Heel and foot pain, part 4. The heel spur.

Heel spurs are the reason for much confusion. As in the infamous mention of a“disc bulge”, the mention of a heel spur brings on a lot of unwarranted cold sweat.

Heel spurs are quite commonly found on X-rays of patients who are being evaluated for another foot trauma and have no current symptom in the arch of heel proper (I lost track of how many times I see a spur on a film taken after a bad ankle sprain). The reason is that the spur, also known as a calcanear osteophyte in medical term, is the end result of a cycle of repetitive strain and tearing of the plantar fascial common ligamentous origin at the heel. When the repetitive tearing involves micro-bleeding, or a lot of persistent inflammation, the body will deposit calcium over the injured area, resulting in a spur.

The heel spur proper is an indication of a prior injury to that area that has resulted in calcification of the injured soft tissue, since the calcification process takes several months to build up, then show on X-rays. However, while many patients will have a non-symptomatic heel spur, many patients will have continued symptoms over the area. The reason is that in many patients, if the mechanical factors causing the strain over the plantar ligamentous origin at the heel are not addressed, the body will go through a cycle of ongoing re-injury of the area, with the heel spur growing over time.

The examination process in patients with heel pain with or without heel spurs is the same, but the presence of the spur is a definite indication that the problems has been going on for a very long time.