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It’s remarkable how a bout of foot pain can make even simple daily activities excruciatingly difficult. Tendons, ligaments, bones, and muscles in the feet can be damaged. Heel spurs are one common issue that can affect foot health but fortunately, there are several treatments available.
What is a heel spur?
A heel spur is a hook-shaped bony outgrowth that forms on the bottom or back of the heel bone, or calcaneus. Spurs result from chronic stress or injury to the heel bone. The body compensates by growing bone in the affected area.
Heel spurs take a long time to grow. They can result from stress caused by an inflamed foot ligament, an injured Achilles tendon, or strenuous activities such as running or jumping for long periods of time. Walking on the inside or back of the heel also overstresses the heel bone. Improper footwear, flat feet, high arches, excess weight, and walking or running on hard surfaces can also stress the heel bone and contribute to the development of heel spurs.
Heel spurs on the bottom of the foot, called inferior calcaneal spurs, are most often associated with plantar fasciitis, or swelling of the plantar fascia ligament, a thick, wide, and tough mat of fibers that runs the length of the bottom of the foot from the heel bone to the ball of the foot. The plantar fascia supports the arch of your foot and absorbs much of the force the foot bears when we stand, walk, run, or jump. Inferior calcaneal spurs form right at the point the plantar fascia connects to the heel bone, a condition called heel spur syndrome.
Heel spurs on the back of the heel bone are often associated with Achilles tendonitis, or swelling of the Achilles tendon due to trauma or repeated injury. When the Achilles tendon is damaged right where it joins the heel bone—a condition called insertional Achilles tendonitis—the additional stress on the heel bone can promote the growth of a spur, called a posterior calcaneal spur. These bony protrusions often grow quite big. They often irritate the Achilles tendon and can cause considerable pain.
About one in three people have plantar heel spurs, but the condition is more prevalent among the elderly. Most plantar heel spurs are painless. Any heel pain experienced is more often due to the underlying plantar fasciitis. When the spur does cause pain, it’s due to irritation of the ligament or heel pad tissue, nerve compression, or microfracture. If a spur on the bottom of the heel grows large enough and at a certain angle, it can become a load-bearing bone and cause significant pain when standing or walking. Excess weight significantly raises the probability that a plantar heel spur will cause chronic pain.
About 13% of the population have posterior calcaneal spurs. Some, like plantar spurs, are painless. However, spurs on the back of the heel can grow quite large. They can stress or irritate the Achilles tendon and cause significant pain.
In most cases, heel spurs are treated by addressing the underlying condition. Symptomatic plantar heel spurs are treated conservatively, but in cases where the pain cannot be managed, the spur can be surgically removed. Spurs associated with Achilles tendonitis are more likely to be surgically removed.
How is a heel spur diagnosed?
A heel spur is diagnosed when it is identified on an X-ray or other medical image. Doctors often discover a heel spur when taking routine X-rays for a fracture or other foot problem. Many heel spur patients may be treated by a general practitioner, but severe or debilitating heel pain is often referred to an orthopedic surgeon or podiatrist.
Most heel spurs do not have symptoms, so the symptoms of heel spurs are the symptoms of associated conditions such as plantar fasciitis or Achilles tendonitis.
Plantar fasciitis pain is usually sharp and intense when weight is put on the foot first thing in the morning. The pain decreases throughout the day to a milder, dull pain. Pain caused by an inferior calcaneal spur, however, is provoked whenever weight is put on the heel. It does not get better throughout the day.
Insertional Achilles tendonitis produces pain whenever stress is put on the tendon, such as walking, running, or jumping. Bending the foot upwards past a 90-degree angle stretches the tendon and produces pain. A posterior calcaneal spur can amplify any pain caused by stretching or stressing the tendon. A posterior calcaneal spur tends to be quite large and often can be easily felt at the back of the heel.
Because most bone spurs take a long time to develop, a healthcare provider will want to have a thorough history of the symptoms, activities, and lifestyle habits that may have contributed to the condition. Outside of X-ray images, no other medical tests or imaging is required.
Heel spur treatment options
Painless heel spurs do not require treatment, but any underlying condition, such as plantar fasciitis or Achilles tendonitis, will be treated appropriately.
Symptomatic heel spurs—ones that cause pain—are primarily treated with conservative treatments: activity modification, lifestyle changes, orthotic devices, or over-the-counter pain medications. Cortisone injections may be given to reduce inflammation from severe heel spurs. Large spurs that are causing pain or damaging soft tissues may be surgically removed.
Activity modification
Plantar fasciitis and Achilles tendonitis will require significant restrictions in physical activity to allow the ligament or tendon to heel. For symptomatic heel spurs, however, the goal is to reduce the load on the heel. Athletic activities, lifting heavy objects, and long periods of standing or walking may need to be limited or stopped altogether to allow tissue swelling to subside.
Lifestyle changes
Heel spurs do not go away unless they are surgically removed. Weight loss, better-fitting shoes, and improving the gait can often reduce load-bearing pain caused by a heel spur. Lifestyle changes can also help reduce irritation of the Achilles tendon by a spur on the back of the heel.
