Heel spur syndrome

Overview

Heel spur syndrome is a condition characterized by pain in the heel due to the presence of a bony growth, or spur, on the underside of the heel bone (calcaneus). This spur develops over time due to chronic stress or strain on the foot muscles and ligaments. Heel spurs are often associated with plantar fasciitis, although not everyone with a heel spur experiences pain. When heel pain is present in combination with a confirmed spur on imaging, the condition is referred to as heel spur syndrome. It is a common cause of heel discomfort, especially in active individuals and those with poor foot biomechanics.

Causes

Heel spur syndrome develops as a result of repetitive strain and microtrauma to the tissues that attach to the heel bone. Over time, the body responds by depositing calcium at the site of stress, forming a bony spur. Contributing factors include:

• Plantar fasciitis: Chronic inflammation of the plantar fascia pulling on the heel bone

• Repetitive stress: Activities such as running, jumping, or long-distance walking

• Improper footwear: Shoes that lack arch support or cushioning

• Obesity: Increased body weight places greater stress on the foot structures

• Flat feet or high arches: Poor foot mechanics can alter weight distribution

• Prolonged standing: Particularly on hard surfaces

Symptoms

Symptoms of heel spur syndrome can vary, but typically include:

• Sharp, stabbing pain in the heel, especially with the first steps in the morning

• Dull ache that worsens after prolonged activity

• Tenderness at the bottom of the heel

• Inflammation or mild swelling near the heel

• Difficulty walking or bearing weight on the affected foot

Pain usually improves with rest but can recur after periods of standing or walking.

Diagnosis

Diagnosis of heel spur syndrome is based on a combination of clinical evaluation and imaging studies:

• Medical history and physical exam: Identifying the location and characteristics of heel pain

• X-ray imaging: Confirms the presence of a bony spur on the underside of the heel bone

• Ultrasound or MRI: May be used to assess soft tissue structures such as the plantar fascia

It is important to differentiate heel spur syndrome from other causes of heel pain, such as plantar fasciitis without a spur, fat pad atrophy, or nerve entrapment.

Treatment

Treatment is typically conservative and aimed at reducing pain and inflammation while addressing the underlying biomechanical stress. Options include:

• Rest: Limiting activities that aggravate heel pain

• Footwear modifications: Using supportive shoes with cushioned soles

• Orthotic inserts: Custom or over-the-counter insoles to support the arch and redistribute pressure

• Stretching exercises: Targeting the plantar fascia, Achilles tendon, and calf muscles

• Ice therapy: To reduce inflammation and discomfort

• NSAIDs: For pain and inflammation control

• Physical therapy: To strengthen foot muscles and improve gait mechanics

• Corticosteroid injections: For temporary relief in severe cases

Surgery to remove the heel spur is rarely required and only considered if conservative treatments fail over 6–12 months.

Prognosis

The prognosis for heel spur syndrome is generally excellent with proper treatment. Most individuals experience significant relief within a few weeks to months of conservative management. Long-term outcomes are favorable if contributing factors such as poor footwear or excessive weight are addressed. Preventive strategies, including good foot support and stretching routines, can reduce the risk of recurrence.