Main
- Pain under the heel or slightly in front of it — the main sign that points to the area affected.
- Morning pain after sleep — the first step after rest is the hardest, which distinguishes a spur from tiredness.
- The size of the growth does not match the intensity of the pain, so it should not be the only thing to go by.
- Flat feet, a high arch and excess weight increase the tension of the plantar fascia at the point where it attaches to the heel bone.
- The condition is managed by a trauma and orthopaedic surgeon, while a podiatrist is involved in foot skin care for calluses and cracks.
What is a heel spur
A heel spur is a bony growth on the heel bone at the point where the ligaments and tendons of the foot attach. It often causes heel pain when walking, especially after exertion or in the morning.
What happens in the body
A heel spur forms where the plantar fascia attaches to the heel bone. This dense ligament supports the arch of the foot and bears the body's weight with every step. With constant overload, inflammation and deposits of calcium salts occur at the attachment point. Over time, these salts harden and turn into a bony protrusion. The protrusion itself may be small, but the pain is caused not so much by it as by the inflammation of the surrounding tissues. A person notices heel pain when walking, especially after exertion or in the morning. If the load on the foot is not reduced, the inflammation persists and the pain intensifies. It is worth remembering that the size of the growth does not always match the intensity of the pain, so one should not rely on it alone.
What causes it to develop
- Flat feet or a high arch: with this foot shape, the load is distributed unevenly, and the plantar fascia is stretched more strongly.
- Excess body weight: extra weight increases the pressure on the heel with every step, causing the ligament and bone to experience constant overload.
- Prolonged standing or walking on a hard surface: hard floors and asphalt do not cushion the impact, and the tension is transmitted directly to the point where the fascia attaches.
- Uncomfortable shoes without arch support: a flat sole and the absence of an arch support make the ligament work under increased load throughout the day.
- Running or jumping: sharp impact loads on the heel create conditions for recurring inflammation at the point where the ligament attaches.
- Age-related changes in ligaments and tendons: over the years, tissues lose elasticity, so even a familiar load is tolerated worse than before.
Who encounters this more often
A heel spur is more common in middle-aged and older people whose lives involve prolonged stress on the feet. Those at risk include sales assistants, hairdressers, doctors, security guards and other professionals who spend most of the working day on their feet. Excess weight, flat feet and the habit of wearing shoes without arch support contribute to the development of the condition. In runners and fans of jumping training, the risk is higher due to the impact load on the heel. With age, ligaments and tendons lose elasticity, so even a familiar load is tolerated worse. Women encounter the problem more often than men because of shoes with flat soles or high heels. If work or lifestyle involves long standing, it is worth thinking in advance about supporting the arch of the foot and relieving the heel.
What symptoms can occur?
A heel spur makes itself known through pain in the heel area, which can easily be mistaken for ordinary tiredness after a long walk. This section will help you work out which signs point specifically to this condition and in which cases a visit to the doctor must not be put off.
How it is noticed at the very beginning
Pain from a heel spur is usually felt under the heel or slightly in front of it. It may be sharp, stabbing or aching and gets worse when walking, running or standing for a long time. Many put the first episodes down to tiredness after a long day on their feet or to uncomfortable shoes. Characteristically, the pain is worst after a period of rest — for example, in the morning after sleep or after sitting. As you walk about, it may ease a little, but it returns after exertion. Because of this, people often put off a visit, hoping the discomfort will go away on its own. If heel pain repeats day after day, it is sensible not to wait but to book a routine appointment with an orthopaedic trauma surgeon.
The signs that occur most often
- Pain under the heel or slightly in front of it: the main sign, which points to the affected area and helps the doctor understand where to look for the cause.
- Sharp, stabbing or aching in nature: the sensations may change during the day, and this matters for assessing how the condition affects daily life.
- Worse when walking, running, standing: the load on the heel noticeably worsens how you feel, so a person begins to avoid their usual activities.
- Morning pain after sleep: the first step after rest is the hardest, which often becomes a reason to suspect it is not simply tiredness.
- Return of pain after exertion: even if it eases after walking about, the discomfort makes itself known again, and this is worth discussing with a doctor.
When to seek help urgently
Examinations and tests
Examination for a heel spur begins with a conversation and an examination of the feet. Additional imaging methods are used to confirm changes in the bone and soft tissues.
How the examination begins
A heel spur is identified primarily through a clinical examination, not from a single scan. The doctor asks in detail about the nature of the pain, when it intensifies and how long it lasts. Then he examines the foot and palpates it, checking for tender points and joint mobility. Such an examination allows an understanding of where exactly the inflammation is concentrated and how much it limits movement. The doctor pays attention to the position of the foot, the condition of the arch and the tension of the calf muscles. If the picture does not fit the typical one, the specialist prescribes imaging to rule out other causes of pain. The patient should recall in advance during which movements the pain is strongest and tell the doctor about this at the appointment.
What is prescribed and what it shows
What to prepare for the appointment
- Discharge summaries: take all medical documents describing previous visits for foot pain so that the doctor sees the full picture.
- Scans: bring any available X-rays and reports, even if they were taken long ago, this will help compare the changes.
- Observations: write down at what time of day the pain is stronger and after what load it occurs, this clarifies the picture.
- Footwear: tell the doctor what shoes you wear every day and for how long, since this affects the load on the heel.
- Questions: formulate in advance what you want to find out from the doctor so as not to forget anything important in the conversation.
