Spur of the heel - Causes, symptoms and treatment. MF.
Heel spur is the growth of bone tissue on the surface of the calcaneus, which looks like a spike. The heel spur is located more often on the plantar surface of the calcaneus( in the region of the medial process of the calcaneus) at the place where the muscles and fascia that hold the arch of the foot attach to it, such a heel spur is called the plantar spine. More rarely, the spur is located on the posterior surface of the calcaneus( in the region of the posterior hillock of the calcaneus) at the attachment point of the Achilles tendon - the posterior calcaneal spur.
Spurs consist of newly formed bone tissue with signs of chronic inflammation. In soft tissues, a mucous bag is often formed over the bone spur.
Heel spurs are quite common. They are found in 26.4% of people aged 40-44 years, and in the age group 70 years and older - in 88.5%.
Schematic illustration of the plantar spinal spine
The causes of the calcaneal spur
1. Chronic trauma is considered to be one of the most common causes of heel spurs, which is observed in athletes, runners, dancers.
2. Flattening, which shows increased tension of the plantar aponeurosis. This leads to the fact that when the foot is rolled during walking, the attachment site of the plantar aponeurosis in the calcaneal bone is constantly damaged. In this place, the inflammatory process develops with the gradual formation of the bony protuberance.
3. Excessive burden on the legs associated with the profession.
4. Rapid weight gain for obesity.
5. Wearing uncomfortable, tight shoes.
6. Chest bone contusion, marginal fractures in the calcaneus calcaneus region.
7. Recurrent bursitis( inflammation of the joint bag) of the Achilles tendon( for example, in athletes with frequent traumatization of this area).
Symptoms of calcaneal spur
Patients with plantar spur complain of acute burning pains in the calcaneal region while resting on it, which they compare with the sensation of "nail in the heel".Pain can spread throughout the calcaneal region. Sometimes they can appear suddenly and have an acute nature, and in some cases develop gradually. The dimensions of the spur do not affect the intensity of the pain caused by it, since the painful sensations are primarily caused by inflammatory changes in the soft tissues( subclavian bursitis, Achilles tendon bursitis, periostitis( periostitis)), sometimes involving nearby small nerve branches. Because of the development of intense pain, patients try to unload the heel, for which they walk on their toes or on the outer edge of the foot( "they will clumsy" the foot), and with bilateral damage the gait acquires a "sliding" character, patients resort to using a cane or even crutches.
Diagnosis of the spur of the calcaneal
In some cases, large-sized spurs of a pointed form do not manifest themselves clinically and are found by chance during radiography.
At inspection of visible inflammatory changes at a plantar heel spur, as a rule, it is not defined. It is not probed under a thick layer of soft tissue, while only soreness is detected when pressing on the heel from the plantar side. With a back calcaneal spur, there is sometimes swelling and omozolelost of the skin at the place of attachment to the heel bone of the Achilles tendon.
For the purpose of clarifying the diagnosis, X-ray and ultrasound examinations are performed. On the X-ray of the foot in the lateral projection, additional formation of bone density in the form of a spine or beak is determined in the area of the plantar surface of the calcaneus calcaneus( at the plantar spur) or at the attachment point of the Achilles tendon( with the back spur).In the ultrasound examination of the soft tissues of the foot with the plantar spur, signs of plantar( plantar) fasciitis are revealed.
Side X-ray of the heel bone of the patient with plantar calcaneal spur( marked with a red arrow)
Treating the calcaneal spur
In the treatment of the heel spur, mainly conservative methods are used to eliminate inflammatory changes in surrounding soft tissues. These methods include wearing special orthopedic insoles and special orthopedic shoes to unload the heel area. Individual orthopedic insoles have a recess and a soft lining in the heel area, and the orthopedic footwear has a groove in the heel( with a plantar spur) or in the back( at the back).Patients themselves can make a soft foam from the foam rubber, making a hole in its center or a hole.
Apply warm baths with the addition of sea salt, prescribe a massage of the feet and shins muscles and therapeutic gymnastics. From fizioprocedures ozokerite or prafinovye applications are used, electrophoresis of novocaine, phonophoresis of hydrocortisone. In the case of severe inflammation, a bed rest is prescribed with resting rest to the foot or by imposing an immobilizing gypsum longus for up to 10-14 days. It is possible to use laser therapy, magnetotherapy and X-ray therapy. Sometimes the puncture of the subclavian bursa and the introduction of glucocorticosteroids into it in strictly sterile conditions are also used.
In case of ineffectiveness of conservative therapy, it is sometimes necessary to resort to an operative intervention, which consists in removing the heel spur together with the underlying bone site, the operation is performed under intraosseous anesthesia. With the plantar spinal spine, a horseshoe-shaped incision is made along the lower edge of the calcaneus, the flap of the skin with the underlying subcutaneous tissue is turned toward the fingers, after which the muscles and plantar aponeurosis that attach to the heel of the calcaneus are cut off. The spur is removed along with the underlying bone plate, at the same time the subcutaneous calcaneal bag and part of the fatty tissue are excised. The wound is sewn layer by layer. A pressure bandage is applied, immobilization is carried out with gypsum lint for 4 weeks. After removal of the longa, orthopedic insoles are prescribed.
Prognosis with spur
Prognosis for calcaneal spur, provided timely and rational treatment is favorable.
Prevention of heel spurs
In order to prevent the development of calcaneal spurs, it is advisable to avoid excessive loads on the feet, especially to people suffering from flat feet or prone to developing it.
Doctor surgeon Kletkin ME