What are the risk factors for developing heel spurs?

Risk Factors for Developing Heel Spurs

The primary risk factors for developing heel spurs include high body mass index (BMI), increased physical workload, and biomechanical abnormalities that create excessive pressure on the plantar fascia. 1

Intrinsic Risk Factors

• Body Mass Index (BMI): Higher BMI is strongly associated with the development of heel spurs, likely due to increased mechanical stress on the plantar fascia and calcaneus 1

• Age: Older patients have a higher prevalence of heel spurs, with increasing incidence as age advances 1

• Gender: Women are more likely to develop heel spurs than men 1

• Comorbid Conditions:

  • Diabetes mellitus (4 times higher risk) 1
  • Lower-limb osteoarthritis (10 times higher risk) 1
  • Arthropathies and gout 2

• Foot Structure Abnormalities:

  • Pes planus (flat feet) 2
  • Pes cavus (high arches) 2
  • Limited dorsiflexion range of motion 3
  • Altered biomechanics in the presence of neuropathy 3

• Reduced Physical Capacity:

  • Decreased strength and coordination 3
  • Limited overall ankle joint range of motion 3
  • Decreased peroneal reaction time 3

Extrinsic Risk Factors

• Occupational Factors:

  • High physical workload 3
  • Occupations requiring prolonged standing or walking 2
  • Heavy lifting activities 3
  • Kneeling, squatting, and bending (which can alter foot biomechanics) 3

• Footwear:

  • Inappropriate footwear, particularly high heels 3
  • Ill-fitting shoes 3
  • Inadequate foot support 4

• Activity-Related Factors:

  • High medial plantar pressures during running 3
  • Sports with jumping and landing components (volleyball, basketball) 3
  • Repetitive microtrauma to the heel 4

• Environmental Factors:

  • Walking barefoot on hard surfaces 3
  • Inadequate cushioning during weight-bearing activities 4

Clinical Implications

• Heel spurs are often associated with plantar fasciitis, though they can exist independently and cause pain even without plantar fasciitis 1

• The presence of a heel spur may be an indicator of foot pain and should prompt investigation of associated conditions 1

• Patients with heel spurs typically report worse foot and ankle outcome scores compared to those without spurs, indicating their clinical significance 1

• Early identification of modifiable risk factors (BMI, footwear, activity modification) can help prevent progression of heel spur formation 4, 2

• Patients with multiple risk factors should be monitored more closely and may benefit from preventive interventions such as appropriate footwear, orthotic devices, and weight management 2

Understanding these risk factors is crucial for both prevention and management of heel spurs, as addressing modifiable factors can significantly reduce symptoms and improve quality of life for affected individuals.