Definition
The heel spur is an exostosis of the calcaneus, that is, a calcification that develops in the lower part of the heel, generally at the medial level, at the point where the plantar fascia originates.
This benign neoformation of the bone develops due to the repeated tractions and stresses of the plantar aponeurosis on the periosteum of the calcaneus: the persistent inflammation of the tendon insertion on the heel (enthesopathy) which consequently causes the formation of a deposit of calcium salts.
Over the years, this accumulation interferes with the movements, irritates the surrounding tissues and leads to the formation of the exostosis.
The heel spur is mainly due to arthrosis, an anatomical predisposition (eg flat foot, hollow, hindfoot, etc.) or to the chronicity of plantar fasciitis.
Favoring factors are also a sedentary lifestyle, excessive weight, intense athletic activities, repeated trauma and prolonged use of unsuitable footwear.
Also problems of uric acid metabolism can favor the formation of heel spurs.
Most common symptoms and signs *
- Foot pain
- Heel pain
- Swollen and tired feet
Further indications
The heel spur develops very slowly, so it may initially be asymptomatic. As the exostosis progresses, the patient often reports an acute pain localized to the heel. This increases during walking and under load, with a certain type of shoe and when it remains barefoot. Pain tends to decrease, however, with bed rest.
In some cases, the heel spur can cause swelling in the affected area and tension in the muscles and ligaments, which can develop into inflammation caused by the continuous injuries of the sub-calcaneal spine, such as plantar fasciitis and calcaneus bursitis.
On the radiographic examination of the foot this bone process can be highlighted, especially in the lateral projection. Finally, an MRI or ultrasound scan gives a more detailed picture showing the state of the surrounding soft tissues, possible hematomas, edemas, thickening of the plantar fascia or lesions.
Treatment includes functional rest, taking NSAIDs and physical therapy aimed at stretching the calf muscles and the soft parts of the foot. Other measures may include the use of braces and orthoses to allow mechanical stresses to fail. Furthermore, massages, ultrasounds and tecar therapy may be useful, possibly associated with local infiltrations.
In patients who have not benefited from conservative therapy, surgery can be indicated according to more or less invasive techniques.
