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Plantar Heel Spurs: Probably not the Cause of Your Pain | Find Your Stride | Edinburgh Podiatrist

Introduction

Plantar heel spurs are one of the most common findings seen on foot and ankle x-rays. Despite their prevalence, it is important to note that not everyone with heel spurs experiences symptoms. In fact, it has been suggested that just 1 in 20 individuals with these bony protrusions on the underside of the heel suffer from associated discomfort.


Plantar heel spur seen on x-ray
X-ray showing a plantar heel spur

What are they?

Plantar heel spurs, also known as calcaneal spurs, are bony outgrowths that develop on the underside of the heel bone, or calcaneus. They are often picked up by x-ray when investigating chronic cases of plantar fasciopathy or heel pain. Research indicates that plantar heel spurs are relatively common, with one study finding an overall prevalence of around 10% (1 in 10 people), though this number may vary among different populations and it could be argued that some smaller heel spurs are simply a normal prominence. It is worth emphasising (again!), that most heel spurs do not cause any symptoms. It has been estimated that just 5% of those with heel spurs actually develop symptoms associated with the bone itself.


What are the symptoms?

Symptomatic plantar heel spurs can cause various degrees of discomfort. Individuals may experience sharp or dull pain in the heel. I would expect pain during weight-bearing activities, such as walking or standing on hard surfaces for extended periods. The affected area may feel tender to touch and may exhibit swelling or redness in some cases.


Why do they happen?

While the exact cause of symptomatic heel spurs remains unclear, certain risk factors have been suggested. These include obesity, biomechanical abnormalities, inappropriate footwear, and repetitive activities placing excessive stress on the heel. Although heel spurs can be detected by X-ray, it is essential to note that their presence alone does not necessarily indicate symptoms. Diagnosis of symptomatic spurs is primarily made based on clinical evaluation, including assessing the patient's medical history and conducting a physical examination, MRI (magnetic resonance imaging) can also be helpful.


Treatment options

Treatment for symptomatic plantar heel spurs often involves a multi-faceted approach. Conservative options include rest, ice, stretching exercises, wearing appropriate footwear, and using orthotic devices to support the foot/redistribute forces. Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections may be utilized to alleviate pain and reduce inflammation. In severe cases, when conservative measures fail to provide relief, surgical intervention may be considered.


Conclusion

Plantar heel spurs are a common foot condition, with approximately 1 in 20 individuals experiencing associated symptoms. Understanding the prevalence and potential factors contributing to symptomatic heel spurs can help enhance diagnosis and guide appropriate treatment strategies, ensuring individuals can effectively manage their discomfort and regain mobility. Surgery is an option but should only be considered if conservative treatments have failed.

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