Causes of heel spurs

The lower limbs and in particular the feet are the parts of the human body that experience the greatest load. The part of the foot that is commonly called the heel suffers the most, because it has to bear the weight of the entire human body. And it is not surprising that under the influence of certain provoking factors and age-related changes, pathological changes can occur in various tissues of the heel, such as the formation of a painful growth called a heel spur. The causes of the appearance of a heel spur can be different and most often it affects women who have crossed the 40-year mark. But it should be noted that in fact, almost no one is immune from this pathology, you just need to carefully study the factors that cause degenerative changes in the tissues of the foot and heel.

What is a heel spur?

A sharp pain in the foot that does not allow a person to lean on the heel when walking or standing still, in the absence of a serious injury with damage to the heel bone, is considered a clear symptom of plantar fasciitis. The name of the disease itself suggests that we are dealing not just with a pain syndrome, the occurrence of which is associated with mechanical or thermal damage to the skin, muscles or bones, but with inflammation of the tissues in the heel area, more precisely at the junction of the heel bone and the Achilles tendon.

Thus, plantar (or plantar) fasciitis is an inflammation of the soft tissues - fascia (connective tissue that covers the human organs and connects them together) in the foot area. But what does a heel spur have to do with it, which, judging by the name, has a slightly different nature than simple inflammation of the muscles or fascia?

The fact is that people often call plantar fasciitis a heel spur due to the similarity of the symptoms of the pathology. Sharp pain when pressing on the heel is the main symptom of both pathologies, but is also the cause of confusion. In reality, plantar fasciitis can be considered the most common cause of heel spurs, since the disease causes inflammatory and degenerative changes in various tissues of the foot.

By its nature, a heel spur is one of the types of osteophytes - bone growths that can form on the surface of the bones of the upper and lower extremities (most often on the end sections of the bones in the area of the joints, but sometimes their appearance can be expected along the bone). Such a growth, formed on the heel bone, usually has the shape of a thorn with a fairly sharp end (resembles a growth on the leg of a rooster, called a spur). When a person steps on the heel, the growth begins to press hard on the soft tissues of the sole, resulting in excruciating acute pain, with which patients usually consult a doctor.

Since a heel spur is a growth inside the tissues and is not visible to the naked eye, many people wonder what a heel spur that brings so much pain and suffering actually looks like? A heel spur has a slightly unusual shape with a tip directed toward the front of the foot and slightly bent upward. Its size can change, because now the inflammation in the heel area supports the growth itself, regularly injuring the soft tissues. And chronic inflammation, in the end, provokes metabolic disorders and dysplastic processes in bone tissues, which cause not only the appearance, but also the subsequent growth of osteophyte.

In the heel bone, the inflammatory process usually occurs in the area where the plantar fascia attaches to it (fasciitis). The periosteum, unlike the bone itself, is supplied with many nerve endings, which cause pain when inflamed. The inflammatory process in the periosteum leads to its thinning, but this part of the bone cannot recover on its own, and the body begins to redirect calcium to the affected area to hide the defect. Over time, if the inflammation is not stopped, calcium accumulates and not only covers the defects of the periosteum, but also begins to protrude beyond its limits.

An identical situation can also be observed with hormonal imbalances and endocrine pathologies, when the body's metabolism is disrupted. Metabolic disorders in various tissues of the heel (fascia, cartilage, periosteum) cause calcium salts to accumulate in the area of the heel bone, which over time become denser and acquire the shape characteristic of a heel spur. The longer the inflammatory process lasts, the more the resulting osteophyte will grow.

So it turns out that a heel spur is a salt deposit? In a sense, yes, if we are talking about the accumulation of calcium salts. But we should not confuse this pathology with the verdict "salt deposits" in the case of arthritis, arthrosis, osteochondrosis, etc. Salt deposits in large joints, as it is understood in medicine, are the accumulation of uric acid salts (sodium and potassium salts) in the joint area, causing the destruction of bones and cartilage and provoking inflammatory processes. Here we are usually talking not only about metabolic disorders in the body, but also about kidney pathologies that cause uric acid retention in the body.

While the heel spur is small (1-3 mm), a person does not experience discomfort in the heel area, and may not suspect the presence of a defect until it is accidentally detected by an X-ray of the foot, often done in connection with another disease. A growth from 4 to 12 mm in size cannot help but injure the tissues around it, inflammation and pain appear, limiting the patient's movements and changing his gait, although external changes in the foot will not be visible.

Risk factors for heel spurs

As we have already understood, a heel spur does not appear suddenly and out of nowhere. Its appearance is preceded by long-term inflammatory processes, which the patient may not even suspect. This is the insidiousness of the pathology, the diagnosis of which without an X-ray examination is very difficult, and prevention does not always give positive results.

