Achilles heel bone spur treatment: Heel Spur Treatment, Symptoms & Pictures
Achilles Spur – Podiatry, Orthopedics, & Physical Therapy
Robert H. Sheinberg, D.P.M., F.A.C.F.A.S., D.A.B.F.A.S.
Below is an x-ray demonstrating a lateral view of the heel bone where one can see spurs on the bottom of the heel near the origin of the plantar fascia and at the origin of plantar foot muscles. There is also a spur at the back of the heel where the Achilles attaches. These occur over a long period of time because of excess stress applied to the areas due to tight ligaments and muscular structures.
- Inflammation can be related to a Haglund deformity (postero-superior prominence – normal variant) which causes overlying bursitis.
- The prominence of the posterior superior calcaneal tuberosity contributes to inflammation of the overlying tissues and the Achilles tendon.
- Most often occurs in women and is related to shoe wear with rigid heels or heel counters.
- Patients note posterolateral prominence and tenderness.
- Useful to determine if there are distinct degenerative areas within the tendon (Achilles tendinosis), which might require debridement if resection of the Haglund’s deformity were indicated.
- Nonoperative treatment consists of heel cord stretching, change in shoe wear, NSAIDs.
- Raising the heel out of the shoe with a heel insert shifts the contact against the heel and often relieves symptoms.
- Excision of the Haglund prominence can be effective in chronic cases.
- Excision must be kept proximal to the Achilles insertion.
- Lateral approach is easier but care must be taken to avoid sural nerve.
- The posterior calcaneal tuberosity is removed and the Achilles tendon is debrided and reattached using bone anchors.
- Calcium deposits are removed from the Achilles tendon if they are present.
- Patients are immobilized for six weeks.
These are intraoperative pictures of removal of a painful spur in the back of the heel bone that failed conservative treatment.
This is an intraoperative pic of a heel spur in the back of the heel prior to resection. It is next to the instrument on the bottom right. The spurs cause pain, as it irritates the Achilles tendon.
This is the bone cut performed to remove the spur and bone that causes pain.
This is a picture of the bone that is removed. Underneath the bone is the void left after removal.
This is a picture of the size of the bone removed. The top portion should have glistening white cartilage. It is yellowish and devoid of cartilage due to constant irritation from the Achilles. The spur is at the bottom 30% portion of the bone.
This is a picture of the suture placement in the Achilles tendon to reattach the tendon to bone. There are anchors in the bone that have the suture already attached. The anchors are driven into the bone to allow the Achilles tendon to reattach to the heel. These sutures are then tightened down for an intimate bone to tendon apposition.
Resection of hypertrophic heel spur in the back of the heel that is removed.
In this pic, the Achilles can be seen on the right being pulled from the back of the heel. The Achilles becomes irritated due to chronic pressure against the heel bone
This is the piece of bone removed from the back of the heel.
These are the sutures going through the Achilles to reattach to the back of the heel bone.
Pre and PostOp Heel Spur resection with reattached of Achilles.
Pre and postop heel spur resection with reattachment of Achilles.
Postop bilateral calcaneal spur resection.
Postop x-ray after spur resection with reattachment of Achilles with the G2 anchor.
Intraop Pics of Posterior Achilles Spur Excision and Reattachment of Achilles Tendon
Heel Spur Surgery: Preparation, Recovery, Long-Term Care
Calcaneal spur reduction is a procedure used to remove all or parts of a heel spur—a painful outgrowth on the heel bone (calcaneus) that causes pain, inflammation, and swelling. Heel spur surgery is done when conservative therapies fail to provide relief.
There are two approaches to the surgery: one that targets inferior spurs on the bottom of the heel and another that targets posterior spurs on the back of the heel. Heel spur surgery can be highly effective, but it may take up to three months for some patients to fully recover.
Ralf Liebhold/Getty Images
What Is Heel Spur Surgery?
Heel spur surgery can be performed as either open surgery (involving a scalpel and large incision) or endoscopic surgery (using “keyhole” incisions with a narrow scope and operating tools). Open surgery is better able to remove the entire spur.
- Inferior heel spur resection: Inferior heel spurs typically develop in the presence of plantar fasciitis (inflammation of the plantar fascia ligament, located on the bottom of the foot) and are often referred to as plantar fasciitis bone spurs. In many cases, the removal of spurs will immediately follow plantar fasciotomy, also known as plantar fasciitis release surgery. Once the ligament is partially or fully severed (“released”), the surgeon will remove any large or suspect spurs.
- Posterior heel spur resection: This less common approach targets posterior heel spurs located near the Achilles tendon on the back of the foot. Also referred to as Achilles bone spurs, these generally develop at the point where the tendon attaches to the heel bone. It is not uncommon for spurs to also develop in the tendon itself. Simple spurs on the bone are relatively easy to remove, but those imbedded deep in the Achilles tendon may require the detachment and reattachment of the tendon (Achilles tendon repair), making spur resection more complicated.
Heel spur surgery is performed on an outpatient basis, allowing you to return home as soon as the surgery is complete. Depending on the aims of the surgery and other factors, the procedure may involve local, regional, or general anesthesia.
According to research, heel spur surgery is effective in around 69% of cases, with another 25% reporting a moderate improvement of symptoms.
There are few absolute contraindications to heel spur surgery. The surgery should be approached with caution in people with severe bleeding disorders, diabetes co-occurring with peripheral artery disease, or a history of deep vein thrombosis (DVT). These relative contraindications need to be assessed on a case-by-case basis.
One absolute contraindication for heel spur surgery is the absence of symptoms. If a spur is accidentally found on an X-ray, it should not be removed just because it is there. Doing so not only exposes the individual to unneeded surgery but may cause serious and potentially permanent injury.
As with all surgeries, there are risks associated with heel spur surgery, including the use of anesthesia. Common complications specific to this procedure include:
- Temporary or permanent heel pain
- Temporary or permanent nerve injury (including foot numbness)
- Acquired pes planus (fallen arches) and flat-footedness
- Tendinitis (tendon inflammation)
- Metatarsalgia (pain in the ball of the foot)
- Foot cramps
- Foot instability
- Development of hammertoes or claw toes (due to the contraction of the plantar fascia ligament)
- Heel fracture
Compared to open surgery, endoscopic surgery is associated with a faster resolution of symptoms and less postoperative pain and complications.
Purpose of Heel Spur Surgery
Heel spurs are essentially the abnormal accumulation of calcium, most commonly caused by repetitive foot strain. Repeated injury can lead to changes in the foot as scar tissue develops and calcium released from microfractures and bone degeneration begins to accumulate into bony outgrowths.
The size or shape of a spur has nothing to do with the incidence or severity of symptoms. Large spurs can often cause no pain, while tiny ones can cause excruciating pain and extreme loss of mobility.
Heel spur surgery is not used because a bone spur is large—or simply because it’s there—but rather because it is causing refractory (treatment-resistant) pain.
Luckily, more than 90% of people with heel spurs experience spontaneous recovery without surgery. By committing to a holistic, non-surgical treatment plan, you may find that your heel spur symptoms resolve on their own. It’s when they don’t that surgery can play a role in treatment.
Heel spur surgery is generally considered a last resort, and the American College of Foot and Ankle Surgeons (ACFAS) recommends it be considered if symptoms fail to resolve with non-surgical treatments after 12 months.
In some cases, the pain is not associated with the spur itself but the condition that gave rise to it.
Heel spurs associated with plantar fasciitis do not point downward but rather forward toward the toes. Because of this, the pain in the heel is usually not caused by the spur but rather the persistent inflammation of the ligament at its attachment point at the heel.
Such heel spurs may be removed anyway when a surgeon suspects that they could become problematic.
Heel spurs are most easily detected on X-ray while standing. Even if spurs are identified, every effort should be made to ascertain whether the pain is the result of the spurs or an associated condition. Heel spur surgery is not only difficult to recover from but can cause more problems than it solves if not used appropriately.
The presence of a spur, even a large one, doesn’t necessarily mean that it is the cause of the pain. Consulting with an experienced podiatric surgeon or foot and ankle orthopedist is essential to getting a correct diagnosis. Either one of these specialists can perform the surgery, if needed.
Heel spur surgery is often considered when heel spurs are accompanied by severe plantar fasciitis or Achilles tendinitis (both of which may benefit from surgery).
On the other hand, there may be “clues” that cast the viability of heel spur surgery into doubt. One such example is bilateral heel pain, in which the pain in both heels may be the result of systemic diseases or infections rather than any spurs the doctor may find.
To this end, doctors will typically conduct a differential diagnosis to exclude other possible causes before heel spur surgery is recommended. These may include:
How to Prepare
If heel spur surgery is recommended, you will meet with the surgeon to review the lab and imaging reports and discuss how the operation will be performed. You will also discuss pre-operative and post-operative procedures you need to follow to better ensure the intended result.
The surgical approach used will be determined by the underlying cause and location of a spur. Neither procedure is inherently “better” than the other at providing relief, although recovery times tend to be shorter with endoscopic surgery.
Do not hesitate to ask the surgeon why a particular surgery was chosen. While open surgery is associated with a greater risk of complications, there may be reasons why it is a better approach in your case. Keep an open mind and seek a second opinion if needed.
Heel spur surgery is performed in the operating room of a hospital or specialty surgical center. The operating room will be equipped with standard surgical equipment, including an anesthesia machine, surgical table, an electrocardiogram (ECG) machine to monitor your heart rate, and a mechanical ventilator to deliver supplemental oxygen if needed.
For endoscopic surgery, there will also be a rigid fiberoptic scope called an endoscope that delivers live images to a video monitor. Specialized surgical equipment that can access the foot through tiny incisions will also be there.
What to Wear
Depending on the extent and location of the surgery, your foot may be bandaged, placed in an ankle splint or walking boot, or covered with a cast afterward. To accommodate for this, wear baggy shorts or loose-fitting pants (e.g., yoga or pajama bottoms) that slip easily over the foot. Skirts also work, or you can cut the side seam of an old pair of pants to widen the leg opening.
In addition to changing into a hospital gown before surgery, you will be asked to remove contacts, hairpieces, dentures, hearing aids, and tongue or lip piercings prior to the surgery. Leave any valuables at home, including jewelry and watches.
Food and Drink
You will be advised to stop eating at midnight the night before your procedure. On the morning of the surgery, you can take a few small sips of water to take your morning medications. Within four hours of surgery, you should not consume any food or liquid.
Your doctor will advise you to stop taking certain medications that promote bleeding and slow wound healing, including anticoagulants (blood thinners) and nonsteroidal anti-inflammatory drugs (NSAIDs).
You may need to stop taking certain drugs for anywhere from one day to two weeks before surgery and discontinue use for up to a week or two after surgery.
Among the drugs commonly avoided prior to surgery:
To avoid drug interactions and complications, always let your doctor know about any medications you are taking, whether they are prescription or over-the-counter. The same goes for herbs and supplements.
