Heel spur – What is it and how do we cure it?

Chronic heel pain can pose a serious limitation in mobility and consequently cause a decline in the quality of your lifestyle. Heel pain can be caused by various conditions, such as overuse of the foot due to running or prolonged walking, heel spurs, inflammation of the Achilles tendon attachment, flat feet, calcaneal fracture, or a blow to the heel.

Heel spurs, which often cause pain in the heel area, affect as many as 35% of individuals over the age of 60, with an overall prevalence of 15%. Heel spur is a condition that is treated surgically in only 5% to 10% of patients when physiotherapy treatment is unsuccessful.

Did you know that heel spurs are successfully treated with specialised physiotherapy in 90% of cases? You probably did not know that a heel spur can be more than 1 centimetre long and is almost always caused by plantar fasciitis, or inflammation of the connective tissue of the foot arch and inflammation of the Achilles tendon.

Heel spurs develop slightly more often in women, especially when they are bilateral – wearing high heels is a proven risk factor for developing heel spurs, with individuals with increased body weight and top athletes in high-impact sports, which involve a lot of jumping, also at greater risk.

Successful rehabilitation of a heel spur requires patience and precision. Only experts with experience in rehabilitation and prevention can ensure proper progression and prevent re-injury.

Book an appointment for heel spur physiotherapy

A heel spur is an osteophyte, or bone outgrowth, caused by the deposition or accumulation of calcium in the area of the heel bone (calcaneus), and can take on various shapes, specifically pointed, hooked, or shelf-shaped. A heel spur can occur in the area of the Achilles tendon attachment, on the back of the heel bone, and grow upwards (dorsal heel spur, also known as Haglund’s heel – spina calcanei superior) or in the area of the plantar fascia attachment, on the underside of the calcaneus and growing straight towards the arch of the foot (plantar heel spur – spina calcanei inferior).

Heel spurs are characterised by morning pain, as the plantar fascia shortens and expands during sleep, and we put our full body weight on it when we take our first steps in the morning. The plantar fascia is under load due to tensile forces with every step, so every step can cause unpleasant pain in symptomatic heel spur, with pain typically improving with mild activity.

A heel spur is characterised by a sharp, stabbing pain in the morning with the first steps, with the type of pain also depending on the size and location of the bone spur and, above all, on which nerve receptors are stimulated.

The sharp morning pain usually subsides after walking a short distance, but later persists as long-lasting, chronic, unpleasant pain. A characteristic of heel spurs is that increased physical activity can cause the condition to worsen and cause more severe pain during the day.

Book an appointment for heel spur physiotherapy

Did you know that a heel spur can also be asymptomatic and completely painless?

Heel spurs are discovered in many individuals incidentally as they can be asymptomatic – various studies have found that between 40% in 65% of heel spurs are asymptomatic and therefore do not cause any pain.

What to do when you experience pain?

A heel spur needs to be treated with specialised physiotherapy, as even in an asymptomatic condition, it can progress and begin to cause symptoms of varying intensity. In the most severe cases, a heel spur can interfere with walking and most sports activities, and the pain can radiate to the entire foot. Heel spurs involve a characteristic post-static dyskinesia, so they can be quickly distinguished from other pathologies that cause pain in the heel area. Post-static dyskinesia means that a sharp pain appears in the heel during the first few steps after rest or inactivity.

Pain due to a heel spur can last for several years and in rare cases requires surgical treatment, especially in patients who did not start treatment with physiotherapy and kinesiology on time.

Does a heel spur occur on one or both heels? A heel spur is mostly located on one side; however, in two thirds of patients it is also asymptomatically present on the other leg – they usually report occasional problems with the other heel in the past.

A heel spur develops because of prolonged increased tension caused by excessive stretching of the plantar fascia, which leads to calcium build-up and point bone formation, which then further irritates the plantar fascia and pain receptors in the heel area.

A heel spur on the back of the calcaneus is caused by prolonged increased tension because of excessive pulling of the Achilles tendon in the area of its attachment, and the resulting bone formations exacerbate the already present pain and the intensity of inflammation.

The entire underside of the foot is covered by a connective tissue, which has the technical term plantar fascia, and it runs from the heel, through the arch of the foot, and to the toes. The function of the plantar fascia is to transfer force through the foot during walking and push-off, and to provide the shape of the longitudinal arch of the foot. The plantar fascia is exposed to heavy loads as it carries the entire weight of the body during walking and other sports activities.

