Lower heel spur

This is the "right" heel spur, popularly known as such, and more often than the upper heel spur.

The load-dependent bright heel pain, located in the middle of the heel or somewhat inside, traces its origin almost always to the so called heel spur.

It is actually a bone formation, which presses on the plantar longitudinal ligament under load, where it causes inflammation and pain. A radiographic detection of the heel spur size is irrelevant, as the size has nothing to do with the pain scale.

This typical pain may also occur in complete absence of the spur, in this case we talk about the plantar fasciitis (see the inflammation of plantar).

Often even a small nerve, whose passage is hindered due to adhesions, is involved in the pain syndrome.

Treatment principle

The heel spur should be treated conservatively:

• calf stretching, special inserts
• buffer heels
• targeted infiltrations
• physiotherapy
• X-ray irradiation
• possibly shock wave therapy 
• (the latter hurts and does not help much, although it is very popular lately due to good marketing)

Only in a few cases, surgery is indicated, in which the fibers of the longitudinal ligament running over the spur (plantar fascia) are split. The spur itself is removed there. It is also sought to interrupt the nerve fibers.

Aftercare

Relief with two forearm crutches for two weeks.

Ability to work

Office work after two weeks, hard physical work can be started after about six weeks.

Results

Only about half of the operated patients are truly symptome-free, approximately 15 percent of the operations result in no improvement in terms of pain.

Therefore, in the treatment of a calcaneal spur, conservative treatment is to be fully exploited, an operation should be performed only after a treatment period of at least six months.

Conversely, the operation is a good chance to get rid of the discomfort in "desperate" cases, in which the conservative treatment does not remove the pain and further detailed investigations suggest no other diagnosis.

Complications

Infections in about 2 percent, rarely wound healing disturbances, very low risk of thrombosis.

Example:

A spur-rich foot:

Yellow arrow: The actual heel spur is the lower one: yellow arrow

Red arrow: upper heel spur

Green Arrow: additionally a small lower heel spur.