What to Bring
You will need to bring your driver’s license (or some other form of government ID), your insurance card, and an approved form of payment if copay or coinsurance costs are required upfront. (Be sure to call the office beforehand to confirm that they accept your insurance and are in-network providers. )
You will also need to bring someone to drive you home and, ideally, to stay with you for a day or two to help you out and monitor for any adverse symptoms.
What to Expect on the Day of Surgery
Depending on the scope of the operation, the surgeon may be accompanied by an anesthesiologist, operating nurse, endoscopic technician, and surgical scrub.
Before the Surgery
Upon your arrival at the hospital or surgical facility, you will register, fill out medical information forms, and sign consent forms confirming that you understand the aim and risks of the surgery. You will then be led to the back to change into a hospital gown.
A nurse will take your weight, height, vital signs, and a sample of blood to check your blood chemistry. An intravenous (IV) line is then inserted into a vein in your arm to deliver medications and fluids. (Even if the procedure is performed under local anesthesia, an intravenous sedative is typically used to induce “twilight sleep. “)
In addition, EGC leads are attached to your chest to monitor your heart rate, while a pulse oximeter is clamped to your finger to monitor your blood oxygen levels.
During the Surgery
Once you are prepped, you are wheeled into the operating room. The appropriate form of anesthesia will be administered:
- If general anesthesia is used, the medications are delivered through the IV line to put you completely to sleep.
- If regional anesthesia is used, the anesthetic may be injected in the spine (spinal epidural block) or a shallow bundle of nerves behind the knee called the popliteal fossa. An intravenous sedative, also known as monitor anesthesia care (MAC), typically accompanies the regional block.
- If local anesthesia is used, it is delivered by injection in and around the surgical site. MAC is also commonly used.
You will be positioned on the surgical table in either a supine (downward-facing) or lateral decubitus (sideways-facing) position, depending on how the heel spur(s) are best approached.
The open or endoscopic procedure is then performed:
- Open reduction: An incision is made either along the bottom of the foot (to access a plantar bone spur) or down the back of the heel (to access an Achilles bone spur). If plantar fasciotomy or Achilles tendon repair is needed, it is performed first. The heel spurs can then be cut away in a secondary procedure, flush to the bone.
- Endoscopic reduction: For this procedure, a tiny incision (usually about an inch in length) is made on the side of the heel to insert the endoscope. A second incision is made to insert a cutting instrument to reduce the spur. Because endoscopic surgery does not remove as much of a spur, it is generally reserved for combination surgeries in which heel spurs are involved.
Finally, the incision is closed with sutures or adhesive strips, and the foot is bandaged. An ankle splint, walking boot, or a cast may be used to immobilize the foot and/or ankle if needed.
After the Surgery
After the surgery is complete, you are wheeled into recovery and monitored by a nurse until you awaken. This can take anywhere from 10 minutes for local anesthesia with IV sedation to 45 minutes for general anesthesia. Food and drink are usually provided when you are fully awake.
It is not uncommon to experience pain and discomfort around the surgical site. You will be given the appropriate painkiller and a nurse will administer anti-nausea medication if you feel ill from the anesthesia.
Once your vital signs normalize and you are steady enough to change into your clothes, you can be taken home by a friend or family member.
The doctor will give you a prescription for a short course of an opioid like Vicodin (hydrocodone plus acetaminophen) to help you manage pain.
When you arrive home from surgery, you should relax for the rest of the day with your foot propped up on pillows. Do not bathe or shower for the first day.
If there is any pain, you can either take Tylenol (acetaminophen) or the pain medication prescribed by your doctor. If there is any pain, bruising, or swelling, you can apply an ice pack to the affected area for no more than 15 minutes several times a day. Do not apply the ice directly to the skin.
Stay off your feet as much as possible for the first few days after surgery as well. To avoid placing any strain on the foot, your doctor may provide you with a pair of crutches or a hands-free knee crutch. Use whatever is provided, even if you feel confident without it.
Until the wound is amply healed and the stitches removed, you will need to keep the foot dry. This applies whether you are icing the area or washing yourself. When showering, you can either cover the foot with a plastic bag (secured with a rubber band) or ask your doctor about using a watertight cast cover.
The wound dressing should be changed daily with sterile gauze and an alcohol-free topical antiseptic. Check daily for any abnormal changes in the wound or skin.
When to Call Your Doctor
Call your surgeon if you experience any of the following after undergoing heel spur surgery:
- Increasing pain, redness, and swelling around the incision site
- High fever (100.5 degrees F) with chills
- A yellowish-green and/or foul-smelling ooze from the wound
- Nausea and vomiting
- Wound dehiscence (an opening incision)
After seven to 10 days, you will visit your surgeon to have the sutures removed and check on how your wound is healing. An X-ray or computed tomography (CT) scan may also be ordered, especially if other procedures were performed along with heel spur removal.
Based on the findings, the doctor will have a better idea of your prognosis and the appropriate rehabilitation plan. If needed, you may be referred to a physical therapist.
The duration of rehabilitation varies not only by the surgery used but your general health and adherence to the treatment program. Broadly speaking, it takes around six weeks to recover from plantar heel spur surgery and up to three months for Achilles heel spur surgery with tendon repair.
Most people with office-based jobs can return to work in two weeks with a walking boot or crutches. Those who work on their feet may need to wait for at least four weeks unless their doctor says otherwise.
Coping With Recovery
Your surgeon will want to see you again when it is time to have your cast removed or to step you down from crutches to a walking boot.
As you are gradually stepped down to walking shoes, physical therapy may again be needed to teach you how to walk correctly and how to stretch your arches to compensate for any tissue retraction.
During the recovery period, it is not unusual to feel pain and aggravation as you challenge muscles and tissues that have laid dormant for weeks. With persistence and adherence to your rehabilitation plan, you will improve. Support from family and friends can help this process tremendously.
During follow-up appointments, your doctor will want to check for improvements in your symptoms. Not everyone who undergoes heel spur surgery experience the complete resolution of symptoms, but many do. Be patient with your body as it heals.
Possible Future Surgeries
If you still have pain, inflammation, and swelling after rehabilitation, let your doctor know. In some cases, revision surgery may be needed. At other times, further investigations may be needed to explore other possible explanations for your symptoms.
A Word From Verywell
Surgery is a less common treatment for heel spurs but one that may be necessary if nothing else is able to relieve pain and loss of mobility. Even so, heel spur surgery is not a “quick fix.”
Before seeking heel spur surgery, ask your doctor if all treatment options have been explored, including therapeutic ultrasound and extracorporeal shockwave therapy (ESWT). At the same time, ask yourself if you have been adherent to your doctor’s treatment recommendations, including routine exercise, weight loss, and the consistent use of night splints and orthotics.
North Star Foot & Ankle Associates: Podiatry
What You Need to Know About Treating a Heel Spur
Heel spur (also known as osteophytes or calcaneal spur) is a bony outgrowth at the plantar area of the foot, i.e., under the foot sole. This condition is related to calcium deposits that grow between the arch of the foot and heel. In fact, it extends from the underside of the heel toward the arch, creating pointy, shelf-like, or hooked growths.
Heel spurs and plantar fasciitis (inflammation across the foot) tend to go hand in hand.
However, these two conditions can also occur independently.
Additionally, heel spurs can be associated with underlying diseases causing arthritis. They include ankylosing spondylitis, reactive arthritis, and DISH (diffuse idiopathic skeletal hyperostosis).
This condition frequently occurs in people with active lifestyles. Those with heel spurs usually experience severe pain and tenderness when exercising or walking. This is because the spurs dig into the heel pad when stepping down and putting pressure on the heel. That causes a stabbing or shooting sensation so that the pain gets worse with every step you take.
The Top Treat Options for Heel Spurs
There are a number of different heel spur treatment options available for you to try that range from relieving pain to curing the condition. Check out the following options to discover the treatment that works for you.
Cushioned Shoes and Orthotic Inserts
The pain caused by heel spur usually happens due to the uneven pressure and poor arch support and. This is where specially designed shoe or orthotic inserts come in. By spreading pressure evenly and providing extra heel support, these inserts cut the pressure on the heels and reduce pain.
Comfortable, well-fitting, cushioned shoes can give you much the same effect. These also relieve pressure and alleviate heel pain. Your best bet is to go for sports running shoes that come with soft soles. When evaluating the shoes for comfort, you should look for the following things:
- Firm heel support
- Slightly elevated heel
- Moderate flexibility
Cold therapy that involves local ice application is proven to relieve inflamed tissues. The same goes for heel spurs. Ice can reduce both foot pain and swelling.
- Simply apply ice packs covered with cloth to your heel.
- To keep the ice packs in place, apply a cold compression.
- Leave it on for about ten minutes and then unwrap.
- Repeat the process several times a day.
Physiotherapy (Physical Therapy)
Stretching exercises for the plantar fascia and calf can relax the foot muscles. This significantly reduces strain on the heel spurs. The most helpful stretches include foot flexes and calf stretches. Once prescribed by an orthopedic doctor or podiatrist, these exercises can be done at home and/or at the clinic.
Anti-inflammatory over-the-counter (OTC) medications can relieve heel pain and inflammation. That way, they prevent further damage. The most commonly used medications for heel spurs include:
- Ibuprofen (Advil)
- Naproxen sodium (Aleve)
People with kidney problems as well as those with a history of ulcers and stomach bleeding should steer clear of these medications.
Injections to Treat Heel Spur Pain
Note that injections of steroids (cortisone injections) are meant to alleviate pain, not to cure the heel spurs. Actually, these injections reduce pain and swelling in the affected areas. They are only prescribed in more advanced cases if OTC anti-inflammatory medications are not effective.
Deciding on Heel Surgery
Surgical intervention may be necessary in case of chronically inflamed heel spurs.
It is only recommended if the condition persists for a long time and all non-surgical treatment options have been exhausted.
Luckily, the above-mentioned treatment methods are effective in most cases, so surgery is usually not needed. The most common surgical techniques for heel spurs are the removal of a spur and release of the plantar fascia. Aside from curing the bone spurs, they are supposed to improve foot mobility and relieve pain.
Treating Your Heel Spur
In less severe cases, natural homemade remedies can also be helpful. The most effective remedies include Epsom salts, apple cider vinegar, baking soda, and coconut oil. Also, it is important to note that people suffering from heel spurs should take a rest whenever possible. They are advised to avoid activities which aggravate the symptoms of calcaneal spurs, such as extended periods of standing and jogging.
Heel Spurs | Heel Spur Treatment in Sydney by Heel Clinic
What are heel spurs?
When a calcium deposit forms on the heel bone (the calcaneus), it forms a bone-like growth that is known as a heel spur. Heel spurs are usually only visible on xrays, and cannot normally be detected with the naked eye. Heel spurs can be underneath the heel or at the back of the heel, and they may be present on one or both heels of an affected patient. They are commonly associated with the inflammatory conditions: plantar fasciitis and Achilles tendonitis.
What causes heel spurs to develop?
