Heel Spurs: Causes, Symptoms, Treatment, and Prevention

A heel spur (calcaneal spur) is a bony outgrowth at the plantar fascia insertion on the calcaneus. It develops in response to chronic traction stress on the plantar fascia.

Pathophysiology

• Repetitive strain (prolonged standing, running, poor footwear) → microtears at fascia-bone interface.
• Repair process deposits calcium → osteophyte formation.
• Spur itself is often asymptomatic; pain comes from associated plantar fasciitis (inflammation of the fascia).

Symptoms

• Sharp, stabbing heel pain with first steps (post-static dyskinesia).
• Dull ache after prolonged weight-bearing.
• Tenderness at medial calcaneal tubercle.

Conservative Treatment (90%+ Effective)

• Rest, activity modification, ice.
• Supportive shoes + OTC or custom orthotics (arch support, heel cup).
• Stretching: gastrocnemius/soleus, plantar fascia (towel stretch).
• Night splints (maintain dorsiflexion).
• NSAIDs, topical diclofenac.
• Physical therapy: strengthening, gait analysis.

Advanced/Refractory Options

• Corticosteroid injection (limited use—fat pad atrophy risk).
• ESWT (extracorporeal shockwave therapy).
• PRP injection.
• Surgery (spur resection + plantar fascia release) — last resort, 6–12 month recovery.

Prevention

• Supportive footwear, replace worn shoes.
• Gradual training progression.
• Weight management.
• Regular calf/plantar fascia stretching.