Heel spur

Definition

What is a heel spur?

A heel spur (also called a “calcaneal spur”) is a bony outgrowth that forms on the calcaneus (heel bone). One distinguishes between a plantar heel spur and a dorsal (or cranial) heel spur. A plantar heel spur is much more common and is located at the transition where the plantar fascia (also called the “aponeurosis”) attaches to the heel bone. A dorsal heel spur is located at the tendon insertion of the Achilles tendon.

A heel spur can be visualized on an X-ray and thus diagnosed by a physician. Many people already have a heel spur without feeling it or without it causing heel pain. Unfortunately, this bony growth can also lead to injuries and complaints around the heel area. Although a heel spur as a bony structure cannot be reversed, appropriate treatments can achieve a significant reduction in pain and an improvement in quality of life.

What is plantar fasciitis?
Plantar fasciitis is an inflammation of the so-called plantar fascia (also called the plantar tendon or aponeurosis). The plantar fascia is a strong band of connective tissue that runs from the heel bone to the base joints of the toes and supports the arch of the foot. In everyday language the condition is often mistakenly referred to as a heel spur. However, a heel spur is only very rarely responsible for heel pain, as explained in the next section. Depending on the inflammation and irritation of the plantar fascia, foot pain can vary. Heel spurs and plantar fasciitis can occur independently of each other, but they can also occur together.

Where does the foot pain come from in heel spur and plantar fasciitis?
The pain around the heel bone and the sole of the foot occurs due to irritation of the plantar fascia. The following faulty and overloading patterns can create increased tension in the myofascial structures of the posterior chain (including the sole of the foot, calf and hamstring muscles). This increased tension pulls the plantar fascia into length, which can become inflamed and lead to the well-known symptoms of plantar fasciitis. The body, due to the increased tension, wants to protect possible weak points from injuries and tears. In this case, the transition from the heel bone to the plantar fascia and the attachment of the Achilles tendon to the heel bone are potential weak spots. The body reinforces these points with bone-forming cells (osteoblasts). The spur is the result of this process. The spur only becomes problematic if it presses on the sensitive soft tissues (e.g. the plantar fascia) around the heel bone and thereby causes additional irritation. This irritation can also lead to inflammation in the heels and the sole of the foot, which is then called plantar fasciitis. The causes of plantar fasciitis and heel spur formation are explained below. From this knowledge, one can deduce what the treatment for heel spurs and plantar fasciitis might look like.

Causes of a heel spur and plantar fasciitis

The causes of plantar fasciitis and heel spurs are closely related to modern lifestyles and changed environmental conditions. In the past, our ancestors had to move much more and in a more holistic way to obtain food. Hunting, gathering berries or agriculture are just a few examples. Much of this movement was performed barefoot and on natural ground. The ground surface and the amount of movement led, among other things, to well-developed and naturally loaded foot and leg muscles. Lifestyle has changed dramatically over millennia. Modern civilization is often characterized by lack of movement and a sedentary lifestyle. When we do move, it is usually on hard, flat surfaces such as concrete or asphalt and in rigid, supportive shoes. Consequently, changes in movement quantity and quality lead to physical adaptations. The following describes how these adaptations contribute to the development of a heel spur and plantar fasciitis.

Lack of exercise and a sedentary lifestyle

Modern lifestyle with lack of exercise and a sedentary routine changes the load on our musculoskeletal system, which leads to corresponding adaptations. These adaptations play a decisive role in the causes of plantar fasciitis and heel spurs. The following changes significantly contribute to the development of plantar fasciitis and heel spurs:

• Weakened muscles

  Lack of movement and a sedentary lifestyle cause essential muscles to atrophy. The muscles of the foot and lower leg play a crucial role in supporting the foot arch and absorbing impact forces during walking and running. If these muscles are weakened, they cannot perform these functions effectively, leading to increased load on the plantar fascia.

• Foot deformities

  Weakened muscles can additionally cause foot deformities. The responsible muscles are no longer able to sufficiently support the longitudinal arch, which can lead to a collapsed or flat foot. Due to the lowering of the arch, the plantar fascia, which attaches to the heel bone and the base joints of the toes, is unnaturally stretched. This increases tension in the plantar fascia, which can result in irritation and inflammation. A valgus (pronated) foot can cause the heel to shift outward and the mid- and forefoot to collapse inward, leading to torsion of the plantar fascia and thus faulty and excessive loading of the aponeurosis.