Heel spurs develop when calcium builds up in a ‘stressed’ location. This happens as a result of constant and excessive pressure placed on the attachment points of the ligaments or tendons in the foot that attach at the heel. In patients with heel spurs associated with plantar fasciitis, the growth is underneath the heel, where the plantar fascia ligament attaches to the calcaneus; and in patients with Achilles tendonitis, the associated heel spur is usually at the back of the heel bone, where the Achilles tendon attaches. Repeated strain from walking, running, or jumping barefoot, especially on hard surfaces, is a common cause of heel spurs. Heel spurs can also be a common issue in people with problematic foot biomechanics (less than ideal gait/walking pattern in the foot due to malalignment of the muscles and soft tissue structures in the lower leg and foot). Some other causes of heel spurs may include wearing unsupportive footwear and overweight / obesity.
What are the symptoms of heel spurs?
It was previously though that heel spurs are the direct cause of heel pain. It is now widely accepted that the spurs themselves do not cause the pain, but rather, the pain is caused by the inflammation of the surrounding tissues. This inflammation may be due to inflammatory conditions such as plantar fasciitis or Achilles tendonitis, or the physical pressure on structures such as the heel fat pad, where the heel spur ‘digs in’ to the tissue.
The pain associated with heel spurs is usually described in ways ranging from intermittent to constant and chronic. The pain is normally localized and can be pin-pointed, and it is usually worst first thing in the morning. It may be sharp initially, but often subsides to a dull ache. Patients usually experience more severe pain when walking or running barefoot, especially on hard surfaces.
How are heel spurs diagnosed?
You will need to see your specialist sports podiatrist for a proper diagnosis, as the symptoms of heel spurs are very similar to many other ankle and foot complaints that will need to be excluded. In the majority of cases, heel spurs can only be diagnosed on xray. Before requesting you have an xray though, your sports podiatrist will ask you a number of questions about your pain, and they will conduct a series of tests. Some of these may include palpating (physically feeling) the areas of the foot to locate the source of the pain.
As part of their examination, your sports podiatrist may wish to conduct a biomechanical assessment and motion analysis of your lower leg and foot on their treadmill. This can be a fantastic diagnostic tool, as it will allow your podiatrist to determine the alignment of your foot and visualize any imbalances in your gait (walking pattern), therefore providing valuable information about where the areas of greatest pressure in your foot are.
What treatments are available for heel spurs?
Treatment for heel spurs is usually based around reducing inflammation to relieve pain. Your sports podiatrist may recommend some of the following treatments:
- Rest, to take the pressure off your feet, reduce inflammation and help to relieve pain
- Use a cold compress or ice pack for 15-20 minutes a few times a day to reduce inflammation
- Stretching and strengthening exercises, to assist you in managing the pain long-term. Your sports podiatrist can recommend which types of exercises are most appropriate for your condition, to ensure that you are only undertaking beneficial exercise and not exacerbating your condition
- Shoe inserts such as heel pads or orthotics may be recommended for you to provide arch and heel support to reduce pain and allow healing to take place more permanently.
Over-the-counter anti-inflammatories may be advised for short-term use in patients with severe and debilitating pain, however these have side-affects and are therefore not a solution in the longer term.
In some severe cases, if the heel spurs are very painful and ongoing, surgery may be recommended, though this is uncommon. Of the patients that do have surgery to remove their heel spurs, most are also suffering with plantar fasciitis or Achilles tendonitis, and the surgery indicated is corrective for these conditions as well.
Are heel spurs preventable?
Preventing heel spurs from developing is largely a case of paying attention to the overall health of your feet and arches. Simple things like managing your weight and ensuring that you are wearing correctly fitted and appropriate shoes for your foot and type of activity are key. Always ensure that you are taking time to warm up appropriately with functional stretches for the type of exercise you are engaging in, so that you reduce the risk of over-stretching or straining the ligaments and tendons in your ankle and foot, or developing tight calf muscles that will pull on the heel. Avoid running and jumping on hard surfaces.
Most importantly, never continue to push through any heel pain. Heel spurs develop from prolonged and repeated stress, and with that in mind, you should not continue to exercise or wear shoes, that cause you pain. If you experience heel pain, ice the sore foot, elevate and rest it, and make an appointment with your sports podiatrist as soon as is practical for a thorough medical assessment.
The information regarding heel spurs provided above should not be taken as general advice and is for educational purposes only. If you have heel pain and suspect you may have a heel spur, you should consult with a suitably qualified sports podiatrist to discuss your condition. You can make an appointment with one of our specialist podiatrists by emailing [email protected] or by calling 91998754.
For many years Heel spurs have been misdiagnosed as the cause of the severe pain in the heel. Upon x-ray, practitioners observed a spur-like growth of bone at the point where the plantar fascial ligament, or Achilles Tendon inserts at the heel – this can be clearly seen in the x-ray below. It was therefore wrongfully concluded that such an obvious growth must be the cause of the pain.
Heel spurs can occur under the heel in association with plantar fasciitis and at the back of the heel in patients with Achilles Tendon problems / tight calf muscles.
Unfortunately, this misdiagnosis resulted in many years of ineffective treatment (and this still occurs today) with patients unable to find a cure that offered any long-term relief. Spurs are nature’s way of making a connection to tight tissue that pulls on an attachment. They are created by pulling, but are not a part of the pain.
The actual pain is the pulling and tearing of the micro fibres of the soft tissue at its insertion point at the heel. The ensuing growth of bone or “heel spur” is merely a by-product.
For more information or to book a consultation phone us on (02) 9199 8754 or Enquire Online. We currently consult in Crows Nest, Sydney CBD, Parramatta and Narellan.
Karl Lockett – sports podiatrist.
How are Heel Spurs (Bone Spur) Treated?
First, let’s start off by talking about what a heel spur is. A heel spur develops when there are calcium deposits on the back and bottom of your heel bone. The growth often occurs at the interface where a tendon or a ligament attaches to the heel bone. Even though they’re usually painless, sometimes they can cause heel pain though. The two most common types of heel spurs are Achilles insertional and plantar fasciitis bone spurs. Below you will find the different types of heel spurs and treatment options.
The Achilles Insertional Bone Spur
Our bodies have different tendons. The Achilles tendon is not only the largest but the strongest too. It’s formed when two muscles of your leg combine, and it attaches to the back of your heel. It’s this tendon that enables us to lift our feet down and walk on our tiptoes.
An Achilles bone spur occurs directly where the tendon and the edge of your shoe merge with your heel bone. Mostly, they are caused by injuries and genetics. But at times, they may be caused by overuse. Spurs begin as a small growth, but if left untreated, they will grow widely within the tendon.
The irony, however, is that the size of a bone spur does not reflect on the level of pain one may feel. In fact, a large heel spur can be completely painless. On the other hand, a small one can cause excruciating pain.
Treatment involves alleviating pressure from the shoe on your heel bone with gel pads and the use of spot stretching shoes. But in some severe cases, your physician may suggest heel lifts to keep your bone elevated in a way that your backpack is also raised above the shoe edge. If the inflamed area has a fluid, pain medication may also be prescribed.
Surgery can be performed in extreme cases. If spurs are on the surface, a simple operation may do. But if there’s significant growth, it’ll require surgical detachment and reattachment. Some patients may also need tendon transfers. Generally, healing will take between 6 to 8 weeks, but during this time, one must rely on crutches.
Plantar Fasciitis Spur
The plantar fascia supports the arch. Bone spurs developing on this ligament can cause inflammation called plantar fasciitis. Note that while heel spurs may not often occur with plantar fasciitis, they are common in individuals who have plantar fasciitis.
Unlike other spurs, this type tends to point forwards towards the toes. Therefore, the pain one feels is not directly from the bone spur, but instead, it’s caused by inflammation and microtears of this ligament.
Treatment involves lots of rest and arch support to stabilize your ligaments. Physicians prescribe anti-inflammatory medications, icing, and physical therapy to help reduce inflammation. Severe cases may force someone to use casting and crutches.
There is some good news! And that is that this kind of bone spur typically resolves after several months. However, if it persists after a year of treatment, surgery to control lengthening will be necessary.
Bone spurs are common, and there are high chances of developing them as we age. So, we must understand the different types of heel spurs and their treatment, as this will support a speedy recovery.
If pain persists, call us at 888-409-8006. Our top foot/ ankle board-certified specialist is here to help.
Faster Recovery from Achilles Tendon Issues: Florida Orthopedic Foot & Ankle Center: Foot and Ankle Specialists
Many Achilles tendon surgery patients in the United States are getting back on their feet faster, thanks to new procedures and techniques.
James M. Cottom, DPM, FACFAS, a foot and ankle surgeon with offices in Sarasota and Arcadia, FL, says the introduction of tissue graft products, bone anchors, radio frequency treatments and new arthroscopic procedures provide patients with less invasive treatments and speedier recovery times.
“These surgical advances will shorten recovery times for many patients, allowing them to get back to their jobs and active lifestyles in less time,” says Cottom.
The Achilles tendon connects the calf muscle to the heel bone in the back of the leg and facilitates walking. The most common Achilles condition is tendonitis, an inflammation of the tendon. Cottom says most tendonitis cases can be successfully treated with non-surgical methods such as rest, ice, anti-inflammatory medications and physical therapy.
But some tendonitis patients develop scar tissue on the tendon, or their tendon fibers weaken and develop microscopic tears, a condition called Achilles tendonosis. Fixing these problems may require surgery and weeks to months of recovery.
Cottom says recently-introduced radio frequency technology can shorten recovery time for some patients by using radio waves to stimulate healing in the tendon. The procedure requires smaller incisions to insert the wand-like radio frequency device. Smaller incisions mean less damage to skin and muscle, less pain, and lower risk of surgical infections. Patients recover faster.
Overuse, especially in athletes, can cause the Achilles tendon to tighten and pull so hard on the heel bone that a bone spur, or bump, develops. Shoes can rub against the spur and cause pain. In addition, a painful fluid-filled sac called a bursa can develop between the heel bone and the tendon. Traditionally, correcting this tightness involved cutting the tendon, removing the bone spur or bursa, and then reattaching the tendon.
According to Cottom, new arthroscopic techniques can provide a minimally invasive option to removing bone spurs and bursas without significant damage to the Achilles tendon. When the tendon does have to be surgically detached, new bone anchor constructs (screws that are drilled into the heel bone to secure the tendon and tissues) can reattach the tendon, minimizing the chance of a potentially painful knot developing on the back of the heel.
Achilles tendon ruptures are the most serious Achilles injuries. Most patients require surgery to decrease the likelihood of a re-rupture. Various techniques are available, and increasingly may include tissue grafts used as a bridge to link the detached tendon lengths. The graft provides a scaffold on which new tissue grows, increases the overall strength of the repair, and is usually absorbed by the body within a year.
Cottom is a member of the 6,000-member American College of Foot and Ankle Surgeons (ACFAS) and is double board certified. He completed a 3-year intense surgical residency in Detroit, MI followed by a 12 month orthopedic foot & ankle fellowship. This is the same type of fellowship MD/DO orthopedic surgeons complete if they wish to sub-specialize in foot and ankle surgery. He is a native of Michigan and has been practicing in the Sarasota area since 2007. Contact us to book a consultation or call us.
