What is a Heel Spur?
The structure that runs under the sole of the foot and connects the heel bone to the toes is called the plantar fascia. The condition caused by injury to this thick band of tissue is known as plantar fasciitis. If the plantar fascia is injured and left untreated, calcium deposits will accumulate at the area where the tendons attach to the heel. Over time, this bony projection, which can be seen on plain X-rays, is called a heel spur.

Under normal conditions, the plantar fascia acts like a shock-absorbing arch and supports the foot. Excessive tension and stress in this band can cause small tears to develop.

What Causes Heel Spurs?
Chronic stretching of the plantar fascia, repetitive microtraumas, inflammation, and ruptures lead to injury in the sole band. Over time, calcium deposits may form in this area. The plantar fascia is a connective tissue band that links the heel bone to the toes. Calcium buildup on the heel side of this fascia can cause a heel spur.

Risk Factors for Heel Spurs
The exact cause of heel spurs is unknown, but several factors increase the likelihood of developing the condition. It is mostly seen between the ages of 40 and 60.

• Certain types of exercise, especially brisk walking and running on hard surfaces
• Long-distance running such as marathons
• Ballet and aerobic dancing
• Being overweight
• Wearing unhealthy shoes that do not fit the foot structure
• Occupations that require standing for long periods

What Are the Symptoms of Heel Spurs?
Heel spurs often do not cause symptoms. The most common complaints are intermittent or constant pain. Generally, the pain is not caused by the heel spur itself but by the soft tissue injury in the associated plantar fascia.

Many patients complain of stabbing pain like a knife or needle prick during the first few steps after getting out of bed in the morning. The pain may then become a bothersome ache. Pain can also suddenly appear after prolonged inactivity. It can be triggered by standing for long periods or rising after sitting. Additionally, a visible bony protrusion may be seen under the heel. Swelling and increased warmth may be detected in the affected area.

How is Heel Spur Diagnosed?
Diagnosis is generally made based on medical history and physical examination. Radiologically, if there is a bony outgrowth on the heel bone, diagnosis can be confirmed. Usually, the patient’s history guides the diagnosis. In cases where no calcium accumulation has occurred, no findings may be seen on X-rays, and there is no definitive physical exam sign for heel spurs.

What Are the Treatment Methods for Heel Spurs?
The treatment aims to:

• Reduce the pressure on the foot
• Control pain and inflammation
• Promote tissue healing with rest
• Increase soft tissue flexibility

Treatment methods include:

• Rest: Reducing the load on the foot allows tissue repair time.
• Ice application: Applying 20 minutes of ice compress to the painful area twice a day can reduce symptoms.
• Anti-inflammatory drugs and pain relievers
• ESWT (Extracorporeal Shock Wave Therapy)
• Stretching exercises and physiotherapy: Stretching the muscles and ligaments in the calf area can be done through exercises and physiotherapy.
• Use of orthotics: Shock-absorbing shoes with cushioned insoles, appropriate heel pads, and orthopedic devices can be used. The foot can be taped in a special position, and night splints may be used for this purpose.
• Wearing shock-absorbing sports shoes and special insoles to reduce pressure on the foot is important.

In most cases, these treatment methods are sufficient, and more than 90% of patients improve. Steroid injections are not administered in these patients.