• Fascial dysfunction

  Fascia can change its original structure and become brittle when loaded irregularly and unnaturally. Tension, adhesions and blockages of the fascia are the result. This impairs fascial function and can lead to increased tension in the posterior myofascial chain. The plantar fascia is then unnaturally stretched and becomes susceptible to inflammation and injury.

• Joint stiffness

  Due to lack of movement and a sedentary lifestyle, joints are not moved through their full possible range of motion. A natural stiffening of the joints results. Immobile joints, especially in and around the foot, increase the force impact on the plantar fascia, which leads to additional faulty and excessive loading. Joint stiffness can therefore be a cause of plantar fasciitis and heel spurs.

Hard, flat floors and rigid, supportive shoes

Changed environmental conditions have a significant impact on loading of the musculoskeletal system. Hard, flat floors and rigid, supportive shoes change the biomechanics of every single step and thus play a decisive role in the causes of plantar fasciitis and heel spurs. The following changes substantially contribute to their development:

• Force impact

  When walking on hard, flat floors and in rigid, supportive shoes, especially during heel strike, higher forces act on the musculoskeletal system. Because industrial floors are rigid and conventional shoe soles are stiff, the occurring forces cannot be absorbed, which increases the load on the body. This increased force impact first affects the feet and thus the plantar fascia, leading to additional faulty and excessive loading. In addition, due to the increased and earlier force impact, the possible reaction time of the responsible muscles is shortened. If the muscles cannot contract in time, the respective joint will not be stabilized adequately, which also leads to faulty and excessive loading. The muscles around the numerous joints in the feet and the ankle help to protect the plantar fascia.

• Unnatural sequence of movement

  Hard, flat floors and rigid, supportive shoes considerably hamper a physiological sequence of movement. On the one hand, due to lack of muscle activation at heel strike (see “Force impact”), the foot can collapse uncontrolled downward. The so-called “collapse foot” occurs. As a result, the plantar fascia is “struck” with every step instead of being guided in a controlled manner. On the other hand, natural forefoot rolling is reduced. Because of the lacking roll-off, the plantar fascia is loaded more intensely in a reduced area, which can injure and inflame it. The natural stretch of the plantar fascia during forefoot roll-off, which keeps the fascia supple and elastic and thus protects against faulty and excessive loads, is also missing.
  

• Weakened muscles

  Also, the passivity of the feet on hard, flat floors and in rigid, supportive shoes leads to a breakdown of the essential muscles that support the longitudinal arch and protect the foot from malposition. With weakened muscles, the plantar fascia is overloaded and is thus a cause of plantar fasciitis and heel spurs. Walking on compliant natural ground (e.g. sand or moss) challenges and strengthens the responsible muscles and thereby strengthens the feet.

Symptoms of heel spur and plantar fasciitis

It is important to mention that the following list contains the most common heel spur and plantar fasciitis symptoms. The list is not exhaustive. Atypical symptoms are also possible and are not listed here. Symptoms of heel spur and plantar fasciitis often depend on factors such as pain sensitivity, cause of the injury, severity of the injury and physical constitution. To obtain a clear diagnosis, a physician should be consulted.

• Heel pain or sole pain, which can also radiate across the entire sole of the foot.
• Starting pain when taking the first steps after sleeping or after long sitting.
• Heel pain when stepping down with the foot.
• Symptoms come on gradually and worsen over time.
• Initially, pain in the heels and sole occurs only during weight-bearing.
• Pain on the inner side of the heel.
• Burning pain, as if a nail or knife is piercing the sole of the foot.
• Inflammation around the heels or across the whole sole of the foot.
• Foot pain when walking in the area of the heel and the sole.
• Pain in the heel or sole when pulling the toes upward and rolling the foot.
• Extreme loads, such as jumping, increase the pain.