Plantar fasciitis is a condition of inflamed or irritated plantar fascia due to overuse or age-related degenerative changes. Plantar fasciitis can also be indirectly caused by weak foot muscles and muscle asymmetries of shin musculature. When the foot does not assume the correct position during running and walking, e.g. has overpronation (rolled inward), oversupination (rolled outward), or is a generally flat foot, there is a pronounced risk factor for the development of plantar fasciitis.

Did you know that a heel spur in isolation does not cause pain? The pain occurs primarily due to inflammation of the plantar fascia or Achilles tendon in its vicinity at the attachment points. A heel spur is caused by a long-term or chronic condition of plantar fasciitis or Achilles tendinitis, which then becomes an additional symptom enhancer and further exacerbates the chronic condition that caused it.

Treatment of a heel spur, regardless of its stage and duration, requires a comprehensive physiotherapy approach, which for physiotherapists at MEDICOFIT clinic means simultaneous application of manual therapy, instrumental therapy and specialised training therapy, i.e. kinesiotherapy.

A common mistake in the treatment of heel spurs is the isolated use of only one therapeutic technique, e.g. extracorporeal shockwaves, which are an effective treatment method for all types of heel spurs, but only when used in combination with kinesiology training, manual therapy and other instrumental techniques, e.g. TECAR therapy and LASER therapy.

Extracorporeal shockwaves (ESWT)

Extracorporeal shockwaves have an immediate analgesic and anti-inflammatory effect in 80% to 90% of patients diagnosed with heel spurs, and represent the most effective non-surgical heel spur treatment technique when performed in combination with proper kinesiology training and manual therapy. Extracorporeal shockwaves are divided into mechanical and acoustic, and they work through the mechanism of transferring mechanical force to local tissue, which causes increased blood flow and the influx of micronutrients at the site of injury. At MEDICOFIT clinic, we use extracorporeal shockwaves as the leading treatment technique for heel spurs with the goal of reducing the size of the bone outgrowth.

Extracorporeal shockwaves cause the deposited calcium to break down into smaller crystals, which are then dissolved and absorbed into the surrounding tissue.

In practice, extracorporeal shockwaves are often used incorrectly in the treatment of heel spurs, as they are only applied directly to the heel spur area. Since a heel spur is usually accompanied by inflammation of the surrounding connective tissue, extracorporeal shockwaves should also be used at the site of the inflamed plantar fascia or Achilles tendon attachment to heal the inflammation and microinjuries to the connective tissue.

Manual therapy

In the case of a heel spur, manual therapy targets the surrounding connective tissue, which is always the cause of pain or symptoms. Using manual techniques, the physiotherapist performs a plantar fascia massage and, using different variations of techniques, mobilises the shortened plantar fascia and accelerates blood circulation and healing of degenerated collagen fibres. Manual techniques are an important tool in the comprehensive approach to treating heel spurs and are often performed in combination with TECAR therapy.

TECAR therapy

Another instrumental technique of the comprehensive approach to treating heel spurs is TECAR therapy, which increases tissue temperature and increases the energy potential of cell membranes. TECAR therapy is a non-invasive physiotherapy technique performed in the early acute phase, when the heel spur is painfully irritated.

Kinesiology training

Since heel spurs are an overuse condition, it is crucial to be aware that in the acute phase, the load-bearing capacity of the foot arch and the area of the calcaneus will be very low, which means that we will have to gradually restore it. At MEDICOFIT clinic, we perform active physiotherapy, so we perform tailored exercises early in the painful phase of the plantar fascia, thereby accelerating the formation of new collagen structures and the healing of damaged fibres.

Within the framework of kinesiology training, there is a great deal of individualisation, as individuals undergoing heel spur treatments have different goals regarding sports activities. If we have a top athlete or a recreational athlete who will be running and jumping, we need to perform progressive strength and endurance training and prepare the patient for the loads during running. At MEDICOFIT clinic, we also perform plyometric rehabilitation, i.e. we establish the correct technique for running, jumping, and landing after a heel spur has been resolved.

Regardless of the level of sports activity, for long-term successful treatment of heel spurs, it is necessary to strengthen the area where the plantar fascia and Achilles tendon attach to the heel bone.

We have presented the comprehensive treatment for a heel spur, and below we present some self-help measures that you can implement yourself until your rehabilitation begins.