Do I Need Surgery for Bone Spurs?: Michfoot Surgeons PC: Podiatry
If you think you have bone spurs and are dreading foot surgery, you’re in luck! Many times there are non-surgical options for foot pain, and not all foot pain is due to bone/heel spurs. If you’re experiencing foot pain and suspect you have bone spurs, as a foot surgeon and podiatrist I urge you to come into my office for an examination so we can get to the root of the problem.
What is a Bone Spur?
Let’s assume you’ve gotten an official diagnosis of bone spurs, and explain what they are in detail. Bone spurs, more often known as heel spurs, are growths of bone along the edges of your bones. In heel spurs, they happen in the heel bone (calcaneus). They are attributed to chronic local inflammation at the insertion of soft-tissue tendons or fascia in the area. Heel spurs can be located at the back of the heel or under the heel, beneath the sole of the foot. Heel spurs at the back of the heel are frequently associated with inflammation of the Achilles tendon (tendinitis) and cause tenderness and pain at the back of the heel made worse while pushing off the ball of the foot.
Symptoms of Heel Spurs
Heel spurs can be painless, but are often associated with heel pain and plantar fasciitis. There’s often localized tenderness at the bottom of the heel, making it difficult or painful to walk barefoot on hard floors.
How are Heel Spurs Treated
Once a diagnosis of heel spurs has been made, there are many options for treatment. At our podiatrist office we aim to treat the symptoms of heel spurs and their resulting inflammation conservatively at first, often with inflammation reducing medication, injections, or even our MLS laser therapy. Additionally, we’ll likely recommend that you invest in orthotics and comfortable, supportive shoes, as those will help reduce the irritation from heel spurs.
In those cases where heel spurs cause chronic inflammation, surgery may be an option.
Heel Spur Foot Surgery
Surgery is performed on an outpatient basis. You will be put in a post-operative boot after the surgery, and though you can likely walk after surgery we recommend our patients to limit the amount of wight bearing activities they undertake. The first week you should expect to stay off your feet except for going back and forth to the bathroom or to get food. By the second week you can likely be more mobile, and by the third week some patients are able to walk normally. As with anything, your case might be different- your foot surgeon will discuss everything with you before foot surgery is performed, and will update you on your progress as you continue to check in at your followup appointments.
Haglund Exostosis | EMC
Haglund’s exostosis is a special type of lesion of the calcaneus with concomitant reactive changes in the adjacent tissues. For the first time the so-called “shoe tumor” syndrome of the heel was described in 1928 by the Swedish surgeon Haglund, after whom it got its name.
Clinically, Haglund’s exostosis manifests itself in tendonitis, bursitis and tenodynia at the site of the Achilles tendon insertion. External symptoms are characterized by the presence of seals in the area of the calcaneus tuberosity, pain with pressure and inflammation of the skin.
The reasons for the development of Haglund’s disease are most often the wearing of shoes, which creates discomfort in the heel area. Especially insidious in this regard are the pumps, so beloved by women: the heel of such shoes is usually curved in such a way that it bites into the back of the heel bone, as a result of which a spur forms on the heel, due to which the distance between the heel and the metatarsal heads is reduced. Exostosis can also form on the back of the heel, and skin inflammation occurs due to constant mechanical friction against the surface of the shoe.Ski boots and skates are also common culprits in the development of Haglund’s disease, so ski enthusiasts should be especially careful.
Haglund exostosis is diagnosed on the basis of a physical examination and radiography: a significant growth of bone tissue will be visible on the image at the superior posterior protrusion of the calcaneus. The main difficulty is that both types of the disease – Achilles bursitis (between the Achilles tendon and bone) and bursitis of the subcutaneous calcaneal bursa (between the tendon and skin) – are not easily distinguished from simple inflammation of the Achilles tendon.
In the vast majority of cases, conservative treatment of Haglund’s exostosis is indicated. A number of physiotherapy procedures are carried out to improve blood circulation, analgesic drugs are prescribed for severe pain, wearing special shoes with an orthopedic backing is mandatory. In some cases, the doctor applies a plaster cast to ensure the rest of the limb.
Surgical treatment is used extremely rarely (2% of all cases): surgical removal of osteochondral growths.The operation is performed under local anesthesia, the procedure is low-traumatic and does not require long rehabilitation.
Prevention of Haglund exostosis is to wear loose shoes, the ideal option would be to use orthopedic insoles-instep supports.
90,000 How is heel spur treated? | Dikul center
Bony growths in the form of a thorn or beak in the area of the plantar surface of the calcaneus tuberosity or at the point of attachment of the Achilles tendon are usually called heel spurs.Most often, heel spurs are a consequence of involutive processes of the human body and are found as an anatomical feature in middle-aged people.
The causes of spur formation can be longitudinal flat feet, acute and chronic trauma, rheumatism, infection, vascular and neurodystrophic disorders.
The clinical picture is typical. Most often, patients complain of the so-called “starting pain”. Those suffering from this ailment are most difficult for the first steps after sleep, prolonged sitting.The pain can be burning, sharp when resting on the heel, defined by patients as a feeling of a nail in the heel. Pain can spread over the entire heel area, or be localized along the inner surface of the heel. Pain can appear suddenly and be acute or develop gradually, becoming chronic. Patients involuntarily try to relieve the heel.
When examining the heel area, as a rule, pathological changes are not detected. When pressing on the tubercle of the calcaneus from the side of the sole and when squeezing the heel from the sides, pain is determined.
With a posterior calcaneal spur, pain is noted at the site of attachment of the Achilles tendon when walking and pressure from the back of the shoe. Edema of this area, callousness of the skin is possible.
The intensity of pain does not depend on the size of the spur, determined on the radiograph. Quite often, spurs, sharp in shape and large in size, are an accidental X-ray finding. At the same time, severe pain in the heel area is possible with a normal X-ray picture.
Thus, clinical symptoms are primarily due not to the presence of the spur itself, but to changes in soft tissues: inflammation of deep mucous bags (calcaneal bursitis, achilobursitis), phenomena of periostitis, and most often plantar fasciitis .
Plantar fasciitis is an inflammation of the plantar fascia. The plantar fascia is a wide strip of fibrous tissue that runs along the sole of the foot from the heel to the forefoot. There is a justified opinion that plantar fasciitis is primary in the development of the heel spur. The inflammation causes a reactive osteoblastic process, as a result of which the heel spur develops.
Signs of plantar fasciitis are well detected by ultrasound examination of the soft tissues of the foot.It is advisable to perform ultrasound of the soft tissues of the foot before choosing a method for treating a heel spur.
Heel spur treatment
Treatment of a heel spur is conservative and depends on the cause of the development of the disease and the stage of the process. A complex of therapeutic measures aimed at eliminating the inflammatory process is recommended. Nonsteroidal anti-inflammatory drugs are prescribed, place of gels and ointments with anti-inflammatory and absorbable effect, phonophoresis with hydrocortisone, cryotherapy.A good and lasting effect is provided by a single administration of topical diprospan.
The most important condition for the effectiveness of treatment is the provision of unloading of the painful area. To do this, according to indications, individual orthopedic insoles are prescribed with the layout of the inner and outer longitudinal arches, a depression and a soft pad under the heel. As a temporary measure, it is recommended to use a heel pad with a recess or hole in the center – the so-called unloading device. These devices are sold in orthopedic salons.Unloading with the help of orthopedic shoes with a depression in the heel is considered the most complete. With a back spur, a recess is made in the heel. As a temporary measure in the treatment of heel spurs, wearing shoes without a heel can be recommended. The complex of heel spur treatment will include warm baths with sea salt, soap, soda, therapeutic exercises, massage of the muscles of the foot and lower leg. These activities are aimed at improving the blood supply to the tissues of the foot.
After the inflammatory process subsides, which must be confirmed by ultrasound diagnostics, shock wave therapy is prescribed.
In our Center, the use of shock wave therapy (SWT) techniques in combination with injections of drugs (in particular, diprospan) gives stable positive results, which allows you to heal the heel spur faster.
Author: V.I. Dikul
90,000 How to cure foot and heel pain?
- What to do with foot pain?
- When should I see a doctor?
- Pain in the foot and heels in athletes-runners:
Achillodynia, heel spur, march fracture, bursitis
- Pain in the foot in women:
Neroma Morton, transverse flat feet, metatarsal valgus deformity
- Pain in the foot in the elderly : Plovalgus deformity, rheumatic arthritis, gout, arthrosis
- Pain in the foot in children and adolescents:
Pain in growth, osteochondrosis, deformity of the arch of the foot,
osteochondroma of the talus
- Frequently asked questions
Foot pain is a biologically important warning signal that indicates foot pathology.Pain in the foot appears as a result of overload, deformation, fractures, pathologies of tendons and joints, or general diseases caused by metabolic disorders.
In order to establish the correct diagnosis, the specialists of the Gelenk-Klinik in Freiburg need to know under what circumstances the pain in the foot has occurred.
Pain in the foot can appear as a result of increased training, improper load distribution and injuries. In addition, there are other diseases that manifest themselves as pain in the foot, but have nothing to do with orthopedics.
How to avoid foot pain?
In case of sudden or chronic pain, do not wait until the last. See a specialist before the pain in your foot worsens and causes permanent damage.
Pain in the foot can be treated in stages: Pain in the heels or in the Achilles tendon is characteristic of the hindfoot, while pain in the foot, instep and internal lateral pain is characteristic of the midfoot.
Pain in the toes, often as a consequence of transverse flat feet, occurs in the anterior part of the foot.
It is not always necessary to consult a doctor with these complaints: Sometimes, in order to successfully treat pain in the foot, it is only necessary to change shoes, reduce the load in the foot or change the walking technique.
Anatomy of the foot. Anatomy of the foot. Pain can occur in any part of the foot. The ankle joint connects it to the knee. A strong heel bone is the ankle support. The tarsus is partly responsible for the vertical mobility of the foot. The skeleton of the foot consists of three sections: the tarsus, metatarsus, and toes.The arch from the calcaneus to the toes forms the longitudinal arch of the foot. When rolling from heel to toe, the heads of the metatarsal bones transfer force to the floor and, together with the toes, form the forefoot. © Viewmedica
When do I need to see a specialist?
- For painful swelling in the foot or ankle, lasting more than five days.
- For open and purulent wounds.
- For stabbing and cutting pain.
- For repeated complaints.
- If the pain in the foot continues for several weeks in a row.
- If, in addition to cramps in the foot, you have a fever.
- For structural changes in the foot, calcaneus or ankle.
Foot and heel pain in athlete-runners
In athletes involved in active sports, foot pain has orthopedic reasons. “Orthopedic” means damage to bones, joints, tendons, muscles and ligaments. During training and competition, the legs are most exposed to stress, which is interpreted as the basis of most injuries in the foot.In this case, the severity falls on all tissues in the foot: tendons, bones, cartilage and periarticular bursa (bursa). Excessive or improper exercise can lead to foot fractures, tendon inflammation, and muscle tears.
