The calcaneal spur is a calcification of the plantar fascia at the level of its insertion in the plantar tuberosity of the calcaneus.
The calcaneus bone is part of the bones of the back of the foot, specifically the heel. It is the largest bone in the foot and the one that supports the most weight.
The pressures that the feet bear and that run through the entire lower limb to end there, are distributed by the bones of the ankle, talus and calcaneus, which are later in charge of transferring these pressures to the rest of the bones in the middle and anterior of the foot.
Calcaneus and talus are therefore the strongest bones and those that bear the most load, especially the calcaneus, which is located in the posterior area of the sole of the foot, specifically in the heel. The plantar fascia originates from the calcaneus, which is a muscle-ligamentous structure that covers the muscles of the sole of the foot and forms the most superficial layer immediately after the skin and subcutaneous cellular tissue.
Certain mechanisms can produce an increase in tension at the level of the insertion of this plantar fascia, which will lead to the appearance of a calcaneal spur.
Causes of heel spur
There are different causes that can cause a heel spur.
- Alterations in the structure or shape of the foot can lead to increased tension in the insertion of the plantar fascia in the calcaneus bone. Flat or pronated feet cause an increase in tension at this level.
- Achilles tendon retraction can also cause increased reflex tension on the plantar fascia. This circumstance is explained by the functional union of the Achilles tendon and the plantar fascia that function as a cord on a pulley that would be the calcaneus bone. If there is an increase in tension in one part of this cord, this tension will be transferred to the rest and of course to the insertion areas in the calcaneus. The group that forms the Achilles tendon, the calcaneus and the plantar fascia is called the Achilles-calcaneus-plantar system. Achilles tendon retraction is also related to flat and valgus feet.
- Certain muscle or neurological diseases that cause muscle spasticity can develop a heel spur.
- Metabolic diseases such as gout or diabetes can cause a heel spur due to an increase in the deposit of calcium in the attachments of the muscles in the bones.
- Rheumatic diseases such as rheumatoid arthritis or spondyloarthropathies can cause a heel spur.
The circumstance that leads to calcification of the insertion of the plantar fascia in the calcaneus bone is explained by the appearance of chronic inflammation in this area.
Any of the circumstances that cause the calcaneal spur lead to an inflammatory process in the area of insertion of the plantar fascia, which produces a metabolic change at this level that favors the deposit of calcium. This calcium deposit progressively causes the transformation of the muscle fibers of the plantar fascia, which harden and over time make a bridge between the bone and the insertion, causing a bone extension in the form of a lance or spur.
In reality, the pain that appears does not occur in the bone, but in the place of insertion of the fascia when it is inflamed.
Heel spur symptoms
Among the symptoms that we can find in the calcaneal spur are the following:
- Heel pain. The pain is intense and is usually stronger when starting to walk or getting up in the morning, and as the person walks, the pain decreases although it is not completely eliminated.
- Inability to walk and especially to perform marches that require prolonged standing.
- Cramps or burning that radiates from the heel to the calf or to the balls of the feet.
- Swelling and redness in the heel. It usually appears swollen and reddish in color, tender to the touch that causes pain.
How is it diagnosed?
Diagnosis of heel spur is conventionally made using plain radiography.
The X-ray is usually used in lateral view of the foot, in loading or unloading. In the X-ray we are going to observe bone growth at the level of the plantar tuberosity of the calcaneus, in the area of insertion of the plantar fascia. Bone growth appears as a lance or spur-shaped prolongation of the bone, much like the spur of an animal. For this reason it takes the name of calcaneal spur.
The clinical symptoms serve to supplement the diagnosis. The heel is red, swollen and sore, especially in its internal area.
Apart from the more conventional diagnostic methods there are other more specific ones such as nuclear magnetic resonance. Its use would be limited to ruling out this problem with other ailments that can occur at this level and especially aimed at establishing the cause that causes it.
Apart from the local diagnostic examination, it is necessary to search for general pathologies that are related to the appearance of the calcaneal spur such as rheumatoid arthritis or spondyloarthrosis. In this case, it will be necessary to have the collaboration of the Rheumatologist or the Family Doctor to carry out blood and urine tests on the patient and confirm the diagnostic judgments.
Heel spur treatment
The treatment of the calcaneal spur will vary according to its cause, although ultimately the action at the local level will coincide in both cases.Treating the underlying disease is a priority if it is a metabolic or degenerative disease, but it is also necessary to associate a treatment for the disease itself.
Treatment generally follows a logical sequence of being conservative, moving to surgical treatment when the first fails. Normally the painful and inflammatory phases are treated with the administration of anti-inflammatory and analgesic drugs (NSAIDs) such as Paracetamol , Enantyum , Ibuprofen or Indomethacin.
Corticosteroid injections mixed with a local anesthetic are also used in these periods.
Its effectiveness is relative and it must always be borne in mind that no more than three injections can be administered and that they are spaced ten days apart.
Infiltrations can often cause crystallization of the infiltrated drug, making the problem worse. The action of the corticosteroid can also promote fibrillar rupture of the plantar fascia, increasing pain and inflammation.
Orthopedic treatment usually achieves good results if it is well oriented. It is about putting an orthopedic insole that compensates the structural problem of the foot, that corrects the anomalous way of walking of the person and that alleviates the tension at the heel level.
The use of heel pads made of different materials has been useful at times. Lately, silicone or hydrogel heel pads give good results in relieving symptoms, but sometimes they are not enough to solve the biomechanical problem that exists in the foot. It is important to always opt for these treatments with advice and prescription from the podiatrist, avoiding the dazzling promises of spectacular successes and cures.
The last treatment option is surgical intervention. It is a very controversial and disputed decision, because it is not clear that it offers an effective solution. However, the surgical option has offered a solution to patients who have been treated conservatively for years.
In Podiatry, less traumatic techniques are used than those traditionally described, and consist of making a small incision in the heel of the affected foot and through it proceed to remove the spur. A good radiological study is needed to determine the incision site and, of course, the support of a fluoroscopy equipment that allows visualizing the bone anatomy intraoperatively.
How can I avoid it?
In the case of the prevention of the calcaneal spur, it is difficult to guide about attitudes that prevent its appearance, since it is often associated with metabolic or degenerative diseases and in others with alterations of the structure of the feet, however we must take into account count the following.
- Do not wear an excessively flat shoe that increases tension at the heel and Achilles tendon. It is always advisable to wear a 3-4 cm heel. Tall.
- If it has been detected that you have flat or valgus feet, go to the Podiatrist for evaluation and treatment.
- If you suffer from heel pain, have your Podiatrist see you, who can do a radiological study to detect a possible spur.
- If you suffer from a degenerative disease of the joints or metabolic diseases related to the deposit of calcium or any other sediment, visit the Podiatrist to check the affectation of your feet and establish the preventive treatment that he deems appropriate.
You should go to the Podiatrist when:
- Have some recurring heel pain.
- If you notice inflammation and redness in the heel and inability to walk for a long time, especially when getting up or after sitting for a while.
- If a spur has been detected in an X-ray so that your Podiatrist can assess it and establish the treatment you need.
- If you have been on treatment for a while and have not seen improvement, to discuss the possibility of surgical treatment.
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.