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19th June 2020
I have heel pain - I must have a heel spur
A very common question I get asked in my Townsville Podiatry clinic: "I have heel pain, so I must have a heel spur" !?!
- Having heel pain does not necessarily mean you have a heel spur.
- Conversely, having a heel spur does not necessarily mean you will have heel pain.
One study showed that 45% of the heels analysed were either painful with no plantar heel spur or had a plantar heel spur but were not painful. Another study showed plantar heel spurs in 10-63% of asymptomatic controls.
The most common cause of heel pain in adults is Plantar Fasciitis (now more correctly termed plantar heel pain) however there are many other causes of heel pain.
Plantar Fasciitis is a condition where the plantar fascia (strong supporting structure of the arch) is placed under too much stress and as a result becomes weakened and degenerative at the point where it inserts into the heel bone. This can cause pain in your heel – especially first thing out of bed in the morning and with increased activity. The pain you are experiencing is due the soft tissue damage of the plantar fascia.
A plantar heel spur is a bony outgrowth from the calcaneal (heel) tuberosity and are present in 55% of adults above 60 years of age (yet heel pain is only present in ~15% of the adult population).
The prevalence of plantar heel spurs increases with the following factors: age, increased body weight, increased foot pronation and presence of arthritides (particularly osteoarthritis and rheumatoid arthritis).
Increased risk factors for plantar fasciitis also includes increasing age, obesity and increased foot pronation; suggesting that plantar heel spurs and plantar fasciitis may be linked etiologically.
So yes, a plantar heel spur can cause heel pain. But in the majority of cases of heel pain a heel spur is NOT the cause of the pain.
Heel spurs are of significance as they increase in size, if there is a micro-fracture, if the spur is weight-bearing in a heavily pronated foot, or if the spur is compressing the inferior calcaneal nerve or compressing the heel fat pad.
In my Townsville Podiatry clinic we will quite often refer for x-rays and they will show heel spurs on both feet yet the patient will only have heel pain in 1 foot. After treatment their heel pain has resolved, yet the heel spurs are still there!
Heel pain in adults is common, complex, yet very treatable! And it’s super important to have the correct diagnosis and appropriate treatment plan. If heel pain is getting you down and stopping you from reaching your lifestyle goals, come and have a chat with our friendly Biomechanical Podiatrists today!
The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations - Joshua Kirkpatrick, 1 Omid Yassaie, 2 and Seyed Ali Mirjalili 1
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