Which doctor should I see?
A heel spur is managed by an orthopaedic traumatologist and a podiatrist, and the choice between them depends on what exactly is causing the trouble. Below is who does what, how care is organised, and what remains on the patient's side.
Which specialist manages this condition
A heel spur is managed by an orthopaedic traumatologist, while a podiatrist joins in for foot care. The orthopaedic traumatologist examines the foot, assesses gait and joint mobility, and determines exactly where the pain occurs on weight-bearing. They also select footwear and insoles, and refer for physiotherapy and exercises to stretch the plantar fascia. If these measures do not help, it is the orthopaedic traumatologist who discusses injections or surgery with the patient. The podiatrist deals with the skin of the foot, cracks, calluses and corns, which often accompany a spur and worsen pain when walking. If there is no specialist nearby, start with an orthopaedic traumatologist at the polyclinic where you are registered. They will examine the foot and decide whether podiatric care is needed or conservative measures are sufficient. This order saves time and prevents missing a case where pain persists for months.
What treatment consists of
- Selection of footwear and insoles: offloading the foot reduces pressure on the heel, so the doctor selects a firm heel counter and soft cushioning.
- Physiotherapy procedures: these are prescribed by the doctor to reduce pain and inflammation in the area of the plantar fascia, and the course is selected individually.
- Stretching exercises: regular stretching of the plantar fascia and calf muscles restores tissue elasticity and reduces morning stiffness.
- Pain relief as prescribed by the doctor: for pronounced pain, the specialist selects a way to relieve it so that the person can walk normally and perform the exercises.
- Injections for persistent pain: if offloading and physiotherapy have no effect, the doctor discusses other options of care with the patient.
- Surgery when other methods are ineffective: surgical intervention is considered a last resort, when the other measures have not helped.
What depends on the patient themselves
The regularity of follow-up with the doctor determines how quickly the heel pain can be managed. If the selected footwear and insoles are worn constantly rather than occasionally, the load on the heel is reduced more noticeably. Stretching exercises for the fascia and calf muscles have an effect only when repeated, so missed sessions bring back the morning pain. Physiotherapy, too, is important to complete fully rather than interrupt at the first improvement in how you feel. If new sensations appear or the pain worsens, it is worth telling the doctor about it rather than changing measures on your own. A patient who honestly says what helps and what does not receives more accurate recommendations at the next appointment. Keep simple notes about when and how the heel hurts — this helps the doctor see the whole picture.
What helps prevent an exacerbation?
Preventing an exacerbation of a heel spur is largely helped by what a person does themselves every day. Below we will talk about habits, regular monitoring of the condition and the timing of visits to the doctor.
What is changed in habits
Maintaining a healthy weight reduces the constant load on the ligament and the plantar fascia of the foot. Excess body weight makes the fascia stretch more with every step, and this maintains irritation at the point of attachment to the heel bone. Footwear with good arch support and an orthotic insole redistributes pressure so that the heel stops taking the impact first. Regular moderate exercise and stretching of the feet and lower legs preserve the elasticity of the ligaments and prevent them from shortening. If your work involves long periods of standing, it is useful to take breaks and let the foot rest from static tension. Heel pain that appears for the first time is a reason not to postpone a visit to the doctor, because early consultation makes it easier to select the right help. It is worth thinking in advance about which footwear you spend most of the day in, and replacing the ones that do not support the arch.
What should be kept under control
- Body weight: its gradual change reduces the load on the fascia, while sharp fluctuations in weight give the foot extra work.
- Footwear for the day: a spare pair with an orthotic insole for long walking and standing reduces pressure on the heel throughout the day.
- Stretching of the feet and lower legs: regular performance of the movements preserves the elasticity of the ligaments and reduces morning stiffness in the heel.
- Breaks during prolonged standing: a short rest for the foot reduces the static load that accumulates by the end of the working day.
- The nature of the heel pain: a change in its intensity or the time of its appearance shows whether the chosen regimen is helping or a doctor's consultation is needed.
How often to see a doctor
A regular examination by a doctor is needed even when the heel does not bother you and it seems that everything is fine. The specialist assesses how the foot copes with everyday load and notices changes earlier than they become noticeable. With a calm course, routine visits are sufficient, and their frequency is determined by the doctor taking into account your work and weight. If the heel pain intensifies or returns after a period of calm, the visit should not be postponed for long. At the appointment, they discuss how suitable the footwear is, how stretching and breaks during standing load are performed. This allows habits to be adjusted in time, before the condition turns into a persistent exacerbation. Arrange the next visit in advance so that monitoring remains regular, and not only when pain occurs.
What is worth remembering
A heel spur is a condition in which heel pain changes the usual rhythm of the day, and a calm, consistent approach helps to make sense of it. Below are the main conclusions worth taking away from this material.
Main conclusions
A heel spur is not a sentence and not a reason to change your whole life, but enduring pain for years is not worth it either. Behind a noticeable bone protrusion there is often long-term overload of the foot, and the protrusion itself is not always to blame for the sensations. Only a doctor can put an end to the guesswork, by comparing the complaints with the results of an examination and scans. If the visit is postponed, the gait changes imperceptibly, and the load is redistributed to the knee and lower back. Seeking help early allows you to understand the causes more quickly and choose a suitable approach. Many people put it off for months because the pain subsides at rest and seems unimportant. A heel spur requires attention to footwear, weight and loads, and not only to the heel itself.