How is foot pain treated in athletic runners?
Not only intensive training, but also deformation of the heel bone can cause overloading of the Achilles tendon. Incorrect position changes the course of the tendons attached to the calcaneus (see figure on the right).The result is twisting, which leads to excessive weight on some parts of the tendon. © Dr. Thomas schneider
Not only athletes, but also other patients suffering from pathologies in the foot, are advised to listen to their body and stop or reduce the load if pain in the foot appears. Trained orthopedic specialists advise you to consult your doctor first before taking pain relievers. In this way, a person can prevent long-term diseases and pain in the foot.In case of pain in the tendons, in no case should you take painkillers, while maintaining the same load in the foot. Competition and strength training while taking pain relievers can wreak havoc on an inflamed Achilles tendon.
Tendon diseases: Inflammation of the Achilles tendon (Achillodynia)
Symptoms of achillodynia
- Stitching pain in the foot at the beginning of the movement.
- 3 cm thickening. above the tendon attachment site.
- Redness and overheating of the skin.
- Crepitation – tendon crunch.
- Early stage: Pain in the foot under exertion.
- Late stage: Foot pain at rest / persistent pain.
The Achilles tendon is anchored across the full width of the calcaneus and is responsible for transferring the load from the calf muscles to the hindfoot.
Achillodynia often manifests itself in the heels as a stitching pain in the foot at the beginning of the movement or at the beginning of training. However, this is quite misleading: Even if during the training itself the pain in the foot passes, the Achilles tendon is still subjected to stress and becomes more fragile, which, sooner or later, will lead to its rupture.
How is Achillodynia treated?
Reduce foot loads. For acute inflammation, use an anti-rheumatic pain reliever (eg ibuprofen).
- Resting and “unloading” the Achilles tendon
- Anti-inflammatory drugs
- Special insoles (increased instep in the foot, protection against excessive pronation)
- Physiotherapy: exercises to minimize deviations of the axes of the lower extremities
- Special exercises for stretching the calf muscles
- Shockwave therapy
- Surgical removal of inflamed tissue
- Reconstruction surgery
heel tendon rupture: Achilles tendon plasty
The lower calcaneal spur is characterized by cutting pain in the sole on the heel.Most often, poor-quality shoes or overstrain in the foot are the basis of inflammatory processes in the plantar tendon.
During exercise, the pain in the foot decreases or disappears altogether.
The area of attachment of the plantar tendon with a heel spur is very sensitive with pressing pain. In addition, the plantar tendon is a tendon plate that extends from the heel bone under the sole of the foot. The lower heel spur often occurs in people who are overweight or in people who are tall.Athletes, runners, as well as people who are fond of other sports, often complain of stabbing pain in the plantar region of the foot.
The upper heel spur is characterized by pain in the heel. The Achilles tendon, which originates at the junction of the medial and lateral heads of the gastrocnemius and soleus muscles, becomes inflamed and causes pressing pain in the foot when wearing the wrong shoes.
Using X-rays, foot pain specialists can immediately identify painful thickening of the plantar or Achilles tendon.
How is heel spur treated?
Athletes with inflammation of the plantar (heel) tendons are advised to reduce the load in the foot and not exercise when they feel pain. Stretching the heel tendons in the foot prevents this condition and accelerates recovery. Special insoles free the place where the tendon is attached to the heel from stress. Shock wave therapy accelerates the treatment of this pathology.
- Instep supports that reduce the weight on the arch of the foot.
- Shockwave therapy
- Biological cell regeneration (YAKE®-Matrix Regeneration Therapy)
- Stretching exercises and physiotherapy.
- Botulinum toxin injections
Inflammation of the tendon sheath (tendovaginitis) causes pain in the instep
Inflammation of the synovial sheath of tendons moving from the anterior tibial muscle along the dorsum of the foot and connected to the toes.These tendons can become inflamed and swollen due to overuse. © Grays Anatomy
Symptoms of tendovaginitis
- Stitching / pulling pain in the foot
- Redness and overheating of the skin
- Crunching of the tendons (crepitus)
- Perceptible thickening of the tendons in the foot
Sometimes, while walking, pain is felt in the back of the foot. A number of tendons run from the tibial muscle through the dorsum and supply each toe. Excessive stress can cause inflammation in the tendons.
Pain in the foot, namely on its back, is very similar to a march (fatigue) fracture in which the patient feels a stabbing pain while lowering the leg to the heel. The tendon sheath also becomes inflamed due to improper shoes or prolonged exercise. Incorrect and too narrow shoes, as well as excessive sports loads, are the main causes of inflammation of the tendon sheath.
How to cure tendon inflammation in the foot?
- Cooling compress
- Painkillers (Ibuprofen)
- Orthosis fixation
- Operative treatment
People who play sports are advised to stop training and replace shoes with more comfortable ones until the pain in the foot is completely gone …NSAIDs are non-steroidal anti-inflammatory drugs that can help you overcome and stop foot pain. In addition, the experts at Gelenk Klinka in Freiburg do not recommend exercising while taking Ibuprofen.
Calcaneus exostosis (Haglund exostosis): stitching pain in the hindfoot
Symptoms of calcaneus exostosis
- Swelling and redness on the heels
- Aching pain in the foot
- Hyperthermia, redness
In addition to the heel spur and achillodynia, there are other causes of stabbing and pressing pain in the back of the foot.For athletes, these are, for example, sneakers with tapered heel pads. These shoes put a lot of pressure on the upper surface of the heel bone and are the beginning of a number of abnormalities in the foot. When wearing unsuitable shoes, other defects may appear in the foot, which the patient may not have known about. Thus, hollow foot often leads to deformation of the heel and the formation of an outgrowth on it. Therefore, in people with this deformation, cartilaginous outgrowth on the heel is formed more often than in others.
How is Haglund’s exostosis treated?
Athletes-runners are most often affected by this disease. Patients are advised to pause training and reduce the load in the foot. Exostosis of the calcaneus is treated with the following methods:
- Calcaneal inserts
- Orthopedic insoles
- Antirheumatic drugs
- Surgery (e.g. removal of the periarticular mucosa)
Symptoms of a marching fracture
- Stitching pain in the metatarsal foot
- Swelling in the foot
Excessive or intense training can lead to painful marching fractures of the metatarsal bones in the foot.Due to overload, fractures are formed not only in the foot, but also in other congested areas. Most often, fatigue fractures are observed in the foot because it carries the entire body weight. In addition, such injuries to the metatarsal (metatarsal) bone of the midfoot are observed in the area of the second metatarsal bone. In this case, the big toe, which is held by the adductor muscle, begins to move outward.
In most cases, stress fractures in the foot are mistaken for joint sprains or bruises.However, with this pathology, due to overload, the structure of the metatarsal bone is disrupted. Stitching pain in the foot under stress is characteristic of a fatigue fracture.
How to cure a marching fracture?
- Immediate load reduction
- Anti-edema treatment: (YAKE®-Matrix regeneration therapy, Lymphatic drainage)
- Anti-inflammatory drugs
- Foot immobilization, load reduction
Stop playing sports until the pain in the foot is gone.Anti-inflammatory drugs speed up the process of reducing swelling in the foot. Reducing the weight on the forefoot with special shoes accelerates recovery. With a marching fracture in the foot, no displacement of bones is observed. In most cases, only the cortical bone is damaged. It follows from this that complete immobilization of the foot is not necessary. The recovery process takes up to six weeks. That is how much the patient is recommended to keep the foot at rest.
Posterior calcaneal bursitis and inflammation of the bursa surrounding the Achilles tendon (Achilles bursitis)
Symptoms of Achilles bursitis
- Swelling of the heel
- Redness and overheating of the skin
- Stitching pain in the heel with each step
Painful inflammation of the joint capsule (bursitis) Can also cause pain in the foot. The periarticular synovium is a thickened cavity containing synovial fluid, which is responsible for the mobility of tendons and muscles.In addition, they protect soft tissue from pressure and injury.
One of the signs of bursitis is pain in the back of the foot. The Achilles tendon is formed as a result of the fusion of the flat tendons of the posterior calf muscles – the gastrocnemius muscle and the soleus muscle and is attached to the tubercle of the calcaneus. In addition, the Achilles tendon sits between two bursae, which can become inflamed with excessive exertion. Quite often, Achilles bursitis cries out pain in the back of the foot.
How to cure posterior calcaneal bursitis?
- Reducing foot load, cooling compresses, immobilization
- NSAIDs are non-steroidal anti-inflammatory drugs (e.g.Ibuprofen)
- Puncture of the inflamed bursa (bursa synovial)
- Operative removal of the synovial bursa
Shoes with tapered heel inserts should be replaced with more comfortable shoes with orthopedic shock-absorbing insoles. Anti-inflammatory drugs can help treat foot pain and relieve symptoms. In order to “unload” the foot a little, patients are advised to suspend sports. In advanced cases, surgical removal of the synovial bag of the posterior part of the foot is performed.
Intermetatarsal bursitis – inflammation of the synovial bursa of the forefoot calving
Pain in the foot also appears as a result of intermetatarsal bursitis. Inflammation of the bursa of the forefoot can occur as a result of strength exercises and the wearing of tight shoes that squeeze the toes. Since with each movement a significant part of the load falls on the phalanges of the fingers and bones of the metatarsus, the foot can be deformed. Thus, pathologies in the foot, namely transverse flat feet or hallux valgus can lead to over-irritation of the synovial bursa of the forefoot calving.
Quite often, orthopedic specialists observe bursitis of the first metatarsophalangeal joint (metatarsophalangeal bursitis) in patients. Due to the already frolicking deformation of the big toe, the shoes in this area begin to press even more. A misalignment of the first toe often leads to bursitis and painful swelling. The bursae between the other metatarsal bones become inflamed during vigorous exercise.
How is forefoot bursitis treated?
- Insoles for transverse flat feet
- Non-steroidal anti-inflammatory drugs (ex.Ibuprofen)
- Surgical removal of the bursa
Anti-inflammatory drugs reduce pain and swelling in the foot in the foot. Strength sports loads for patients need to be reduced urgently. Flatfoot insoles will help reduce stress on the forefoot in the area of the toes.
The abductor big toe muscle – bottom view in red – is responsible for abducting the big toe. In cross-country athletes, this muscle can become inflamed.© Grays Anatomy
Muscle pain in the foot: Inflammation of the abductor hallucis muscle (Musculus abductor hallucis)
Symptoms of inflammation of the muscles of the inner part of the foot
- Stitching pain in the foot
- Redness and overheating of the skin
Muscle appears in the foot pain: The muscle of the abductor big toe (Musculus abductor hallucis) occupies a medial position in the plantar part of the foot. In addition, this muscle is responsible for the flexion process of the thumb abduction.Stitching pain in the foot is one of the signs of pathology of the muscle that abducts the arch of the foot.
