Calcaneal spur

In summary: the spur is rarely the true cause of the pain; this usually comes from the associated fasciitis. This is why we treat the cause —shock waves, insoles—, not the image on the X-ray, and we assess it with an ultrasound at the first visit.

A calcaneal spur is a calcification at the bottom of the heel. It is clearly seen on the X-ray, but —and this surprises many people— it is often not the true cause of the pain: this, in most cases, comes from the associated plantar fasciitis.

This is why we do not treat “the spur in the image,” but what is actually hurting. With an ultrasound and gait analysis we find the cause and treat it.

I have a spur on the X-ray: what it really means

Finding a spur on the X-ray is frightening. You see a bone “hook” under the heel and it seems logical to think it is what stabs with every step.

The reality is more reassuring. The spur is the consequence of years of traction of the fascia and muscles on the bone, not an object that stabs into it. In fact, many people have spurs on both feet and only one heel hurts —or neither.

This is why what we explore is not the bone, but the surrounding tissues: the associated plantar fasciitis is responsible for the pain in most cases. The ultrasound at the first visit shows us this on the same day, in the same consultation.

Shock waves for calcaneal spur: what to expect

Regenerative treatments — such as ultrasound-guided PRP — are one of the options for persistent heel pain that does not improve with rest. No treatment “breaks” the spur, as is sometimes said: the goal is to stimulate the recovery of the irritated tissue surrounding the area.

The treatment is done in the consultation, in short sessions, and is combined with the rest of the plan: activity guidelines, footwear, and if gait contributes, custom insoles that offload the exact point.

A detail that surprises many patients: the goal of the treatment is not for the spur to disappear from the X-ray. It is for it to stop hurting. And one thing does not depend on the other.

What happens if it is not treated

A heel that hurts conditions much more than it seems. Without realizing it, you change the way you walk to protect it: you put more weight on the toes or the outer edge of the foot.

This change in gait overloads other structures —the forefoot, the ankle, even the knee— and can add new problems to what was already there. Moreover, the longer the tissue has been irritated, the slower the response to treatment tends to be.

The good news: you don’t have to let it get to that point. If heel pain has been going on for more than two weeks, a gait analysis and an ultrasound in the consultation are usually enough to know what is happening and how to address it. And almost never is the answer the operating room.

The first step is simple: a visit with an ultrasound on the same day, in Martorell, Barcelona (Teknon) or Igualada, to put a name to what is happening to you and leave with a concrete plan.