Conventional therapies - What helps with heel spur and plantar fasciitis

There are several approaches to treating plantar fasciitis and heel spurs. Some plantar fasciitis and heel spur therapies are presented below. The list is not exhaustive. Various measures can be combined to treat plantar fasciitis and heel spurs. A medical consultation is recommended to determine the appropriate therapy.

• Rest and unloading:

  To relieve pain from a heel spur or plantar fasciitis, the affected heel and plantar fascia should be rested and activities reduced. Light exercises for heel spur and plantar fasciitis can be helpful.
  

• Exercises:

  A common therapy for plantar fasciitis and heel spurs includes stretching exercises to relieve the plantar tendon. These exercises can be done at home without equipment. Targeted exercises can help treat both types of heel spurs (dorsal and plantar) and plantar fasciitis.
  

• Physiotherapy:

  With special stretching and strengthening exercises for the foot muscles, a heel spur can be treated and the irritated plantar fascia relieved. Manual therapies can release tension and blockages and thus be a helpful treatment for heel spurs and plantar fasciitis.
  

• Orthotic insoles:

  Orthotic insoles can be a helpful transitional solution for treating heel spurs and plantar fasciitis. The supportive elements of the insoles help to unload the heel and the plantar fascia, which can play an important role in treatment. Insoles for heel spur and plantar fasciitis are often equipped with soft material in the painful area to relieve the sensitive spot.
  

• Medications:

  Painkillers and anti-inflammatory medications can help alleviate symptoms when heel inflammation is severe. There are no specific medications for plantar fasciitis or heel spurs. In combination with other measures such as stretching exercises, treatment can be made more effective.
  

• Shockwave therapy:

  This form of therapy is an effective method to treat plantar fasciitis and heel spurs. This targeted therapy is particularly suited for chronic pain and supports the healing process.
  

• Surgery:

  In rare cases, surgery may be necessary to remove the heel spur if conservative treatment does not lead to the desired result. The aim of the operation is to remove the heel spur that caused persistent inflammation and pain. This solution should always be considered only after a series of conservative treatments have failed.

Often these measures unfortunately do not lead to a long-term reduction of heel spur pain or plantar fasciitis pain because the underlying causes are not addressed. The goal of any heel spur and plantar fasciitis treatment should therefore be to eliminate the causes. As described above, lack of movement, a sedentary lifestyle, hard, flat floors and rigid, supportive shoes should be addressed. The kybun mode of action proves to be a suitable therapy for heel spur and plantar fasciitis because it can eliminate the causes mentioned.

kybun mode of action - What helps with heel spur and plantar fasciitis

kybun products aim to eliminate the harmful effects of hard, flat floors and rigid, supportive shoes and to actively address lack of movement and a sedentary lifestyle. Due to the elastic-springy property of kybun products, the feet are both unloaded and activated. The unloading helps reduce pain in the feet as a first step. Activation addresses the causes of plantar fasciitis and heel spurs so that complaints become a thing of the past in the long term. Thus, kybun shoes are well suited for heel spur and plantar fasciitis treatment because they help through the following mechanisms:

• Optimized pressure distribution through reduction of focal pressure points

  Thanks to the elastic-springy property of kybun shoes, the foot can sink deeply into the kybun material which then surrounds the entire foot. This optimized pressure distribution reduces focal pressure points. The sensitive areas around the heel spur and plantar fascia are thus relieved, which often immediately leads to pain relief. Due to unloading, inflammation around the heel and sole can slowly subside. Furthermore, the constant slight movement on the elastic-springy kybun products increases the loaded area, thereby reducing focal pressure points as well.

• Reduction of the force impact from hard, flat floors through cushioning effect

  When the heel strikes in kybun shoes, the elastic-springy material is compressed. This rebound effect of the sole causes some of the occurring forces to be absorbed and released again for the roll-off phase. The kybun sole’s ability to absorb force leads to cushioning around the heel area and thus protects the plantar fascia from excessive force impact. The reduced force impact lessens the load on the feet, which reduces the risk of inflammation of the sole and promotes healing of an already inflamed plantar fascia.