Orthotics
Orthotic devices such as arch supports are used to treat plantar fasciitis or Achilles tendonitis pain. However, heel inserts or heel spur pads can significantly relieve pressure and pain on load-bearing heel spurs. Inserts and pads also evenly distribute the shock of walking or running. A podiatrist can help fit orthotics that correct for flat feet, fallen arches, or improper walking styles to reduce the extra stress that is causing heel spurs to develop.
Bracing
Night splints, bracing, and taping are all standard and successful therapies for both plantar fasciitis and Achilles tendonitis. In addition to significantly reducing foot pain and aiding recovery from these conditions, a night splint may be recommended to reduce pain from heel spurs.
Medications
In most patients, the pain from symptomatic heel spurs can be successfully managed with ice packs and over-the-counter pain relievers. If conservative pain management is not sufficient, an orthopedist may use cortisone injections in the soft tissues surrounding the spur to provide long-term pain relief.
Surgery
When all other treatments have been exhausted, an orthopedic surgeon can surgically remove the heel spur. However, surgical treatment of plantar fasciitis or Achilles tendonitis usually includes removing any bone spur or calcium deposits on the bone. Bone spur removal often relieves heel pain, but not always. In addition, heel spurs can always grow back if the underlying cause is not addressed.
Heel spur medications
Medications can help relieve pain caused by heel spurs, but they do not treat the spur itself or the underlying problem. Applying ice packs and over-the-counter pain relievers are typically sufficient, but more severe pain may require corticosteroid injections.
Pain relievers
Over-the-counter analgesics are usually sufficient to control pain caused by a heel spur. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen will relieve pain and reduce any swelling in the soft tissues surrounding a heel spur. For patients who cannot tolerate the side effects of NSAIDs, acetaminophen will relieve pain but not help with swelling. Icing the affected area for 10 to 15 minutes four times a day can help reduce soft tissue swelling in addition to helping soothe the pain.
Corticosteroids
When pain cannot be managed conservatively, an orthopedist may inject a corticosteroid, such as methylprednisolone or dexamethasone in the soft tissues surrounding the bone spur. Corticosteroids rapidly reduce any swelling in those tissues and can provide pain relief from the bone spur for a few weeks to a couple of months. Injections are typically administered every two months for up to six months.
What is the best medication for heel spur?
Medications alleviate the pain caused by symptomatic heel spurs. Pain relief is very subjective and does not fix the problem, so there is no “best” medication for heel spurs.
| Best medications for heel spur | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Aspirin | NSAID | Oral | 325 to 650 mg every four hours. Maximum of 4,000 mg per day | Upset stomach, heartburn, bleeding |
| Advil (ibuprofen) | NSAID | Oral | 200 to 400 mg every four to six hours as needed. Maximum of 1,200 mg per day | Nausea, headache, rash |
| Aleve (naproxen) | NSAID | Oral | 500 mg once, and then 250 mg every six to eight hours as needed. Maximum of 1,250 mg on day 1 and 1,000 mg on the following days | Nausea, heartburn, headache |
| Tylenol (acetaminophen) | Analgesic | Oral | 650 mg every four to six hours as needed. Maximum of 3,250 mg per day | Nausea, itching, headache |
| Depo-Medrol (methylprednisolone acetate) | Corticosteroid | Injection | Dosage varies depending on patient response and severity of the condition | Injection site reactions, rash, edema |
| Dexamethasone | Corticosteroid | Injection | Dosage varies depending on patient response and severity of the condition | Injection site reactions, rash, edema |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of heel spur medication?
Over-the-counter pain relievers are both safe and effective for relieving heel pain. The most significant side effects of NSAIDs, such as ibuprofen or aspirin, are stomach pain, stomach ulcers, bleeding problems, and heartburn. Because NSAIDs block the ability of the body to form blood clots and protect the digestive system from stomach acid, people with bleeding or stomach acid disorders should avoid NSAIDs. Acetaminophen does not affect the gastrointestinal system or interfere with blood clotting, but the medication can cause nausea, headache, or stomach pain. Acetaminophen’s most serious side effect is liver damage from overdose, so carefully follow the package’s directions.
Corticosteroids commonly produce side effects, but doses for heel pain are very low and spaced out over months. Commonly-experienced side effects such as mood and behavior changes, aggressiveness, increased appetite, fluid retention, and weight gain are less likely with low doses. Heel pain patients more typically are at risk for injection site pain, increased pain in the heel pad, skin thinning on the bottom of the foot, and rupture of the plantar fascia. Even in small doses, injected corticosteroids can increase blood pressure and blood glucose levels, so diabetic and hypertensive patients should be cautious.
Side effects are possible with all medications. Different drugs have different side effects. This is not a complete list of side effects, so consult with a healthcare provider if you have concerns about possible side effects or drug interactions.
What is the best home remedy for heel spur?
Heel spurs don’t go away. They are, after all, made of bone. There are, however, a few home remedies that can help relieve the pain of symptomatic heel spurs and prevent the further growth of painless heel spurs.
