Skip to content
The Health Brief

The spur is not the nail in your heel

Most people who have one never knew. That does not make it nothing.

3 min read

Feel-good Friday

My x ray showed a spur, and I spent a month believing I had a nail in my heel.

The word does the damage. Spur. You picture a spike growing off the bone, pointing down into the sole, stabbing you with every step.

That picture is wrong, and I want to walk you through the numbers that fixed it for me.

Then I want to give you the half that usually gets left off the end.

Who has one

Hylton Menz and colleagues x rayed the feet of 216 people in their sixties, seventies and eighties.

More than half had at least one heel spur. And of those, 61% had never had heel pain in their lives.

Hold onto that one. The spur is common, and most of the people carrying one feel nothing at all.

It runs the same way in the general public. The counts put the share of us walking around with a quiet spur somewhere around 10% to 15%.

So a spur on a film is not news. It is closer to gray hair… common by a certain age, and not a diagnosis on its own.

Where the spike story breaks

The old account says the rope under your arch tugs at the heel bone year after year, until the bone grows out along the line of the pull.

The Menz team went looking for that. If the tug story held, spurs should track with the shape of the arch. They did not track with it at all.

What they tracked with was weight and arthritis, and the weight link was the strong one. Carrying too much ran with odds near eight times. Arthritis in the foot, about two and a half. Next to those, the pull of the arch did not register.

So the team said the spur may be bone answering pressure from above, rather than a tug from the front.

A response to being stood on. Not a hook growing into your foot.

And the shape of it is wrong for the spike story too. A spur grows forward off the heel bone, not down into the sole.

Then look closer. Under the microscope the grain of that new bone runs up and down… and not along the line the arch would have pulled it. Which is one more mark against the tug.

Now the honest half

I would love to stop there. But the same study found the odds of heel pain, now or in the past, ran about four and a half times higher in the people who had a spur.

Odds are not the same as risk, and odds run high when a thing is common. So do not read that as four and a half times the chance of it. The x rays and the questions came on the same day, so nothing in there tells you which arrived first.

So a spur is not decoration. It keeps company with heel pain far more often than a clean heel bone does.

The way I hold both halves is this. A spur says the heel has been under load for a long time. It is a marker, not the knife.

Surgeons found the same thing from the other end. Taking the spur out does not track with a better result… and if the spur were the cause, taking it out would fix it.

 

What the evidence does say

Heel spurs are common in older feet, and most people who have one have no pain. They line up with weight and with arthritis, not with the shape of your arch, so the tug story does not hold up.

 

What it does not say

It does not say a spur means nothing. People who have one are several times more likely to have heel pain. Read it as a sign the heel has been working hard, and treat the heel rather than the picture.

 

That was the week. Monday, two minutes of pulling the toes back before you stand up. Tuesday, the rope and the winch, and why the first ten steps are the worst ones. Wednesday, the towel and the bottom stair. Thursday, the slippers in the bin.

None of it costs much. The stair is free… and the slippers were free to throw away.

Anyway, that is where I would start if my heel went again. Not with another x ray.

When to stop and call your doctor

An x ray finding is not a diagnosis on its own. See your doctor if you felt a pop and then could not stand on the foot, if the heel is hot, red and swollen, if you have numbness or pins and needles in the foot, if you have diabetes and any break in the skin, or if heel pain wakes you in the night. Pain in both heels together with other sore joints needs a proper look rather than another x ray.

Here is to a heel that has been working hard,
Walt

One useful thing a day

Start with tomorrow morning.

A stretch, a sleeping position, a heat trick for a stiff hour. Short enough to read with your coffee. If one does not fit, skip it. The next one might.

Almost there. Check your inbox to confirm.

Free, five days a week. One click to leave, no hard feelings.