Heel pain is a common complaint, and one of the questions we often get asked is whether heel spurs are the cause. In this post, we’ll break down what heel spurs are and their role in plantar heel pain.
How common are heel spurs?
Heel spurs are quite common, with around 15% of the population having one (Moroney 2014, Kilpatrick 2017). Interestingly, they are more frequently seen in people with a higher BMI, lower limb pain, or osteoarthritis (anywhere in the body). This suggests that heel spurs may be a reactive process. While 45-85% of those with plantar heel pain have a heel spur, does the spur itself cause the pain?
Do heel spurs cause pain?
Having a heel spur doesn’t necessarily mean it’s the cause of your discomfort. Many people with heel spurs are completely symptom-free. While heel spurs may increase the likelihood of pain, the spur itself is often not the direct source of pain.
What causes heel spurs?
It was once believed that heel spurs resulted from traction of the plantar fascia or intrinsic foot muscles. However, research now suggests that they may form as an adaptive skeletal response, redistributing impact forces away from the calcaneal insertion site to surrounding tissues.
Does size matter?
The size and shape of the heel spur might influence symptoms. Larger spurs are associated with more severe pain (Cho 2022), but interestingly, people with larger horizontal or hooked spurs often see greater improvement with treatment (Ahmad 2016, Okçu 2023).
🔑 Key takeaway:
A heel spur is unlikely to be the primary cause of your heel pain. However, its presence may indicate that the area is under increased load.
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References
Ahmad J, Karim A, Daniel JN. Relationship and Classification of Plantar Heel Spurs in Patients With Plantar Fasciitis. Foot Ankle Int. 2016 Sep;37(9):994-1000.
Cho BW, Choi JH, Han HS, Choi WY, Lee KM. Age, Body Mass Index, and Spur Size Associated with Patients' Symptoms in Plantar Fasciitis. Clin Orthop Surg. 2022 Sep;14(3):458-465.
Kirkpatrick J, Yassaie O, Mirjalili SA. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations. J Anat. 2017 Jun;230(6):743-751
Lee W, Metgud N, Moore M. Association of Obesity and Plantar Fasciitis in Patients With Plantar Heel Spurs. Foot Ankle Orthop. 2023 Dec 9;8(4):24730114231213625.
Moroney, P. J., et al. (2014). "The conundrum of calcaneal spurs: do they matter?" Foot Ankle Spec 7(2): 95-101.
Okçu M, Tuncay F, Koçak FA, Erden Y, Ayhan MY, Kaya SS. Do the presence, size, and shape of plantar calcaneal spurs have any significance in terms of pain and treatment outcomes in patients with plantar fasciitis? Turk J Med Sci. 2023 Feb;53(1):413-419.