Heel Spur and Achilles Heel Spur (Retrocalcaneal Exostosis)

Heel Spur 

Heel spurs bony protrusions that grow at the bottom of the heel, on the sole of the foot. They are also referred to as calcaneal spurs.

A heel spur forms where the plantar fascia (the ligament along the bottom of the foot) —connects to the heel bone. The spur is often hook-shaped and grows in the direction of the plantar fascia.

Achilles Heel Spur (retrocalcaneal exostosis)

Achilles bone spurs occur at the back of the heel, where the Achilles tendon attaches the bone. This painful condition is often related to the chronic tugging of a tight Achilles tendon on the heel bone. The bone spur can destroy the attachment of the Achilles tendon so it is important to seek proper medical attention at the onset of the condition.

This condition typically affects adults, and because of the types of shoe women wear, they are more at risk.

Heel Spur Symptoms and Causes

Most of the time heel spurs present as pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue.

Generally caused by lack of flexibility in the calf muscles and/or excess weight, heel spurs occur when the foot bone is exposed to constant stress and calcium deposit build-up on the bottom of the heel bone. Repeated damage can cause these deposits to pile up on each other, presenting a spur-shaped deformity.

Diagnosing a Heel Spur and Achilles Heel Spur

Diagnosis is made using a few different technologies. X-rays are often used first to ensure there is no fracture or tumor in the region. Then ultrasound is used to check the fascia itself to make sure there is no tear and check the level of scar tissue and damage. Neurosensory testing, a non-painful nerve test, can be used to make sure there is not a local nerve problem if the pain is thought to be nerve-related.

It is important to remember that one can have a very large heel spur and no plantar fasciitis issues or pain at all, or one can have a great deal of pain and virtually no spur at all.

Heel Spurs vs. Plantar Fasciitis, What's the Difference?

Although a heel spur is often thought to be the source of heel pain, it rarely is. When a patient has plantar fasciitis, the plantar fascia pulls on the bottom of the heel bone. Over time this can cause a spur to form. Heel spurs are a very common x-ray finding, and because the heel spur is buried deep in soft tissue and not truly in a weight-bearing area, there is often no history of pain.

It is important to note that less than one percent of all heel pain is due to a spur but frequently caused by the plantar fascia pulling on the heel. Once the plantar fasciitis is properly treated, the heel spur could be a distant memory. Learn more about Plantar Fasciitis here. 

Non-Invasive Heel Spur Treatment Options

Initially, treatment usually consists of a combination of home remedies such as ice therapy, stretching exercises to improve flexibility (especially in the mornings), and anti-inflammatory medications (NSAIDs).

Additional treatments include:

• Custom-molded orthotics to help control the motion in the foot and arch of the foot, which takes the strain off the plantar fascia and reduces the pull on the Achilles tendon.
• Cortisone injection may be used to calm the severe swelling and pain in the affected area. 
• A night splint to maintain a stretch in the plantar fascia throughout the night and physical therapy may be prescribed.

At the University Foot and Ankle Institute, we will try conservative and non-invasive treatments when a condition is in its early or “acute” phase. With a success rate of over 90%, a slow and steady course of treatment usually is just what the doctor ordered. 

Non-Surgical Treatment Options

Though conservative treatments for heel spurs work most of the time, there are some cases where we need to take your treatment to the next level. Luckily, with today’s technologies, you can still often avoid surgery.

Some of the advanced technologies we have to treat a Heel Spur are:

Platelet Rich Plasma Therapy (PRP)

Shockwave Therapy 

Topaz for Heal Spurs and Pain

Heel Spur and Retrocalcaneal Exostosis Surgery

Endoscopic Plantar Fasciotomy is one surgical procedure that we consider to release the tight fascia. University Foot and Ankle Institute has perfected an endoscopic (camera-guided) approach for fascia release to allow rapid healing and limited downtime with minimal pain.

If spur removal is required for Achilles heel spurs, the procedure may be done arthroscopically to limit the incision and trauma to the area. Surgery with an open incision may be needed in severe cases. The key to a good outcome is a solid reattachment of the Achilles tendon and complete removal of scar tissue and bone spurs.

Why is University Foot and Ankle Institute the Best Choice for Heel Spur Treatment?

Awarded Best Podiatrists in Los Angeles by LA Magazine and Best Foot and Ankle Surgeons in California, our physicians have decades of extensive experience treating heel conditions and spur removal related to retrocalcaneal exostosis.

We are pleased to offer multiple locations throughout Greater Los Angeles and Southern California.  Our Valencia, Sherman Oaks, Beverly Hills, Manhattan Beach, West Los Angeles, and Santa Monica Podiatry locations offer a range of services. These include full radiology, MRI, neurosensory nerve testing, and ultrasound. This means you will rarely have to go from office to office if tests are ordered.

We are also proud to offer state-of-the-art surgical centers and physical therapy services conveniently located within our Valencia and Santa Monica Podiatry offices and close to our other locations. Our advanced services get you back on your feet and back to your life in the least amount of time possible!

Frequently Asked Questions about Heel Spurs and Heel Spur Surgery

 

Q: Once a heel spur is removed, will it come back?

A: Yes, a heel spur can “technically” return, but that is really rare.

 

Q. For heel spurs, I was told that it is caused by the excess calcium deposit. In this case, how can the Topaz procedure remove the excess calcium, because you have mentioned it will only remove the damaged tissue and not the calcium?

A. The heel spur is not the source of pain. The pain is from the scar tissue and damage to the plantar fascia insertion on the heel. We prefer a newer technique called hydrocision from TenJet.

 

Q: If I have a Heel Spur, does it always need to be removed? 

A: No, a Heel Spur does not always have to be surgically removed. If it is causing no physical pain or harm, then there is probably no good reason to remove it since avoiding surgery whenever possible is the smartest way to go.

But if you have symptoms, it also does not mean you need to remove the spur. For example,  if the Heel Spur is on the bottom of the heel, it generally does not need to be removed and only a plantar fascia release would be necessary. But If the Heel Spur is on the back of the heel and the patient has Achilles Tendon problems, it very well may need to be removed. Surgical decisions and treatment plans are always made by us based on the individual patient's physical condition and lifestyle.

 

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