Inflammation of the plantar fascia with subsequent formation of a heel spur can be provoked by the following situations:

• Increased load on the legs and heel bone due to excess weight, diseases of the spine, large joints of the lower extremities, congenital or acquired defects in the structure of the foot (for example, flat feet), changing a person’s gait,
• Injuries to tendons, bones and soft tissues in the heel area, which are almost always accompanied by an inflammatory process. Even jumping onto a hard surface from a great height and the resulting severe bruise of the heel tissue can subsequently cause the appearance of a heel spur.
• Vascular and neurological disorders in the lower extremities can also become one of the factors causing inflammatory processes and metabolic disorders in the tissues of the foot.
• Inflammation of the periosteum of the calcaneus may be one of the symptoms of a chronic inflammatory process of a generalized nature. This is possible with gout, psoriatic arthritis, spondyloarthritis, rheumatism, etc.).
• Inflammation of the mucous bags of the joints in the area of the heel bone and Achilles tendon (calcaneal and Achilles bursitis).
• Heavy loads on the plantar fascia caused by professional activities (plantar fasciitis often affects athletes, whose ligaments are regularly covered with microcracks and become inflamed).
• Inflammation of the tissues in the sole area can be caused by shoes that are the wrong size or too narrow, regular walking in high heels or barefoot on a surface with pronounced unevenness.
• Hormonal disorders and endocrine diseases. They rarely lead to such consequences by themselves, but any injury against their background can be accompanied by increased accumulation of calcium salts in the affected area.

Needless to say, with age, the likelihood of developing a heel spur increases, and this is not only due to physiological changes that lead to hormonal imbalance and a decrease in the fat layer in the sole area, which softens the interaction of the foot and the hard surface, but also due to the baggage of diseases that a person has accumulated over many years.

It turns out that the causes of heel spurs are the same factors that lead to the development of plantar fasciitis. However, inflammation does not always cause the formation of bone growths on the heel. The appearance of such spiky growths is due to a long-term inflammatory process and regular trauma to the tissues of the foot that support it.

In connection with the above, we can conclude that heel spurs most often affect:

• people with a large body mass (their legs are subject to a lot of stress every day),
• patients with flat feet (in this case, the ligaments regularly suffer due to improper redistribution of pressure),
• athletes (frequent cases of sprains, the appearance of microcracks in the plantar fascia, heavy loads on the foot cause the appearance of heel spurs much earlier than 40 years),
• ladies who prefer high heels to shoes with comfortable soles.

These categories of people regularly put stress on their feet, which leads to the development of various pathological processes in them, and a heel spur (no matter how painful its manifestations are) is not the worst of them.

Symptoms of heel spurs

Since heel spurs and plantar fasciitis are related diseases, they are often confused due to the similarity of symptoms. At the same time, plantar fasciitis may be asymptomatic for a while (as in the case of micro-tears of the fascia, which a person may not feel). Even the appearance of a heel spur is not always accompanied by discomfort when walking. It can appear as a result of the pressure of the growth on the tissues of the sole and their inflammation, i.e. when the growth itself becomes the cause of the inflammatory process.

As long as a heel spur does not bother a person, he is unlikely to be concerned about its formation. But when symptoms of the disease appear, it will be quite difficult to tolerate them.

At first, the growth bothers a person only when walking and when heel needs to be supported, but later it can cause not only changes in gait, but also the development of flat feet and spinal diseases. Usually, the pain is stronger in the morning when a person gets out of bed (injured tissues have just begun to heal during rest, so they become very sensitive) and in the evening (due to the load on damaged tissues, the inflammation worsens).

As osteophytes grow and in the case of growths on both legs at once, pain begins to torment a person even at rest, when there is no load on the heel, and walking causes diffuse pain, so that patients have to resort to the help of support (cane, crutches), reducing the pressure on the foot.

Because of leg pain, a person tries to move less, and hypodynamia itself is dangerous due to disruptions in the functioning of various organs. Its consequences are excess weight, disruptions in the digestive system, metabolic disorders, muscle atrophy, deterioration of the brain and central nervous system. It turns out to be a vicious circle. By limiting motor activity, a person only provokes the growth of a heel spur, regardless of the cause of its occurrence.

It should be said that the intensity of pain, which patients describe as sharp, burning, as when stepping on a sharp object (nail, needle, etc.), depends not so much on the size of the bone growth as on its location. The severity of pain is higher, the more nerve endings are compressed by the spur. In this case, pain from a compressed nerve joins the pain from inflammation of the periosteum. And often not only the heel begins to hurt, but the entire foot, and sometimes even the ankle.

External changes in the heel area are rare and do not directly indicate a heel spur. This may be a slight swelling of the tissues in the heel area or the appearance of calluses on it, which are not typical for this part of the foot. But piercing pain in the heel says a lot and requires urgent therapeutic measures. Treatment of heel spurs should be done without putting off a visit to the doctor until the disease becomes chronic and does not cause a significant deterioration in the patient's quality of life or, even worse, loss of ability to work.