Identifying Calcaneal Spur

Posterior Calcaneal Spur

Overview

Heel spurs are usually under the heel and are generally caused by excessive forces acting on the bone. By far the most common cause of heel spurs is abnormal biomechanics - often the same biomechanics that cause plantar fasciitis. Heel spurs are not a direct cause of heel pain. They grow in response to the forces of the soft tissue pulling on the bone. Any condition where the foot has excessive motion can produce tension within the soft tissues acting on the heel.

Causes

This condition is a constellation of many causes; overweight, ill fitting shoes, bio-mechanical problems (mal-alignment of the heel), gout, pronation (a complex motion including outward rotation of the heel and inward rotation of the ankle) and rheumatoid arthritis are some of the causes of heel pain.

Calcaneal Spur

Symptoms

It is important to be aware that heel spurs may or may not cause symptoms. Symptoms are usually related to the plantar fasciitis. You may experience significant pain and it may be worse in the morning when you first wake up or during certain physical activities such as, walking, jogging, or running.

Diagnosis

Heel spurs and plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your heel spur or plantar fasciitis they will investigate WHY you are likely to be predisposed to heel spurs and develop a treatment plan to decrease your chance of future bouts. X-rays will show calcification or bone within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.

Non Surgical Treatment

Initially, treatment usually consists of a combination of ice therapy, stretching exercises to improve flexibility (especially in the mornings), anti-inflammatory medications, and physical therapy. Most patients will also need custom-molded orthotics to help control the motion in the foot and arch, which takes the strain off the plantar fascia. If the pain continues, a cortisone injection may be used to calm the severe swelling and pain. There may the need for a night splint to maintain a stretch in the plantar fascia throughout the night.

Surgical Treatment

Surgery to correct for heel spur syndrome is a common procedure which releases plantar fascia partially from its attachment to the calcaneous (heel bone). This part of the surgery is called a plantar fasciotomy due to the fact the fascia is cut. This is most often done through an open procedure as any heel spur or bursa can be removed at the same time. If the spur is not removed during the surgery, it will probably be just as successful, as the large spur is not the true problem. Some physicians use an endoscopic approach (EPF) where a small camera aids the physician during surgery with typically smaller incisions on each side of your foot.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don't underestimate your body's need for rest and good nutrition. If obese, lose weight.

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