Bone spurs (retrocalcaneal spur, or exostosis) can develop not only on the back of the heel, but also on the toes, mainly around the fifth (small) toe. Most often, they occur next to the toenail on
the outside of the toe; on the inside of the toe near the tip, where the fifth toe presses against the fourth toe; and on the inside of the base of the toe. Bone spurs can also occur on the sides of
the toes. This is usually due to wearing shoes that are too tight in the toe box, which causes the toes to press against each other. Bone spurs may also develop in the arch area of the top of the
foot; this area becomes painful when you tie your shoelaces tightly or exert other pressure on that part of the foot. Formation of spurs in this area is often associated with arthritis.
Bone spurs can occur all over the body including the spine, shoulders, hands, hips and feet. The feet are a common place to find them. A heel spur happens when the body tries to mend itself. Building
extra bone is one way your body tries to correct a weakness. Wearing shoes that are too tight in the heel can cause bone spurs. More women than men get heel spurs because of the kinds of shoes they
wear. Athletes who stress their feet and legs routinely are also prone to heel spurs. Being overweight can also indirectly cause heel spurs by over-exerting the plantar fascia. Some heel spurs are
caused by the aging process, in which the cartilage covering the ends of bones wears away. This process can lead to pain, swelling and spur formation. Stress-related problems with the plantar fascia
frequently lead to heel spurs.
The pain caused by a calcaneal spur is not the result of the pressure of weight on the point of the spur, but results from inflammation around the tendons where they attach to the heel bone. You
might expect the pain to increase as you walk on the spur, but actually it decreases. The pain is most severe when you start to walk after a rest. The nerves and capillaries adapt themselves to the
situation as you walk. When you rest, the nerves and capillaries rest, also. Then, as you begin to move about again, extreme demands are made on the blood vessels and nerves, which will cause pain
until they again adjust to the spur. If excessive strain has been placed on the foot the day before, the pain may also be greater. A sudden strain, as might be produced by leaping or jumping, can
also increase the pain. The pain might be localized at first, but continued walking and standing will soon cause the entire heel to become tender and painful.
Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel
release) along with the plantar fascia release. This surgery is about 80percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.
Non Surgical Treatment
Elevation of the affected foot and leg at rest may diminish the pain. Applying gentle heat to the painful area may ease the pain by dilating local blood vessels. One also can protect the heel by
placing a foam rubber pad in the heel of the shoe. A pad about one-half inch thick will raise the heel, shift the weight of the body forward, and protect the irritated muscles attached to the heel
bone. The same effect can be achieved by using adhesive tape to turn the foot inward. Additional treatment may consist of a number of physical therapies, such as diathermy, ultrasound waves and
Heel spur surgery should only be considered after less invasive treatment methods have been explored and ruled insufficient. The traditional surgical approach to treating heel spurs requires a
scalpel cut to the bottom of the food which allows the surgeon to access the bone spur. Endoscopic plantar fasciotomies (EPF) involve one or two small incisions in the foot which allow the surgeon to
access and operate on the bone spur endoscopically. Taking a surgical approach to heel spur treatment is a topic to explore with a foot and ankle specialist.