Heel Spur
A heel spur is a bony growth under the heel often associated with plantar fasciitis. Although its name may sound alarming, this condition is very effectively treated with custom foot orthotics without resorting to surgery.
What is a heel spur?
A heel spur, also known as a calcaneal spur or calcaneal exostosis, is a small point- or hook-shaped bony growth that forms on the underside of the calcaneus, the heel bone. It develops at the insertion point of the plantar fascia on the calcaneus.
This calcification is the body's response to chronic mechanical stresses exerted by the plantar fascia on its attachment point. The body progressively deposits calcium in the tissue in reaction to repeated micro-traumas, gradually forming this bony outgrowth which can measure from a few millimetres to more than a centimetre.
One important point to understand: the heel spur is not itself the source of pain. Many people have a spur visible on X-ray without any symptoms. Pain instead comes from inflammation of the plantar fascia and soft tissues around the spur. That's why treatment aims at reducing tension and inflammation rather than removing the spur.
The heel spur is frequently diagnosed in people aged 40 to 70, and it coexists in approximately 50% of chronic plantar fasciitis cases.
Causes of heel spurs
The heel spur develops in response to factors that increase tension on the plantar fascia:
- Chronic plantar fasciitis: prolonged inflammation of the fascia leads to progressive calcification of its insertion on the heel.
- Excess weight: excess weight increases the forces exerted on the heel with each step.
- Prolonged standing: workers who spend long hours standing on hard surfaces are particularly at risk.
- Biomechanical abnormalities: flat feet, high arches or excessive pronation increase tension on the plantar fascia.
- Intensive sports activity: running, jogging and impact sports subject the fascia to repeated tension.
- Aging: decreased tissue elasticity and thinning of the heel fat pad favour the development of a spur.
Symptoms of a heel spur
- Heel pain: sharp, localised pain under the heel, often described as feeling like stepping on a nail or needle.
- Morning pain: the first steps upon waking are particularly painful, with pain easing after a few minutes of walking.
- Pain after rest: pain returns after a prolonged sitting period and decreases with movement.
- End-of-day pain: pain progressively worsens after long hours of standing or walking.
- Limp: altered gait to avoid putting weight on the painful heel.
Treatment of heel spurs with foot orthotics
Custom foot orthotics are the most effective conservative treatment for heel spurs:
- Reduction of tension on the fascia: the orthotic supports the arch and reduces traction of the plantar fascia on the calcaneus, decreasing irritation around the spur.
- Targeted cushioning: a cushioning pad under the heel absorbs impacts and protects the painful area.
- Discharge recess: a discharge zone can be built into the orthotic directly under the spur to eliminate direct pressure on the bony outgrowth.
- Biomechanical correction: the orthotic corrects alignment faults that contribute to excessive tension on the fascia.
Treatment is generally complemented by calf- and fascia-stretching exercises, ice application and, if needed, shockwave therapy.
When to consult an orthotist?
Consult an orthotist if:
- You feel persistent pain under the heel
- Heel pain forces you to alter your gait
- You have been diagnosed with a heel spur or plantar fasciitis
- Over-the-counter insoles do not provide enough relief
- Pain limits your work or sports activities
Our orthotists are members of the OTPQ and AOPQ. More than 90% of heel spurs are successfully treated without surgery thanks to custom foot orthotics.
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Frequently asked questions about heel spurs
What is a heel spur?
A heel spur, also called a calcaneal spur, is a pointed bony outgrowth that develops under the calcaneus (heel bone). It results from calcification of the plantar fascia's insertion on the heel in response to chronic tension.
Is the heel spur the cause of my heel pain?
Not necessarily. Many people have a heel spur visible on X-ray without any pain. The pain is generally caused by inflammation of the plantar fascia (fasciitis) associated with the spur, rather than the bony spur itself.
Does a heel spur require surgery?
Surgery is rarely needed. More than 90% of cases are successfully treated with conservative methods including foot orthotics, stretching exercises, ice and rest. Surgery is only considered as a last resort.
Can a foot orthotic make the heel spur disappear?
The orthotic does not make the bony spur disappear, but it reduces tension on the plantar fascia and relieves pain. By eliminating the cause of inflammation, the orthotic lets the tissue heal and pain disappears in the vast majority of cases.
How long does it take to relieve the pain?
With custom foot orthotics and appropriate treatment, most patients feel significant improvement within 4 to 8 weeks. Full relief can take 3 to 6 months in chronic cases.
What's the difference between heel spur and plantar fasciitis?
Plantar fasciitis is inflammation of the plantar fascia, while a heel spur is a bony outgrowth that develops in response to that chronic inflammation. Both conditions often coexist and are treated in the same way.