Modify activities
The basic principle is simple; take a load off your feet and:
- Limit the amount of time you spend standing or walking.
- Wear shoes that have supportive heels and shock-absorbing soles.
- Talk to a podiatrist to find the best shoes for your feet and any foot condition you might have, such as flat feet or high arches.
- Avoid walking barefoot on hard surfaces even at home.
- Limit impact exercises, such as running, and take up no-impact exercises such as swimming or cycling.
Lose weight
Excess body weight may put more stress on the heel bone and make bone spurs more painful. A sore foot is a good incentive to shed any extra pounds.
Use shoe inserts
Shoe inserts help relieve heel spur pain. They absorb much of the force of standing and walking and distribute that force evenly across the heel and the rest of the foot. A podiatrist can help you choose the right kind of shoe inserts or heel spur pads.
Use ice
Place ice over the hurting area for 10 to 20 minutes three or four times a day. The ice can help reduce soft tissue swelling and calm the pain.
Take over-the-counter pain relievers
Pain relievers help with the pain, but the most effective are anti-inflammatory medications such as ibuprofen, naproxen, or aspirin. While NSAIDs relieve pain relatively quickly, it may take up to a week to experience the anti-inflammatory effects of these medications. Consult a doctor before taking NSAIDs for longer than 10 days.
Frequently asked questions about heel spur
How do you get rid of a heel spur?
Heel spurs do not go away. They often do not cause pain, but when they do, conservative treatment is usually enough to relieve the pain. In more severe cases, a bone spur can be surgically removed, but this may not relieve the pain. Bone spurs can, of course, grow back after surgical removal.
How long does a heel spur last?
A heel spur is forever. There are no medications or therapies to shrink or “dissolve” heel spurs. In patients with debilitating pain, the heel spur can be surgically removed.
How long does it take to recover from heel spur surgery?
Recovery from heel spur surgery depends largely on the extent of the surgery. Simple spur surgery may take a few weeks of recovery time, but surgery that also involves the plantar fascia ligament or the Achilles tendon may take months before the foot fully recovers.
How do you get rid of bone spurs naturally?
The only way to get rid of a heel spur is to have it removed by an orthopedic surgeon. Before surgery is ever considered, a symptomatic heel spur will be treated with lifestyle changes, activity modification, shoe inserts, physical therapy, and pain medications.
Do heel spurs go away on their own?
Heel spurs do not go away. However, the pain caused by heel spurs can be managed as can any associated condition such as plantar fasciitis or insertional Achilles tendonitis. Bone spurs that cause severe and debilitating heel pain can be surgically removed.
Does wrapping help plantar fasciitis?
In patients with plantar fasciitis, taping, night splints, and bracing help to limit the movement of the foot. This reduces stretching and movement of the plantar fascia ligament, preventing further damage and allowing the tissue to heal.
What is the best medicine for heel spurs?
No medicine treats heel spurs. However, pain caused by heel spur can be managed with over-the-counter pain relievers and anti-inflammatory medications as well as applying ice to the area several times a day. For pain that cannot be managed with pain relievers, an orthopedist or podiatric physician may inject corticosteroids into the soft tissues surrounding the heel spur. These injections typically relieve pain for a few weeks to a couple of months.
What is the difference between a heel spur and plantar fasciitis?
Plantar fasciitis is swelling of the plantar fascia, a powerful, shock-absorbing ligament that runs along the bottom of the foot from the heel bone to the ball of the foot. Heel spurs are bony growths that often occur right at the point where the plantar fascia inserts into the heel bone. About half of all people with plantar fasciitis also have plantar heel spurs, possibly because the same stresses that cause plantar fasciitis also injure the heel bone at the plantar fascia insertion point. Foot pain is usually due to plantar fasciitis, not the heel spur. However, the heel spur can cause pain if it’s bearing the body’s weight, compressing a nerve, or irritating soft tissues around it.
What is the fastest way to heal a heel spur?
Heel spurs do not heal. Unless they are surgically removed, a heel spur is a permanent part of the foot. Fortunately, many heel spurs are painless. When they do cause pain, non-surgical treatments such as over-the-counter pain medications, ice packs, shoe inserts, and activity modification are enough to manage the pain. For severe pain, doctors will do corticosteroid injections or surgery.
What is a home remedy for heel spurs?
Heel spurs are largely treated by taking care of the foot at home. Rest, activity modification, icing, over-the-counter pain relievers, well-fitting shoes, foot stretches, and shoe inserts all help to manage and reduce heel spur pain.
What exercises help heel spurs?
Physical therapy exercises for heel spurs will focus on increasing flexibility, muscle strength, and range of motion. Calf stretches, heel raises, plantar fascia release, and plantar fascia stretches help to strengthen walking muscles and lengthen the plantar fascia.
What foods help heel spurs?
The formation and symptoms of heel spurs are entirely due to mechanical stress on the heel bone, so diet and nutrition do not play a role in preventing or treating heel spurs. That being said, excess weight makes the formation of painful bone spurs more likely. A nutritious diet that contributes to weight loss can help manage or prevent symptomatic heel spurs.