Patients with posterior heel spurs complain of:
- Prominence on the back of the heel
- Problems with shoe wear
Any shoes with closed heels can be painful because of rubbing in the back of the shoe. People will often use Band-Aids or extra padding to protect the tender area. Open backed shoes are preferred in the warmer months.
Pain from a posterior heel spur is worse with activity or exercise. The posterior heel spur can also be symptomatic during the first steps out of bed. This is because the Achilles tendon contracts during sleep while the ankle is in a relaxed position. When we step out of bed in the morning the Achilles suddenly stretches and pulls on the heel spur causing acute pain.
The diagnosis is usually obvious. There will be visible swelling and redness on the back of the heel and the patient will be tender at the attachment site of the Achilles tendon where the bone spur is palpable. X-rays will confirm the presence of a bone spur on the back of the heel. MRIs can be useful to determine the extent of damage to the Achilles tendon.
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