A calcaneal spur (also known as a heel spur) is a bony outgrowth from the calcaneal tuberosity (heel bone). Calcaneal spurs are typically detected by

x-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

examination. It is a form of exostosis. When a foot is exposed to constant stress, calcium deposits build up on the bottom of the heel bone. Generally, this has no effect on a person's daily life. However, repeated damage can cause these deposits to pile up on each other, causing a spur-shaped deformity, called a calcaneal (or heel) spur. An inferior calcaneal spur is located on the inferior aspect of the

calcaneus In humans and many other primates, the calcaneus (; from the Latin ''calcaneus'' or ''calcaneum'', meaning heel) or heel bone is a bone of the tarsus of the foot which constitutes the heel. In some other animals, it is the point of the hock. S ...

and is typically a response to plantar fasciitis over a period, but may also be associated with

ankylosing spondylitis Ankylosing spondylitis (AS) is a type of arthritis characterized by long-term inflammation of the joints of the spine typically where the spine joins the pelvis. Occasionally areas affected may include other joints such as the shoulders or hip ...

(typically in children). A posterior calcaneal spur develops on the back of the

heel The heel is the prominence at the posterior end of the foot. It is based on the projection of one bone, the calcaneus or heel bone, behind the articulation of the bones of the lower Human leg, leg. Structure To distribute the compressive for ...

at the insertion of the

Achilles tendon The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (h ...

. An inferior calcaneal spur consists of a

calcification Calcification is the accumulation of calcium salts in a body tissue. It normally occurs in the formation of bone, but calcium can be deposited abnormally in soft tissue,Miller, J. D. Cardiovascular calcification: Orbicular origins. ''Nature Mat ...

of the calcaneus, which lies superior to the plantar fascia at the insertion of the plantar fascia. A posterior calcaneal spur is often large and palpable through the skin and may need to be removed as part of the treatment of insertional

Achilles tendonitis Achilles tendinitis, also known as achilles tendinopathy, occurs when the Achilles tendon, found at the back of the ankle, becomes sore. Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties. The ...

Signs and symptoms

Major symptoms consist of pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may report heel pain to be more severe when waking up in the morning. Patients may not be able to bear weight on the affected heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.

Causes

Plantar fasciitis is a common cause of calcaneal spurs. When stress is put on the plantar fascia ligament, it does not cause only plantar fasciitis, but causes a heel spur where the plantar fascia attaches to the heel bone. The considerations that affect plantar heel pain are the alignment of the foot with lower leg, foot and ankle mobility, strength and endurance of muscle. External influences on plantar heel pain are the amount of time spent on feet while exercising or standing, type of footwear used and type of floor surfaces. Calcaneal spur develops when proper care is not given to the foot and heels. People who are obese, have

flat feet Flat feet (also called pes planus or fallen arches) is a postural deformity in which the arches of the foot collapse, with the entire sole of the foot coming into complete or near-complete contact with the ground. Sometimes children are born ...

, or who often wear

high-heeled shoes High-heeled shoes, also known as high heels, are a type of shoe with an angled sole. The heel in such shoes is raised above the ball of the foot. High heels cause the legs to appear longer, make the wearer appear taller, and accentuate th ...

are most susceptible to heel spurs. Flat feet can potentially be attributed to the minimal amount of ankle dorsiflexion during stance phase of the

gait cycle A (bipedal) gait cycle is the time period or sequence of events or movements during locomotion in which one foot contacts the ground to when that same foot again contacts the ground, and involves propulsion of the centre of gravity In physics, ...

causing more tension on the plantar fascia.

Diagnosis

Spur outgrowths can be detected through physical exam followed by a lateral foot x-ray.

Treatment

It is often seen as a repetitive stress injury, and thus lifestyle modification is typically the basic course of management strategies. For example, a person should begin doing foot and calf workouts. Strong muscles in the calves and lower legs will help take the stress off the bone and prevent heel spurs. Icing the area is an effective way to get immediate pain relief. There are several means to get pain relief from plantar heel pain. Plantar heel pain can be a precursor to many pathologies of the foot. There is evidence that corticosteroid injections may reduce pain for up to one month after the injection, which can have an impact on the formation of calcaneal spurs. Side effects of corticosteroid injections includes peripheral nerve injury, plantar fascia rupture, and post injection flare, among others. Laser therapy, dry needling, and calcaneal taping are also utilized in treating plantar heel pain, however, there is not high quality evidence supporting the clinical usage of such modalities in reduction of pain.

References

External links

* {{Soft tissue disorders Foot diseases Soft tissue disorders