How to treat inflammation of the abductor big toe muscle?
- NSAIDs – Non-Steroidal Anti-Inflammatory Drugs
- Stretching the muscles
A stabbing pain in the extensor of the thumb can be confused with pain in the plantar (calcaneal) tendon or with a march (fatigue) fracture. Stretching exercises can help maintain a healthy foot.
Inflammation or rupture of the tendons of the peroneal muscles
Symptoms of inflammation of the tendons of the peroneal muscles
- Pain in the lower leg
- Pain in the lateral ankle
- Pressing pain throughout the tendon of the peroneal muscle
Tendon swelling, external redness
The tendons of the peroneal muscles connect the lower leg muscles (peroneus brevis / peroneus longus) with the tarsus bones: wedge-shaped inside the foot and metatarsal outside.Both bones surround the foot from the medial and lateral sides. The peroneal muscles help extend the foot and toes (plantar flexion).
Ankle and peroneal tendons: The long peroneal tendons are controlled by the gastrocnemius muscles, located in pairs – on the inside and outside of the ankle joint – and anchored in the tarsus region. With excessive exertion and the absence of regeneration, inflammation of the tendon sheath and ruptures of the peroneal tendons are possible.© Bilderzwerg @ fotolia
Peroneal tendons and muscles are often inflamed due to overload, increased exercise, lack of warm-up or deformities in the foot (peroneal tendon tenditis). The critical point in this situation is a sudden change in the total load: People starting with an increased volume of training can develop muscle breaks and inflammation of the peroneal muscles. Pain in the foot, caused by inflammation of the peroneal muscles and tendons, begins in the calf muscles and radiates to the foot through the tendons.First of all, the outer ankle begins to hurt. When the foot is tucked outward, the pain in the peroneal muscles increases as the tendon continues to stretch.
Likewise, in the area of the tendons that run transversely under the ankle joint, inflammation (tendinitis) can occur. Peroneal tendon tendonitis results in painful inflammation as well as swelling and pain in the foot and ankle.
Tight athletic shoes that limit the smooth rolling of the foot also cause painful inflammation of the peroneal tendons.With deformities in the foot, there is no required amount of load on the leg muscles, which causes pain and overload in some parts of the foot.
The inflammatory process can lead to rupture of the peroneal tendon. In addition, a swollen peroneal tendon can compress the nerves of the tarsal (metatarsal) canal, causing the patient to experience itching, numbness, and numbness in the foot.
Treatment of inflammation of the peroneal tendons
- Reducing stress and resting in the foot
- Cooling of acute inflammations in the foot
- Anti-inflammatory drugs (e.g.Ibuprofen)
- Physiotherapy, stretching the calf muscles
- Orthopedic insoles
- Foot surgery
- Removal of dead (necrotic) tissue with a sharp scalpel
- Aligning the bone structures of the peroneal tendon
Frequent foot pain in women
There are no such pathologies in the foot that concern only women. However, pain in the forefoot occurs 10 times more often in women than in men.The reason for this is the fact that the connective tissues in women are weaker. Hormonal changes such as pregnancy or menopause can also change the structure of connective tissue. In addition, women like to wear nice high-heeled shoes, which leads to muscle curvature in the foot. Very often, instead of smoothly rolling the foot from heel to toe, the main weight falls on the forefoot, which leads to muscle deformation.
Pain in the big toe: Metatarsalgia (pain in the metatarsal bones) with transverse flat feet
Symptoms of metatarsalgia
- Lowering the transverse arch of the forefoot
- Extension of the forefoot
- Flexion of the big toe
- Pain in the foot under load
- Calluses on the phalanges (corns))
In metatarsalgia (metatarsal pain), patients experience pain in the metatarsophalangeal joint at the level of the ball of the foot of both feet, which is located just below the toes.This area in the foot is under the most pressure than others. Due to the transverse flat feet , the transverse arch of the foot decreases and the load on the plantar fascia increases. During the roll of the foot from heel to toe, the transfer of body weight to the floor occurs with the help of the ball of the foot. Weak connective tissue or poorly trained legs are two of the most significant reasons why patients begin to feel pain in the foot. If a person wears uncomfortable narrow-toed shoes every day, the risk of illness increases significantly.
And if the shoes are also with high heels, the load on the pads of the foot and connective tissues increases. Patients are advised to take these facts into account and pay attention to the fact that the human foot, by its nature, is not capable of withstanding such loads. After several years of wearing such shoes, many people experience severe pain in the foot, as well as flattening of the arch of the foot and transverse flat feet, in which the forefoot is flattened, and the first toe is retracted outward.
How to treat metatarsal pain?
- Orthopedic insoles for strengthening the transverse arch of the foot
- Exercises for the foot and gymnastics
- Shoes with low soles, not narrowing the toes
- Operation (Weil-Osteotomie: Korrektur des Spreizfußes) Osteotomy (Weil’s operation:
correction of the transverse planes)
The method of treatment of pathology will depend on the reasons for which the pain in the foot began.However, in any case, doctors recommend replacing the most comfortable shoes. Sometimes gymnastic exercises help to strengthen the forefoot. In case of deformities in the foot, due to transverse flat feet, insoles with special wedge-shaped elements are used. In such insoles, a notch is made on the heel, and a metatarsal pad is installed in the area of the transverse arch of the foot. This design allows you to straighten the transverse arch of the foot and reduce stress in the foot.
Morton’s neuroma: pain in the middle of the foot due to pinched nerves
Morton’s neuroma is an abnormal thickening of the common toe nerve that causes pain in the foot between the third and fourth toes. This disease, which is characterized by stabbing pain in the foot, as well as numbness and burning sensation in the fingers, can be triggered by transverse flat feet. © Dr. Thomas Schneider
Symptoms of Morton’s Neuroma
- Stinging pain in the toes and forefoot
- Numbness of the toes
- Feeling as if you are stepping on a pea
- Reduction of pain syndrome after taking off shoes
Disease of Morton’s Neuroma Morton’s neuroma manifests itself in the form of painful edema of the neural membrane between the metatarsal bones, and the transverse flat feet accelerates its development.A decrease in the anterior transverse arch of the foot with transverse flat feet has a negative effect on the condition of the forefoot. As a result, the first metatarsophalangeal joint is directly on the floor, and the area between the metatarsal bones is narrowed. During walking, the metatarsal bones compress the median nerve (Nervus medianus), causing the connective tissue that forms the nerve sheaths to swell.
As a result of the above mentioned edema, the pressure on the nerve endings in the foot increases. Patients feel severe stabbing pain in the foot, and sometimes burning or numbness.Thus, almost the entire area of the blood supply to the nerves in the foot is affected.
If you have the feeling that you are stepping on a pea or pebble while walking, then you most likely have Morton’s Neuroma.
How is Morton’s Neuroma Treated?
- Low-soled shoes that do not narrow the toes
- Gymnastics for the feet
- Local anesthesia
- Operative decompression – reduction of the metatarsal compression
- Metatarsal osteotomy
- Neurectomy – surgical excision of the inflamed nerve
- Outward curvature of the first toe
- Deviation inward of the big toe
- Swelling, redness, overheating and pressing pain in the foot
- Pain in the midfoot (metatarsalgia)
- Swelling of the thumb
- Restricted mobility of the thumb
- Pain depending on the intensity of movements in the first metatarsophalangeal joint
- Noise of friction in the joint
- NSAIDs – non-steroidal anti-inflammatory drugsli>
- Infiltration – injection of pain relievers (e.g.cortisone)
- Orthoses for joint immobilization
- Orthopedic insoles or immobilization of the diseased joint
- Heilectomy – removal of bone growths around the joint
- Osteotomy – shortening of the first metatarsal bone
- Arthrodesis (immobilization of the first metatarsal bone
- Arthrodesis (immobilization 572) of the first joint, plus
0 Hallux rigidus treatment should prevent or at least halt the development of arthrosis. In this case, it is advisable to use special insoles to reduce the load on the joint.Anti-inflammatory medicines (NSAIDs) can help reduce joint pain and reduce the likelihood of wear and tear on the articular cartilage.
Osteoarthritis can change the entire structure of the first metatarsophalangeal joint: Due to the increased pressure around the joint, bone spurs are formed, which accelerate the wear of the articular cartilage. During hailektomy, a minimally invasive joint operation (hailektomy), the surgeon removes these bony growths and thus preserves the vitality of the joint.
If, due to arthrosis, the articular cartilage was completely worn out, then the only method of treatment is immobilization (arthrodesis) of the first metatarsophalangeal joint .Orthopedic specialists of Gelenk-Clinic will carry out this intervention without any particular risks of limiting the patient’s mobility and sports abilities. After arthrodesis, the patient can return to high-profile sports.
Taylor’s deformity (tailor’s foot): deviation of the V metatarsal bone and the formation of a “bump” at the base of the little finger
Symptoms of Taylor’s deformity
- Flexion position of the little finger
- Pressing pain in the foot. due to inflammation of the articular capsule
- Calluses (corns) on the sole of the foot
- Expansion of the transverse arch of the foot
Taylor’s deformity or “tailor’s foot” is a symptomatology similar to arthrosis of the first metatarsophalangeal joint, a disease of the little toe, in which the fifth toe deviates and overlaps adjacent fingers.In this case, the area of the 5th metatarsophalangeal joint becomes inflamed, as a result of which the patient feels severe pain in the foot. The cause of the “tailor’s foot”, as in the case of valgus pathology, is transverse flat feet. Frequent wearing of high-heeled shoes with a tapered toe increases deformity and pain in the foot.
How is Taylor’s Deformity Treated?
- Shoes with low soles that do not narrow the toes
- Avoiding high heels
- Silicone inserts for the distal foot
Wearing loose shoes prevents the progression of deformity.With a balanced distribution of the load on the foot, the process of overloading the connective tissues and destruction of the forefoot arches stops immediately. Silicone pads under the distal foot help prevent existing inflammation and deformities in the foot.
In difficult cases, a tailor’s foot straightening operation is performed. This intervention returns the little toe to its original position, which contributes to the narrowing of the foot.
Foot pain in people of the middle and older age group
While in young people pain in the foot occurs as a result of overload and trauma, in people of the middle and older age group, pain in the foot can occur due to harmless deformities in the foot, which are not cause the young and the slightest inconvenience.In older people, such deformities appear much faster and lead to ankylosis (immobility) in the joints and arthrosis. The reason for this is changes in the metabolic process under the influence of hormonal drugs, which have a negative effect on muscle balance and tendons in the foot. Joint wear leads to arthrosis in the foot or metatarsophalangeal joint.
