Heel Spur: Origin, conservative treatment, and shockwave therapy

A heel spur, often referred to as plantar fasciitis when there’s inflammation involved, is essentially a bony growth at the base of your heel. These spurs, also called calcaneal spurs, develop gradually as calcium builds up on the heel bone (calcaneus), forming a sort of bony protrusion. Our bodies are designed to walk barefoot on natural, uneven surfaces, which kept our foot ligaments active back in the days of hunters and gatherers. Nowadays, we’re mostly walking on hard, flat surfaces and wearing shoes that unnaturally support the foot’s arch. This can stiffen the ligaments in our feet (especially the plantar fascia), making them less flexible. If the plantar fascia isn’t flexible enough, even the slightest strain can cause tiny tears and lead to inflammation, known as plantar fasciitis. When the ligament tears, scar tissue forms over it, which isn’t as elastic as the original ligament, causing sharp foot pain. A loss of flexibility in the plantar fascia often feels like a tightness in the ligament, leading to pain in the Achilles tendon under any strain.

Several factors can contribute to developing a heel spur, such as:

1. Extended time on your feet,
2. Wearing unsuitable footwear,
3. Shoes with built-in arch support that keeps your foot in one position,
4. Walking barefoot or in minimalist shoes on hard surfaces like concrete or tarmac,
5. Carrying extra weight,
6. High arches

How do heel spurs form?

Diagnosing a heel spur:

Medical history: Your doctor will ask about your symptoms, pain duration, and any previous injuries or conditions related to heel pain.

Physical examination: The doctor will examine your heel for signs of inflammation, swelling, or redness and might press on specific areas to pinpoint the pain.

Imaging studies: X-rays are the most common way to diagnose a heel spur, revealing any bony growth. If necessary, ultrasound or MRI scans might be used to check for ligament damage or other soft tissue issues.

Gait analysis and foot posture evaluation: The doctor may observe how you walk and examine your foot posture to identify any biomechanical issues contributing to your pain.

Differential diagnosis: Since heel pain can be caused by various conditions like Achilles tendinitis or arthritis, the doctor may need to rule these out to get a clear diagnosis.

Conservative treatment:

The first approach for heel spur pain is usually non-invasive and includes:

1. Rest: Avoiding activities that aggravate the pain, such as sports.
2. Icing: Applying cold packs to reduce inflammation and discomfort.
3. Exercise: Physical therapy to strengthen and stretch the foot and leg muscles, which can help maintain a proper walking style.

Shockwave therapy:

If conservative measures don’t bring the desired relief, shockwave therapy might be an option. This non-invasive procedure uses shockwaves to break down the bony growth and stimulate healing. It’s often used for orthopedic conditions like heel spurs and tendinitis. However, it does come with some potential downsides:

1. Pain during the procedure: Even though it’s non-invasive, some patients feel discomfort.
2. Temporary worsening of symptoms: Pain or swelling may temporarily increase after the treatment.
3. Uncertainty about the effectiveness: Relief may be incomplete or take time to appear.
4. Multiple sessions : More than one session may be necessary, adding to time and cost.
5. Post-procedure restrictions: Patients might need to restrict activities afterward, which can be inconvenient.
6. Not suitable for all patients: Pregnant women, people with bleeding disorders, or those on blood thinners might not be suitable candidates.
7. Possible side effects: Bruising, redness, or even rare cases of tissue damage may occur.
8. Limited insurance coverage: Some health insurance policies might not cover this treatment, making it costly for those paying out of pocket.

Heel spur surgery:

Surgery may be considered if other treatments don’t bring relief. It involves removing the bony growth, but there’s a risk the pain may persist or return over time. Surgery is generally a last resort.

Treatment of a heel spur with growth factors from blood plasma:

Radiation therapy for a heel spur:

Radiation therapy, while potentially effective in alleviating pain, comes with several potential risks and side effects, which include:

1. Risk of developing a malignancy: Though small, using radiation carries a cancer risk.
2. Skin reactions: Redness, peeling, or ulcers may occur, though usually mild and temporary.
3. Possible worsening of symptoms: Pain or swelling may get worse before it improves.
4. Tissue changes: Radiation can alter tissue in the treated area, with rare long-term effects.
5. Interactions with other conditions: Patients with autoimmune disorders or diabetes may be more prone to side effects.
6. Limited data on long-term effects: While generally safe, there isn’t much long-term information on its efficacy and safety.Conclusion:

Before beginning any treatment for a heel spur, it’s crucial to consult with a doctor, ideally one specializing in orthopaedics.

Exercises suitable for heel spur treatment (video tutorial): 

For effective heel spur treatment, try exercises that strengthen the muscles and ligaments in the feet, especially the plantar fascia and Achilles tendon.

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