Bone Spur of the Calcaneus (Heel Spur)

What a calcaneal spur is

The calcaneus is the large bone of the heel. Where tendons and ligaments attach to bone (an enthesis), constant pulling can cause the body to lay down extra bone over many years. This forms a spur, technically an enthesophyte.

Types of calcaneal spur

A posterior spur can occur along with a prominent bump on the back of the heel (Haglund's deformity) and an inflamed bursa, sometimes called "pump bump".

Symptoms

Many spurs are found by chance on an X-ray and never cause symptoms. When symptoms are present:

Plantar heel spur

• sharp, stabbing pain under the heel with the first steps in the morning or after sitting
• pain that eases after walking for a few minutes, then returns as an ache after long standing
• tenderness on pressing the inner front of the heel

Posterior heel spur

• pain at the back of the heel, worse with running, hills and stairs
• stiffness of the Achilles in the morning
• a tender, sometimes swollen bump that rubs on shoe backs

Causes and risk factors

• Age: most common over 40
• Excess weight: increases load on the heel
• Long hours standing on hard surfaces
• Running and jumping sports, especially with sudden increases in training
• Foot shape: flat feet or high arches
• Tight calf muscles and Achilles tendon
• Worn-out or unsupportive shoes
• Inflammatory arthritis: ankylosing spondylitis, psoriatic arthritis and reactive arthritis can cause spurs and heel pain in younger people
• Diffuse idiopathic skeletal hyperostosis (DISH) and diabetes

Heel spur vs plantar fasciitis

These are often confused. Plantar fasciitis is irritation of the thick band of tissue running along the sole. It causes most heel pain. A heel spur is a bony finding that often accompanies long-standing plantar fasciitis. Studies show that many people with spurs have no pain, and many people with plantar fasciitis have no spur. The spur size does not predict how much pain you have. See heel spur for more on spurs as a cause of heel pain.

Diagnosis

A doctor or podiatrist will ask about your pain pattern, activities and footwear, and press on specific areas of the heel. They will check calf tightness, foot shape and how you walk.

• X-ray: shows the spur and excludes fractures and arthritis. It does not show the inflamed soft tissue.
• Ultrasound or MRI: shows plantar fascia thickening, Achilles tendon damage, bursitis or a stress fracture when the diagnosis is unclear or pain persists.
• Blood tests: if inflammatory arthritis or gout is suspected.

Treatment

Most people (about 9 in 10) improve with non-surgical treatment within 6 to 12 months.

Self-care

• Stretching: calf stretches against a wall and plantar fascia stretches (pulling the toes back) several times a day, especially before the first steps in the morning.
• Footwear: cushioned, supportive shoes with a slightly raised heel; avoid flat, worn-out shoes and walking barefoot on hard floors.
• Heel cups or arch-supporting insoles: over-the-counter inserts work as well as custom orthotics for many people.
• Ice: roll the sole over a frozen water bottle for 10 to 15 minutes.
• Activity changes: switch from running to cycling or swimming for a while.
• Weight loss if overweight.
• Pain relief: ibuprofen or naproxen at the label dose for short periods, if safe for you.

Medical treatments

• Physical therapy: stretching, strengthening and taping.
• Night splints: keep the foot flexed overnight to reduce morning pain.
• Steroid injection: short-term relief for plantar fasciitis, but repeated injections risk fat pad atrophy and fascia rupture. Usually avoided around the Achilles tendon.
• Extracorporeal shock wave therapy: for persistent plantar fasciitis or insertional Achilles pain.

Surgery

Surgery is considered only after 6 to 12 months of failed non-surgical treatment. Options include partial plantar fascia release (with or without spur removal), or for posterior spurs, removing the spur and bump and repairing the Achilles attachment. Recovery takes several months.

Frequently asked questions

Do heel spurs go away?

The bony spur itself does not go away without surgery. However, the pain usually does, because it comes from inflamed tissue around the spur. Most people become pain-free within months with stretching, good footwear and insoles, while the spur remains on X-ray.

What does a calcaneal spur feel like?

A plantar heel spur with plantar fasciitis feels like a sharp, stabbing pain under the heel with the first steps in the morning, easing after a few minutes of walking. A posterior spur causes aching at the back of the heel, worse with activity and shoe pressure.

Should a heel spur be removed?

Rarely. Removal is considered only when severe pain persists after 6 to 12 months of non-surgical treatment. Because the spur is usually not the main source of pain, surgery focuses on the plantar fascia or Achilles tendon, and spur removal alone may not help.

What is the best shoe for a heel spur?

Choose shoes with good cushioning, firm heel support, arch support and a slightly raised heel. Running or walking shoes often work well. Avoid flat, unsupportive shoes and going barefoot. For posterior spurs, choose shoes with a soft or open back.

Can a heel spur cause foot numbness?

The spur itself rarely causes numbness. Numbness, tingling or burning in the heel or sole suggests nerve involvement, such as tarsal tunnel syndrome or nerve entrapment, or a neuropathy from diabetes. These should be assessed by a doctor.