• Activation of foot muscles through elastic-springy property

  On the elastic-springy kybun shoes the feet are constantly slightly in motion and must stabilize balance. This activity trains the foot muscles. Trained foot muscles can on the one hand stabilize the foot joints under load and thereby reduce the force impact on the plantar fascia. On the other hand, activation of the foot muscles also addresses foot deformities that can favor heel spurs or plantar fasciitis. Especially lowering of the longitudinal arch and pronation lead to additional stress on the plantar fascia.
  Furthermore, the musculoskeletal system has more time to react due to the slow sinking of the heel into the elastic-springy material, since the full force impact occurs later and reduced. Because of the delayed force impact, the corresponding muscles can contract in time and thus stabilize the foot during heel strike so that the plantar fascia is not overloaded.

• Natural forefoot roll thanks to muscle activation and roll-off function

  The mentioned delayed force impact with the associated muscle activation leads to the foot not collapsing uncontrolled after heel strike, but to a physiological roll-off. This protects the plantar fascia from uncontrolled loading. In addition, the elastic-springy sole with a roll-off function enables a natural rolling movement over the forefoot. The associated increase in range of motion slightly stretches the plantar fascia with each step, keeping it flexible and resistant to load. A mobile plantar fascia reduces tension on it and thus protects against inflammation-promoting processes.
  

• Protection against fascial dysfunction thanks to physiological movement sequence

  Thanks to the slow sinking at heel strike and the controlled roll-off, a physiological gait is enabled, which also protects the fascia from structural changes. A functioning fascial network reduces tension in the plantar fascia and protects it from faulty and excessive loading.
  

• Improved circulation through increased movement activity

  Increased movement activity and amplitude in kybun shoes lead to improved blood flow in the feet because the involved muscles require oxygen. The plantar fascia is therefore better supplied with nutrients and remains resilient. Increased circulation also helps the body’s own anti-inflammatory substances reach the plantar fascia more quickly and facilitates removal of pro-inflammatory substances. As a result, the tissue is less prone to inflammation or can heal faster.

Usage tips for plantar fasciitis and heel spur shoes

Before wearing kybun shoes for the first time, consider some usage tips. Correct use of the shoes can help relieve complaints. In addition to kybun shoes, treat plantar fasciitis and heel spurs with a targeted therapy, which is described in the next section.

• Wear kybun shoes initially only as long as your body tolerates. Introduce breaks if pain from heel spur or plantar fasciitis increases or if the musculoskeletal system becomes fatigued. Heel spur and plantar fasciitis treatment takes time. Due to the activating property of kybun products, muscles are trained, which can lead to so-called initial reactions, especially at the beginning.
  
• Press your heel slowly and controlled into the elastic-springy material so that the plantar fascia is unloaded. Try to find a loading point at which the pain around the heel is reduced or does not occur. At the beginning, avoid rolling too far over the heel.
  
• Take small and controlled steps at first, reducing forefoot roll-off so that the plantar fascia is not excessively stretched. Gradually increase the range of motion of the feet as tolerated.
  
• Try the following exercises to enhance the effectiveness of kybun shoes and increase the chances of recovery. These are intended as an adjunct therapy for heel spur and plantar fasciitis.

Helpful exercises for heel spur and plantar fasciitis

To boost the effectiveness of kybun shoes and increase the chance of recovery from foot pain, we recommend the following exercises for heel spurs and plantar fasciitis. The selection of exercises is not exhaustive and can be supplemented by other exercises. In general, during all exercises the pain around the heels and plantar fascia must not increase. If any exercise increases heel spur or plantar fasciitis pain, it must be stopped. Pleasant and relieving “pain” outside the painful point of the heel spur and plantar fasciitis (e.g. in the calf) is desirable.
The plantar fasciitis and heel spur exercises are divided into the following areas: “Correct walking in kybun shoes”, “Muscle length training”, “Fascia rolling” and “Strengthening”. Ideally, the different areas are used complementarily as therapy for heel spur and plantar fasciitis.

Correct walking in kybun shoes
The quality of each individual step is crucial in treating heel spur and plantar fasciitis to reduce pain and eliminate faulty and excessive loading. kybun shoes therefore offer an ideal therapy for heel spur and plantar fasciitis.

