Many of the patients we see at the Seattle Heel Pain Center ask if they have heel spurs and whether they need surgery to remove them. On this page we’ll look at what is a heel spur, what causes them and the treatment options. But let’s start this by telling you that you rarely need surgery to remove a heel spur. The main reason we know that you do not need surgery for heel spurs is that chronic heel spurs do not hurt. What hurts is plantar fasciitis - inflammation and damage to the plantar fascia which may cause bone reaction and spur formation. It is not the spur causing your pain.
What Are Heel Spurs?
A heel spur is simply an enlargement of the bone at the attachment point of the thick plantar fascia band that attaches into the heel bone (figure 1)
Figure 1 - Heel Spur bottom of foot
Why do Heel Spurs Form?
Heel spurs form when the arch of the foot flattens excessively. When the arch flattens, the foot gets longer and when the foot gets longer, the plantar fascia gets tighter. This tight plantar fascia tugs on the heel bone and over time the bone reacts by forming the spur.
Do Heel Spurs Pain?
Heel spurs are simply enlargements of bone and they are not poking into anything, thus the spurs themselves do not usually cause any pain. The pain of plantar
fasciitis is caused by inflammation and damage to the plantar fascia
ligament as it attaches to the heel bone (more
details on the cause of plantar fasciitis can be found here).
The bone reacts to the pulling of the fascia and forms a heel spur. When
the plantar fascia is inflamed at the bone insertion you may see a hot
spot on a bone scan, figure 2, and bone marrow edema on MRI scan. During
this active bone formation phase you may have an increase in pain but
once the bone/spur finishes forming your pain will resolve. Thus, old
heel spurs do not cause pain. Studies clearly show heel spurs are normal
with aging but more common in people who had an episode of heel pain.
You may actually have a larger spur on the asymptomatic foot. Thus, only
in rare causes do you need your heel spur removed.
Figure 2: Bone Scan shows increase uptake region of
plantar fascia insertion indicating active plantar fasciitis.
Bone spurs may form during this phase of active
plantar fascia inflammation.
Heel Spur Surgery is RARELY indicated
Heel spurs are simply a reaction of too much tugging of the plantar fascia on the heel bone. The bone reacts by forming a spur.
The active inflammation caused by the pulling of plantar fascia on the
bone is the cause of heel pain not the spur itself. Because the spur is
not the direct cause of pain, we are able to cure your
plantar fasciitis related heel pain without doing surgery to remove your heel spurs. Heel spur surgery was very common 20 years ago – before we really understood the actual cause of plantar fasciitis pain. Today, heel spur surgery is rarely performed. We highly recommend that anyone who has had heel spur surgery recommended to them should get a second opinion before proceeding.
If you are in the Seattle area, call us today to make an appointment at the Seattle Heel Pain Center.
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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