A heel spur (thorn in heel) is the term for a growth on the heel that is present in the form of a calcium or bone deposit or osteophyte. Heel spurs have an overall prevalence of 15%, but are more common in the elderly, with 35% of individuals in the 60-69 age group having a heel spur. Heel spurs can be asymptomatic, i.e. they do not cause any pain, but should always be treated with physiotherapy as they are a risk factor for the onset of pain. A heel spur usually hurts on one side, although 2/3 of patients also have a spur on the other heel, which they cite as a problem with the other heel in the past.
Heel spurs can grow up to 1 cm in size and can occur on the back of the heel (spina calcanei superior), as a result of overloading of the Achilles tendon process, or on the underside of the heel (spina calcanei inferior), as a result of overloading of the plantar fascia process. Plantar heel spur, on the inferior side of the heel, is due to plantar fasciitis, is the more common and usual ”heel spur” reported by patients at the time of the visit.
Risk factors for heel spurs are flat feet, increased body weight, wearing high heels, sports overload especially jumping and running, diabetes mellitus or diabetes mellitus and age. It is more common in women, athletes, the elderly aged between 60 and 69 years and diabetics.
A heel spur has a characteristic pattern of symptoms, making it easy to distinguish from other pathological conditions that cause pain in the heel area. Heel spur pain is sharp and intense, occurring mainly in the morning at the first steps in the heel area. Typically, the pain subsides or diminishes after a short distance has been walked. A heel spur is characterised by post-static dyskinesia, which means that after physical inactivity or rest, the heel always hurts intensely for the first few steps.
Although the symptoms of a heel spur depend on the size, shape and location of the spur, in most cases the pain is most intense in the morning, as the plantar fascia shortens and widens at night. Symptoms typically worsen with running and walking.
The heel spur is one of the pathological conditions that require a comprehensive conservative approach of physiotherapy and kinesiology. This means that if only one type of therapy is used in isolation, the heel spur will not be eliminated. Integrated treatment includes shockwave therapy, TECAR therapy, LASER therapy, manual therapy and kinesiology training.
Treatment of a heel spur usually lasts between 16 – 24 weeks, in case the heel spur has been present for more than a year the treatment is prolonged. To treat heel spurs, shock waves are often performed in isolation and, although they are the most effective method of ”breaking” or eliminating heel spurs, they must be performed together with specific exercises and manual therapy.
Treatment of heel spurs should include techniques to improve the quality of the connective tissue of the plantar fascia, which is achieved by exercises to strengthen the intrinsic muscles of the foot and endurance exercises to strengthen the tibial musculature.
At Medicofit, we use EMS Focused Deep Shockwaves as the leading method of treatment for heel spurs, which are the most effective tool for heel spur rehabilitation in clinical practice, with patients usually noticing the pain-relieving effects after the first treatment. Deep shock waves break down the loaded calcium into smaller units, which are then absorbed and broken down in the surrounding tissue. Shockwave therapy should be performed in combination with special exercises to strengthen the arch of the foot, which is always taken into account at Medicofit.