First of all, avoid plyometric sports activities, i.e. running and jumping, wear footwear that has a padded or cushioned heel, as this reduces direct pressure on the area of the heel spur, and the heel should be cushioned by at least 1.5 centimetres but not more than 4.5 centimetres. We also recommend a custom orthopaedic insole.

At home, you can perform a gentle transverse friction massage of the plantar fascia and the attachment site to the calcaneus, avoid aggressive stretching exercises, and above all, we advise you to start a comprehensive treatment for your heel spur, which should include physiotherapy and kinesiology.

Book an appointment for heel spur physiotherapy

Surgical treatment of heel spurs is rare and is performed in only 5–10% of patients, primarily when conservative treatment with physiotherapy and kinesiology has not been successful in reducing the heel spur and pain.

At MEDICOFIT clinic, we recommend at least 16 weeks of structured physiotherapy and kinesiology in collaboration with orthopaedic specialists before proposing surgical treatment for a heel spur. If the heel spur has been present for more than a year, treatment with physiotherapy can last up to 24 weeks. The first effects of the therapies should be noticeable within the first three weeks of treatment, with rapid signs of improvement in the second half of treatment, usually after 8 weeks.

The generally accepted norm among orthopaedic specialists is that surgical removal of a heel spur is suggested when symptoms do not resolve within 9–12 months of physiotherapy or conservative treatment. Surgical techniques may also include plantar fascia release.

At MEDICOFIT clinic, we are specialists in the treatment of orthopaedic conditions – a heel spur is a condition that we treat with a comprehensive manual, instrumental, and training approach. It is important for us to treat each heel spur individually and adapt the treatment technique to the different variations of symptoms and shapes of the heel spur.

Below, we also present some effective exercises that you can incorporate into your routine to reduce discomfort and regain flexibility and strength in your heel. Performing these exercises correctly will help you improve your quality of life and prevent further injuries.

Important notice

•The exercise can be performed in numerous modifications and different load regimens; proper execution will be prescribed by a MEDICOFIT physiotherapy specialist for heel pain rehabilitation as part of your comprehensive treatment.
• If you have heel problems, please book an diagnostic therapy appointment before performing the exercise. The exercise may also be contraindicated.
• Always do the exercise strictly according to the prescribed regimen and as demonstrated by the physiotherapy specialist for heel rehabilitation and disorders.
• We recommend the exercise as part of guided, comprehensive specialist physiotherapy for heel rehabilitation.
• If you perform the exercise independently without the supervision of a physiotherapy specialist, we are not responsible for potential symptomatic responses.

Exercise no. 1: Double-leg toe raises in bent-knee position + tilting

Exercise no. 2: Toe extensions + myofascial release of the plantar fascia attachment

Exercise no. 3: Toe flexions + foot arch activation + weighted towel pull

What can you do to prevent the development of a heel spur?

Avoid wearing high heels, especially when sitting while working. Regularly do exercises to stretch your shin muscles and exercises to strengthen your foot arch muscles. We recommend that you perform single-leg exercises and also include balance exercises as part of your fitness training, and perform both types of exercises barefoot.

When is heel spur surgery necessary?

Heel spurs are usually not removed; surgical procedures are only performed on the surrounding soft tissues. Surgical treatment is rarely indicated, primarily in cases where prolonged treatment in the form of physiotherapy and kinesiology has not eliminated pain and heel spurs. Surgical treatment is performed in only 5–10% of heel spur cases, usually not before comprehensive conservative treatment has lasted at least nine months.

What do patients with a heel spur need to know?

Conservative treatment is usually long-term, and the physiotherapy timeline is one of the longest among lower limb pathologies. Patients should be aware that treatment for a heel spur usually takes several months, usually at least 16 weeks.

What kind of physiotherapy should patients with heel spurs choose?

The first rule when deciding on physiotherapy for a heel spur is focused extracorporeal shockwaves, without which a heel spur usually cannot be treated. The second rule is active physiotherapy. The experts who leads the treatment of heel spurs must have good expertise in training techniques, which they must progressively incorporate into the rehabilitation programme.

At MEDICOFIT clinic, we only recommend surgery when structured rehabilitation with all the described comprehensive approach techniques has been unsuccessful. If the patient has only undergone extracorporeal shockwave therapy in isolation, which is unfortunately a common practice, or only manual therapy, then we definitely advise against surgical treatment because they have used an optimal overall conservative approach. If severe acute pain is present during physiotherapy treatment, a local anaesthetic or corticosteroid can be injected to reduce pain.