Does arthritis in the foot cause heel spurs?

Arthritis and Heel Spurs: Relationship and Management

Arthritis in the foot does not directly cause heel spurs, but both conditions can coexist due to shared risk factors and biomechanical stress patterns that affect the calcaneus. 1

Understanding Heel Spurs and Their Relationship to Arthritis

Heel spurs are bony outgrowths that form on the calcaneus (heel bone), commonly seen as radiographic findings in patients with heel pain. While arthritis and heel spurs can occur together, they represent distinct pathological processes:

Key Facts About Heel Spurs:

• Heel spurs are typically found on radiographs as calcifications extending from the calcaneus
• They may be present in both symptomatic and asymptomatic individuals
• Spurs can be classified by shape (horizontal, vertical, or hooked) and size (less than 5mm, 5-10mm, or greater than 10mm) 2
• They often indicate that a condition has been present for at least 6-12 months 3

Relationship to Arthritis:

• Patients with lower-limb osteoarthritis are approximately 10 times more likely to have calcaneal spurs 4
• Arthritis in the foot can alter biomechanics, potentially contributing to the development of heel spurs through altered weight distribution and gait patterns
• Both conditions share common risk factors including:
  • Advanced age
  • Increased body mass index
  • Diabetes mellitus 4

Clinical Significance and Diagnosis

Heel spurs themselves may not be the primary cause of heel pain, but their presence can indicate other underlying conditions:

Clinical Presentation:

• Heel pain that is worst upon first steps in the morning or after periods of rest
• Pain with direct palpation over the medial plantar calcaneal region
• Radiographic evidence of calcaneal spurs, which may be incidental or associated with symptoms

Diagnostic Considerations:

• Routine imaging is not usually necessary for initial diagnosis of heel pain 3
• X-rays may show heel spurs but their presence alone doesn't confirm them as the pain source
• The presence of spurs may indicate chronic mechanical stress to the area

Treatment Approach

Treatment should focus on addressing the underlying causes of heel pain rather than the spur itself:

Conservative Management:

1. Rest and activity modification to reduce stress on the heel
2. Ice massage to reduce inflammation
3. NSAIDs to manage pain and inflammation
4. Specific stretching exercises for the plantar fascia and Achilles tendon
5. Orthotic devices to provide support and cushioning 1, 3

Advanced Interventions:

• Injection therapy with corticosteroids if conservative measures fail
• Extracorporeal shock wave therapy for recalcitrant cases
• Surgical intervention only when conservative treatments have failed after 6-8 weeks 1

Important Clinical Considerations

• The mere presence of a heel spur on X-ray is not necessarily the cause of heel pain 3
• Patients with spurs have been shown to have more foot pain and poorer foot and ankle outcome scores, even when plantar fasciitis is excluded 4
• Larger spurs (>5mm) and those with horizontal or hooked shapes may show greater improvement with treatment 2
• The incidence of heel spurs increases with age, weight, and concurrent orthopedic conditions 5

Pitfalls to Avoid

1. Don't assume heel spurs are always symptomatic - many are incidental findings
2. Don't focus solely on the spur - address underlying biomechanical issues and inflammation
3. Don't rush to surgical intervention - most cases respond to conservative management
4. Don't overlook systemic conditions - diabetes and arthritis are associated with higher rates of heel spurs and may require additional management

By understanding that arthritis and heel spurs are distinct but potentially related conditions, clinicians can develop more effective treatment strategies that address both the symptoms and underlying causes of heel pain.