The purpose of this entry is to shed some light on heel spurs and their clinical relevance.
To be more specific, the heel spur that will be discussed in this article is a “plantar” heel spur, not a posterior/retrocalcaneal heel spur (which is located behind the heel bone around the Achilles’ tendon and will be addressed in a future blog entry).
A heel spur is quite surprising visually and easy to see on a lateral x-ray of the foot. It was very common through my training to see this anatomic entity pointed to and blamed as the culprit for a patient’s plantar heel pain. This is a very contentious topic in foot and ankle literature, but it is my opinion that plantar calcaneal spurs have essentially no relevance to the treatment of plantar fasciopathy and are not the source of pain.
From an anatomic standpoint, spurs do vary in size and location, especially with respect to the plantar fascia. The plantar fascia is a large piece of connective tissue that spans from the bottom of the heel bone and fans out to attach to all five digits. The plantar fascia is the anatomic culprit at play when discussing plantar fasciitis/fasciopathy. Please see my other blog entry regarding this very common source of heel pain in my practice.
Studies that examine the anatomy of plantar heel spurs show that their location can vary. They can be located within the plantar fascia origin (where the plantar fascia tissue attached to the heel bone), above or below.
I believe there is some significance to the plantar heel spur as it does imply there is increased traction coming from the plantar fascia. This could be a surrogate indicator that an individual may or may not develop an overuse injury of the plantar fascia at some point in the future (or may have suffered in the past already). Again, the actual spur itself is not a source of pain and I would never recommend having it surgically removed or treated.
If it ain’t broke, why fix it?
If you are experiencing plantar heel pain, then the most likely culprit is plantar fasciopathy/fasciitis. The typical scenario is pain with first steps in the morning (or after periods of rest/inactivity). This initial level of pain will decrease after you get moving. With more activity throughout the day, pain levels can start to rise.
Please see my other blog entry for further details regarding this diagnosis that plagues many people and is a major reason people seek my care.