is difficult; with bursitis, the heel becomes red, swollen and aches.

How a heel spur is diagnosed

The diagnosis is made based on complaints and examination: the doctor checks for tenderness along the sole and along it, looks at the shape of the arch, looks for mild swelling or redness, and assesses stiffness of the arch and Achilles tendon. Radiography can reveal a spur and rule out other causes of pain. If there is no spur but the heel hurts, a differential diagnosis is needed — primarily with systemic inflammatory diseases that may begin with heel pain.

The prognosis is usually favorable: improvement occurs in most cases, although it may take from several months to two years, more often 6–18 months.

When to see a doctor

A visit to the doctor is needed if heel pain is severe and interferes with usual activities, if it intensifies or returns, if there is no improvement within two weeks, if there is tingling in the foot or reduced sensation. Separately — people with diabetes: foot problems are more serious in them.

• pain is severe or prevents usual activities;
• pain intensifies or returns;
• no improvement within two weeks;
• tingling or loss of sensation in the foot;
• diabetes and heel pain.

A heel spur by itself is not a reason to call an ambulance. Call 103 or 112 if severe heel pain appeared after an injury, if because of the pain you feel weakness, dizziness or nausea, if the foot or ankle has changed shape, if a pop or crunch was heard at the moment of injury, if you cannot step on the leg, stand on tiptoes or climb stairs, and also with swelling and bruising on the lower leg.

The material is for reference and does not replace a doctor's consultation: it is easier to discuss doubts at an appointment than to finish reading them in search.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer