Heel spurs are relatively common in people with heel pain, although a heel spur itself may not be painful. A heel spur typically forms on the underside of the heel bone, or calcaneus. X-rays may reveal a bony bump or protrusion on the underside of the heel that can vary in size. According to the American Academy of Orthopaedic Surgeons, or AAOS, a heel spur or calcium deposit is associated with chronic planter fascia problems, such as inflammation.
X-Ray Observation
The presence of a heel spur is definitively diagnosed by X-ray evidence of a bony bump or protrusion on the underside of the calcaneus, or heel bone. According to Dr. Stephen Pribut, a Washington, D.C.-based sports podiatrist, the bone growth characterizing a heel spur typically extends forward in the foot, toward the toes. The heel spur may be associated with plantar fasciitis and ankylosing spondylitis—an autoimmune disease that primarily affects the spinal joints and can lead to spinal fusion. X-ray images of the foot and ankle may also reveal a bone spur that's developed on the back of the heel, near the attachment point of the Achilles tendon. A heel spur on the foot's underside is a spike of calcification that's located just above the plantar fascia, at the insertion point of the intrinsic, or internal, foot muscles. While heel spurs are not caused by plantar fasciitis—many people with plantar fasciitis do not have heel spurs—they are associated with plantar fasciitis.
Heel Pain
The American College of Foot and Ankle Surgeons, or ACFAS, states that when heel spurs are found in patients with plantar fasciitis, the condition may be diagnosed as heel spur syndrome, although the ACFAS notes that heel spurs themselves are an infrequent cause of heel pain. While the AAOS maintains that heel spurs inflame the tissue on the foot's underside and cause heel pain—which is a traditional belief among many practitioners—the American Academy of Family Physicians or AAFP argues that the term heel spur syndrome is a misnomer, that the term incorrectly suggests that bone spurs are a cause of pain instead of incidental X-ray findings only. The AAFP states that there is no correlation between heel pain and the presence or absence of heel spurs, and that heel spur excision or removal is not indicated for people with plantar fasciitis. Heel spurs may cause heel pain in some individuals, but there is significant controversy about whether heel spurs are a legitimate source of heel pain or simply incidental X-ray findings in people with foot pain.
Gait Alterations
According to Dr. Mark H. Tompkins, a San Antonio, Texas-based podiatric physician and surgeon, heel spur syndrome or HSS—which includes heel spurs, plantar fasciitis and heel bursitis as possible causes—is the third most common cause of inflammatory pain in the body, behind headaches and low back pain. Tompkins states that HSS is characterized by heel pain following prolonged periods of inactivity, especially in the morning, and that it often improves with normal activity and worsens again at the end of a day filled with activity. He notes that as the condition worsens, gait alterations--changes in the way a person walks--may develop, which can lead to pain in other parts of the body, including the ankles, knees, hips and back. Compensatory gait alterations due to heel pain can create muscle and structural imbalances in the body that may cause short- or long-term musculoskeletal problems to manifest.