Plovalgus deformity in the foot: painful flattening of the longitudinal arch of the foot on x-ray.© Gelenk-doktor.de
Planovalgus deformity of the foot
Symptoms of planovalgus deformity of the foot
- Swelling of the medial ankle
- Rapid fatigue in the foot when walking
- Pain from the outer edge of the foot
- Pain in the foot, radiating to the lower leg
- Flat feet
- Failure of the foot rolling process
in the foot when rolling the foot from heel to toe
- Pain in the back of the foot
- Swelling and pain in the instep of the foot
- Change in load in the foot
- Pain in the foot when rolling from heel to toe
- Increased pain in the foot while climbing stairs
- Pain in the foot at the beginning of movement
- Anti-inflammatory pain relievers
- Orthopedic insoles to support the longitudinal arch of the foot
- Arthrodesis of the Lisfranc joint
- Lack of sensitivity in the foot
- Altered perception of pressure, cold and heat
- Pain and itching in the foot and lower leg
- Deformation of the muscles in the foot and lower leg
- Improved blood sugar control
- Pain therapy with antidepressants
- Avoiding alcohol and nicotine
- Medications that stimulate blood circulation
Neuropathic foot pain is not treated by an orthopedic specialist: This pathology should be consulted family doctor or general practitioner.The main causes of neuropathic foot pain and diabetes are overweight, smoking, alcohol consumption and poor diet.
Disruption of uric acid metabolism causes gout and stitching pain in the feet
One of the signs of gout may be pain in the foot, accompanied by redness on the skin and soreness when pressed. The initial stage of gout is characterized by a sudden stitching pain in the foot at the base of the big toe. Often, patients suffering from this pathology wake up at night and feel severe pain in the thumb.At the same time, the joint swells and overheats.
Gout is caused by the deposition of uric acid crystals in the joint. From this it follows that the cause of gout is a violation of the metabolism of uric acid.
For normal excretion of urine from the body, limit yourself to the use of meat products and alcoholic beverages.
Treatment of gout (hyperuricemia)
- Nutrition: Less meat and alcohol
- Weight loss
- Pain relievers for acute attacks of gout
- More fluid (promotes the secretion of uric acid)
- Urostatics (medicines that inhibit the production of uric acid)
Metabolic disorders can be cured by changing the diet.For normal excretion of urine from the body, limit yourself to the use of meat products and alcoholic beverages.
Rheumatoid foot: Rheumatoid arthritis causes painful swelling and overheating in the foot
Symptoms of rheumatoid arthritis
Rheumatoid arthritis (rheumatism) is a painful, inflammatory disease of soft tissues and joints, which is characterized by pain in the foot.
The causative agent of the disease are autoimmune pathologies, in which the body’s inflammatory response is directed against its own tissues.This fact is the reason for the wear and tear of the articular cartilage. Arthritis is diagnosed with a biochemical blood test. Stitching pain in the foot, swelling and overheating are considered consequences of rheumatoid arthritis.
How to cure rheumatoid arthritis?
- Medications: NSAIDs – non-steroidal anti-inflammatory drugs
- Rare: Cortisone injections
- Devil’s claw (medicinal plant)
- Omega-3-polyunsaturated fatty acids
hallux valgus and hammer toes
- Itching and numbness in the forefoot of the sole of the foot
- Burning pain in the metatarsal part of the foot
- Unpleasant sensations or sharp pain in the back of the foot
- Pain in the foot at night and at rest
- Pain in the foot, radiating to the lower leg
- Pain relievers and anti-inflammatory drugs
- Mobilization of the lower leg and ankle joint
- Cortisone injections
- Orthopedic insoles
- Surgical expansion of the tarsal tunnel (decompression)
- Pain in the heel, worsening with exertion
- Lameness during exercise
- Pressing pain in the foot
- Swelling and redness of the heel
- Physical rest
- Silicone heel pads
- Orthopedic insoles for the instep
- Weight loss
- Pain relievers
- Pain in the ankle joint during exercise
- Pinching / blockages in the joint
- Pain in the foot due to inflammation of the synovial membrane of the joint (synovitis)
- Immobilization, ban on sports
- Reducing the load in the foot with elbow crutches
- Normalizing calcium metabolism with Vitamin D3
- Operation: Arthroscopy of the ankle joint
- Surgical perforation
- Bone transplantation (spongioplasty)
- Re-fixation of a separated bone fragment
- Frequent twisting of the leg
- Pain and limited movement in the ankle joint
- Plovalgus deformity of the foot in children.
- Fusion of the scaphoid and talus: Coalition talonavicularis in 70% of patients
- Fusion of the calcaneus and talus: synostosis (Coalition talocalcanearis) in 30% of patients
- Fusion of the calcaneus and scaphoid bones: calcaneonavicularis)
Muscle spasm is one of the most common manifestations of the tarsal coalition.To quickly fix the problem, it is necessary to follow the recommendations of the attending physician.
Diagnosis of tarsal coalitions is based on clinical examinations and the use of various imaging methods. The X-ray of the foot is designed to more accurately determine the degree of development of the pathology, and digital volumetric tomography (DVT) helps to obtain a three-dimensional image of the bones, which is the optimal method for diagnosing the tarsal coalition.
How is a coalition of bones in the foot under the ankle treated?
- Surgical separation of the bone fusion of the tarsus
- If necessary, subtalar arthrodesis to restore the longitudinal arch of the foot
Tarsal coalitions in the foot in children is a malformation of the bones of the foot, which can be cured by surgical methods.The operation before the transitional age of the child is necessary to restore the normal growth process in the foot.
During the operation, the surgeon separates the spliced bones in the foot. If the surgery is performed after the patient’s foot is growing, there is a high probability of arthrosis of the lower (talonavicular) ankle joint, or arthrosis of the tarsal bones, which causes additional pain in the foot.
Varus foot, clubfoot and equine foot: Deformities and pain in the foot in children
Clubfoot is a congenital deformity in the foot that occurs in 0.1% of all newborns.Due to the specific shape of the feet, this pathology is determined immediately after the birth of the child. Clubfoot treatment is carried out in infancy with fixing plaster bandages.
In the equine foot, deformation occurs, which manifests itself in the form of persistent plantar flexion and the characteristic installation of the foot. Quite often, children have a double deformity in the foot – clubfoot and equine foot. Like clubfoot, the equine foot is detected immediately after the birth of a child or even before his birth with the help of ultrasound.Often, the equine foot is neurological in nature: damage to the nerves or calf muscles can cause this pathology.
How to cure equine foot syndrome in children?
Physiotherapy is the main treatment for equine foot syndrome in children.
Cartilaginous exostosis / Osteochondroma (benign bone tumor) in children
Cartilaginous exostosis is a benign osteocartilaginous growth on the surface of a bone that forms from ossified cartilaginous tissue.As a rule, this process ends after the patient’s foot stops growing. Surgery is necessary only if osteochondroma causes pain in the foot and affects the nerve endings and joints. © Dr. Thomas Schneider
Osteochondroma in the ankle joint is a benign growth of cartilage tissue in the metaphysis of the tarsal bone, due to which the bone grows in length in childhood and adolescence. Osteo-cartilaginous exostosis causes pain on the surface of the foot in children.In this case, you need to contact a specialist who will successfully perform an operation to remove this growth in the foot.
Treatment of cartilaginous exostosis
- Patience and observation
- If pain in the foot appears: surgical resection of the growth
Surgical treatment of pathology is carried out if osteochondral growths pass through the nerves and blood vessels or form pinching and pinching of the tarsal joint pain in the foot.
Frequently Asked Questions
Pain in the toes
Pain in the toes
Pain in the metatarsophalangeal joints appears due to a violation of the contact of the articular surfaces and a violation of biomechanics in the foot.This leads to trauma to the synovial membrane and osteoarthritis of the articular cartilage, as well as to subluxation of the joints.
Pain in the toes is caused by hallux valgus of the first toe, which causes inflammation of the periarticular sac of the inner arch of the foot. The inflamed articular bag of the first metatarsophalangeal joint swells and begins to hurt when pressed.
Pain in the outer arch of the foot arises from the pronation of the small toes. In medicine, there is such a thing as a varus deviation of the little finger (Taylor’s deformity) or “tailor’s foot” (Digitus quintus varus).Varus deformity of the fifth metatarsal bone can be painless, and sometimes patients do not even notice it.
Autoimmune diseases such as rheumatitis or metabolic disorders such as gout cause severe pain in the foot.
After strenuous physical activity, jogging or hiking, marching (fatigue) fractures of the metatarsal bones (metatarsal bones) can form, which cause severe stabbing pain in the foot and toes.
How does pain appear on the outside of the foot?
A pinched tibial nerve in the ankle can cause pressing pain in the foot and sensory disturbances on the outside of the foot (see Tarsal Canal Syndrome).Also, tibial neuropathy causes stabbing pain and numbness in the foot.
Deformity of the fifth metatarsophalangeal joint of the tailor’s foot may cause pain in the outer arch of the foot.
In some cases, pain on the outside of the foot can be caused by a pathology such as planovalgus deformity.
Pain on the back of the foot
Pain on the back of the foot
In athletes, foot pain occurs due to inflammation of the tendon sheath (Tendovaginitis).
The next reason for pain at the base of the foot is arthrosis of the Lisfranc joint. Stitching pain in the foot with each step can lead to swelling in the back of the foot.
A pinched nerve in the ankle joint can cause anterior tarsal canal syndrome and stitching pain in the foot.
With a strong load with its own weight or prolonged standing in the “standing” position, pain on the outside of the foot may appear without an underlying disease.
Pain on the inside of the foot
Pain inside the foot
Pain on the inside of the foot is the result of deformity of the big toe (Hallux valgus). In this case, the bone of the first toe begins to deviate from its usual position and swells due to inflammation of the periarticular sac (bursitis).
After long walking or hiking, pain in the foot also occurs, namely from its inner side. In case of insufficient regeneration, it can become inflamed (the long extensor of the big toe) along the inner part of the foot.
Deformities such as the planovalgus foot also cause pain on the inside of the foot. As the sole rolls along the inner edge of the foot, the ankle becomes inflamed and patients begin to feel pain in the foot.
Heel pain: causes of
Heel pain has several causes.
For example, heel and foot pain. after an injury, accident or fall from a height may be associated with a fracture of the heel bone.
Tendon disorders cause stabbing pain in the calcaneus (heel spur) under the sole, resulting in perceptible discomfort in the foot.In the case of the lower calcaneal spur, the base of the plantar tendon of the calcaneus is affected, and in the case of the superior calcaneal spur, the base of the Achilles tendon. …
A stabbing pain in the heel and foot from above may indicate various pathologies of the Achilles tendon.
In case of bony growths in the area of the calcaneal tuberosity, leading to inflammation of the soft tissues in the heel and pain in the foot, a diagnosis of Haglund’s disease is made. This problem is aggravated by inflammation of the bursa (bursitis) in front of or behind the Achilles tendon.
Foot pain after rest or in the morning after sleep
Pain in the foot in the morning after sleep
Pain in the foot at the beginning of movement, which appears in the morning after sleep or after a long stay of the foot at rest, has precise causes.
Pain in the foot at the beginning of movement, which appears in the morning after sleep or after a long stay of the foot at rest, has precise causes. Pain in the foot and in other joints at the beginning of movement is one of the signs of arthrosis that affects the ankle and talo-tarsal joints.After warming up the joint, the pain in the foot goes away, but after some time of painless walking, the pain in the foot reappears. The most common arthrosis of the upper ankle joint.