Controlled heel strike

• Gently and controlled press the heel into the elastic-springy material to determine the load intensity and point at which stepping is possible or heel pain is reduced.
• Controlled foot posture so that the foot does not tilt inward or outward.
• Place mid- and forefoot slowly and controlled so that the plantar fascia is not excessively irritated.
• An active roll-off over the forefoot should not yet be performed. The focus is on physiological heel strike.

Controlled roll-off

• Light roll-off in the forefoot without actively pushing off forcefully with the big toes. Active push-off would additionally stretch the plantar fascia and the Achilles tendon, which can further irritate them if injuries are present.
• Test the possible range of motion of the feet without causing pain from heel spur or plantar fasciitis. Increase the range of motion where possible.

Muscle length training
Muscle length training is crucial in treating heel spur and plantar fasciitis because plantar fascia irritation often arises from shortening and tension in the posterior chain (including the sole of the foot, calves, and hamstrings). Targeted stretching exercises for plantar fasciitis and heel spur can actively address these shortenings and tensions and are thus an ideal therapy.

Calf muscles

• Start position in a lunge.
• The rear heel stays in contact with the ground and should not be lifted.
• Slowly bend the front knee forward until a stretch is felt in the calf.
• 3 x 30 seconds per side.
• Perform 1–2 × daily.

Calf and hamstring muscles

• One leg bent and the other leg on the fascia roller. Increase pressure by placing both legs on top. Further increase by stacking the legs.
• If wrist pain occurs, the exercise can also be performed on the forearms.
• Roll actively from the calf above the heel up to just below the knee crease.
• Perform exercises slowly and controlled.
• Adjust pressure to personal tolerance, but work up to a tolerable pain threshold.
• Roll out focal adhesions more intensely or hold the position at that point.
• At least 3 minutes per side.
• Perform 1–2 × daily.

Fascia rolling
Fascia training with a roller is important in treating heel spur and plantar fasciitis because irritation of the plantar fascia often stems from shortening and tension of the posterior chain (including the sole of the foot, calves and hamstrings). Regularly rolling out the shortened and tense myofascial chain makes the fascia roller a useful active therapy for plantar fasciitis and heel spurs.

Sole of the foot

• Actively roll the sole with a fascia roller or ball from the heel to the toes.
• Perform the exercise slowly and controlled.
• Adjust pressure to personal tolerance, but work up to a tolerable pain threshold.
• Roll out focal adhesions more intensely or hold the position at that point.
• At least 3 minutes per foot.
• Perform 1–2 × daily.

Calf muscle

• One leg bent and the other leg on the fascia roller. Increase pressure by placing both legs on top. Further increase by stacking the legs.
• If wrist pain occurs, the exercise can also be performed on the forearms.
• Roll actively from the calf above the heel up to just below the knee crease.
• Perform exercises slowly and controlled.
• Adjust pressure to personal tolerance, but work up to a tolerable pain threshold.
• Roll out focal adhesions more intensely or hold the position at that point.
• At least 3 minutes per side.
• Perform 1–2 × daily.

Strengthening
Targeted strengthening of the feet is especially important for foot deformities (e.g. collapsed, flat, and pronated feet) to protect the plantar fascia from overload. Strengthened muscles support treatment of heel spurs and plantar fasciitis because they reduce the load on the sole and promote healing. This makes strength training an effective therapy for heel spur and plantar fasciitis and helps relieve pain in the long term.

Foot muscles - longitudinal arch

• Stand upright with feet hip-width apart.
• Heel and ball of foot maintain even contact with the ground.
• Slowly raise the longitudinal arch without lifting the heel or the ball of the foot from the ground.
• Also ensure the movement comes from the feet and the lift is not caused by external rotation of the knees.
• Hold the top position for 4 seconds.
• Lower the foot back down slowly and controlled.
• 3 sets of 8–12 repetitions per foot.
• Perform 2–3 × weekly.

Foot muscles - transverse arch

• Place a towel on the floor.
• Stand upright with feet hip-width apart. The exercise can also be performed sitting to simplify.
• Use the toes of one foot to pull the towel toward you.
• Reposition the towel at the end point and repeat.
• 1–2 minutes per side per foot.
• Perform 2–3 × weekly.