Osteoarthritis of the lower ankle joint (calcaneal-talus joint) causes pain in the foot when moving on an uneven surface.
Ankle pain at the beginning of movement can provoke (arthrosis of the Lisfranc joint).
Pain in the forefoot at the beginning of movement causes arthrosis of the first metatarsophalangeal joint.(Hallux rigidus).
In addition, pain in the foot at the beginning of movement can be associated with various inflammatory processes. With inflammation in the area of attachment of ligaments and tendons to the bones (enthesopathy) and inflammation of the tendon sheath (tendovaginitis), at the beginning of training and after a state of rest, stitching pain in the foot appears, which immediately disappears after warm-up. Doctors do not recommend enduring such pain in the foot. If a person feels the above-described pain in the foot, then he needs to be examined and treated.
Pain in the foot in the morning after a breakdown occurs in such a disease as achillodynia.
This also applies to pain in the lower calcaneal spur (Plantar fasciitis), which disappears after a few steps.
Pain during foot roll
Very often, with pain in the foot, a person twists the leg inward, as a result of which the load on the tendons of the calcaneus (Achilles and heel tendons) increases and a heel spur is formed. The result is pain in the foot with every step.
Osteoarthritis of the lower ankle causes stabbing pain in the area between the ankle and heel when rolling the foot from toe to heel. The joint between the talus and calcaneus is responsible for the movement of the foot over uneven surfaces.
If the patient feels pain in the toes when rolling the foot, then the first metatarsophalangeal joint is affected, which accounts for the bulk of the load. After prolonged training, the periarticular bags between the metatarsal bones and the flanks of the toes can also become inflamed.In this case, specialists in the treatment of the foot consider such a pathology as intermetatarsal bursitis. When the foot rolls from heel to toe and vice versa, pressing pain is felt in the inflamed areas of the foot.
This is a ruptured heel tendon. The painful focus is on the anterior edge of the plantar fascia.
Diseases such as gout, diabetes and rheumatism cause pain and discomfort in the foot.
Pinching of the lateral and medial plantar nerve leads to painful sensations in the fingers (Morton’s neuroma).Patients with this condition feel as if they are stepping on a pea or pebble when walking. Most often, patients talk about the presence of a foreign body in the foot, but forget about the pain.
Pain in the foot at night is accompanied by itching, burning and loss of sensation, as well as pinching of other nerves, such as the tibial. In this case, experts consider such a disease as STK or neuralgic pain of the posterior tibial nerve in the foot.
After the patient takes off his shoes, the pain in the foot caused by Morton’s Neuroma immediately disappears.Tight ski boots can also trigger foot pain.
In order for the pain in the foot caused by Morton’s neuroma to go away as soon as possible, it is recommended to abandon pointed high-heeled shoes. However, in some cases, with inflammation and flattening of the nerve, only surgical treatment of Morton’s Neuroma helps.
Hallux valgus – “bump” or curvature of the toes
Hallux valgus symptoms
Hallux valgus occurs when the thumb is supined in the direction of the smaller toes.Inflammation of the bursa (bursa) of the first metatarsophalangeal joint and its wear and tear can cause painful arthrosis. © Dr. Thomas schneider
Hallux valgus is a typical female problem. Women suffer from this disease 10 times more often than men. Hallux valgus is characterized by a painful enlargement of the bone of the first toe on the inside, as well as swelling, redness and pain in the foot during exercise. However, not all patients with hallux valgus have foot pain.
With inflammation of the mucous bags in the joint area (bursitis), pain in the foot is felt with each step, and the endurance of the thumb is significantly reduced. Bunion is formed due to the accumulation of excess fluid in the synovial fluid, which is sometimes purulent.
In the most difficult cases, overloading the small toes in the foot can lead to stress fractures, that is, to a violation of the integrity of the bones.
How is hallux valgus treated?
Severe foot pain requires qualified treatment.In the majority, only surgical treatment of hallux valgus helps to cure pain in the foot to straighten the deformity of the big toe.
Hallux rigidus – arthrosis of the first metatarsophalangeal joint
Symptoms of arthrosis of the first metatarsophalangeal joint
Osteoarthritis can occur on the first plus-nephalangeal joint joint.In this case, specialists consider Hallux rigidus disease, or in other words, a hard (rigid) finger. One of the most important causes of arthrosis of the first metatarsophalangeal joint is the deformity of the thumb (hallux valgus). Other causes of illness can be trauma, injury, or overuse.
With arthrosis, the pain in the foot increases, and the big toe becomes rigid, which is why the definition of Hallux rigidus has gone.Patients have limited movement and severe pain in the foot. In order to reduce pain in the foot, when the foot rolls, the person transfers the body weight to the adjacent small toes, which is the cause of the appearance of transient metatarsalgia (pain in the metatarsal bones due to the transfer of body weight).
Treatment of arthrosis of the first metatarsophalangeal joint
Plovalgus deformity is one of the most common and painful deformities in the foot.This definition describes two main pathologies in the foot that appear simultaneously: the valgus foot is an X-shaped curvature of the heel axis, and flat feet is a decrease in the longitudinal arch of the foot to the floor.
When the longitudinal arch of the foot is lifted, the posterior muscles of the lower leg are active. Together with the gastrocnemius and soleus muscles, the tibialis posterior muscle performs plantar flexion in the foot. She also participates in supination and adduction of the foot. With weakness or instability of the tibial muscle, the longitudinal arch of the foot descends.
All circumstances that reduce muscle performance can cause weakening of the longitudinal arch of the foot. In addition to muscle weakness, such pathologies include diseases caused by metabolic disorders, as well as rheumatism, gout and steroid hormonal drugs. Read more about the causes of pes planovalgus.
Patients suffering from planovalgus deformity feel pain in the foot under stress. With this disease, the distance of “painless walking” is shortened, and the medial ankle is often swollen.With pathologies of the posterior tibial muscle, pain in the foot can be given directly to the lower leg. This deformity in the foot is also noticeable from the patient’s shoes: The inner edges look very worn, as the foot roll is felt not through the big toe, but through the inner edge of the foot. In this case, the toes are deflected outward.
Treatment of painful planovalgus deformity in the foot
Planovalgus deformity of the foot is almost always treated conservatively. Sports training and pain therapy can help treat foot pain.Special orthopedic insoles support the longitudinal arch of the foot and improve gait.
If, with injuries and ruptures of the tibial collateral ligament, physical therapy did not bring the desired result, but the pain remained, the specialists of our clinic perform an operation on the foot.
During surgical treatment, the tibial collateral ligament is shortened and cleared of inflammation.
Another method of treating degenerative changes in the tibial collateral ligament is autogenous transplantation.
In addition, it is possible to perform bone grafting to normalize the position of the calcaneus. This intervention is necessary for muscle contraction and planovalgus deformity in the foot.
Osteoarthritis of the tarsus: Wear of the metatarsal joint (Osteoarthritis in the Lisfranc joint)
Metatarsal arthrosis most often occurs in the area of the thumb and affects other joints and bones of the tarsus. The wear of the metatarsal joint is the cause of pain in the instep.© Dr. Thomas schneider
Symptoms of arthrosis of the metatarsal joint
Arthrosis of the metatarsal joint is characterized by pain over the longitudinal arch of the foot in the instep. The bones of the tarsus (tarsal bones) are located between the bones of the metatarsus and the talus.They form the transition between the tarsus and the long bones of the metatarsus. In medicine, this process is called the Lisfranc joint.
Pain and arthrosis of the metatarsal joint are often caused by trauma: Preexisting fractures of the tarsal bones only increase the pain in the foot. However, in some cases, the reason is unclear. Then experts consider the problem of idiopathic wear in the metatarsal joint.
Quite often, pain and arthrosis in the metatarsal joint occurs along with swelling and overheating of the dorsum of the foot.Damaged joints in the back of the foot are identified by orthopedists during palpation.
At an early stage of the disease, arthrosis of the metatarsal joint and associated pain in the foot are treated by specialists with special orthopedic steles that support the longitudinal arch of the foot. If the pain in the foot increases, arthrodesis of the Lisfranc joint is performed.
How is metatarsal arthrosis treated?
Occasionally, foot pain associated with arthrosis can be treated with anti-inflammatory drugs.In more advanced cases, foot pain is eliminated during arthrodesis of the Lisfranc joint. Surgical immobilization has no negative impact on the performance of the foot and the stability of the Lisfranc joint. The reduced mobility of the Lisfranc joint after surgery plays only a minor role.
Diabetic foot: Pain in the foot due to diabetic neuropathy and poor blood supply
Symptoms of a diabetic foot
Pain can be felt in several parts of the foot, however, in rare cases, it occurs for orthopedic reasons.As a rule, foot pain is associated with metabolic disorders.
Diabetes is one of the main causes of foot pain. Peripheral neuralgia – especially foot pain – is one of the most common comorbid complications of diabetes. Diabetic neuropathy (peripheral nerve damage) is accompanied by impaired sensitivity and pain in the foot. In addition, this pathology is characterized by pain in the heel, numbness of the sole of the foot, as well as a change in the perception of heat and cold.Pain and sensory disturbances in the foot increase the risk of injury. Ulcerative formations and inflammation in the foot are dangerous, as they often remain invisible.
Treatment of diabetic polyneuropathy
Diagnostic imaging (e.g.Ultrasound, X-ray, MRI) helps to distinguish rheumatoid arthritis from other diseases in the foot. The treatment of this disease is associated with a number of difficulties, since it is carried out with the help of antirheumatic anti-inflammatory drugs. It is recommended to undergo rheumatitis treatment by highly qualified rheumatologists. For complicated deformities, surgical correction of the ankle joint is performed.
Tarsal canal syndrome: Stitching pain and numbness in the foot due to a pinched tibial nerve in the ankle.© Dr. Thomas schneider
Tarsal canal syndrome: Pain on the outside of the foot due to pinched tibial nerve
Symptoms of tarsal canal syndrome ::
Tarsal canal syndrome occurs due to pinching (compression) of nerves, just like Morton’s neuroma.In this case, the transverse ligaments of the ankle joint compress the tibial nerve. In turn, burning and dull pain in the foot spreads to the gluteal region along the back of the leg, and then intensifies when the foot is extended. Sometimes, with compression (tunnel) neuropathy, pain occurs depending on the intensity of the load in the foot at rest. Many patients experience the problem of posterior tibial nerve neuropathy after wearing ski shoes.
The metal rods of the ski boots stretch the ankle ligaments, causing the patient to feel pain and numbness in the foot.Quite often, swelling and pain in the foot causes tarsal canal syndrome – for example, in diabetics or with tumors of the soft tissues and ankle joint. As a result, the pressure in the foot increases, and the ligaments, in turn, limit the space for the nerves that pass inside the joint.
Diagnosis of the disease is based on its clinical manifestations and a preliminary survey of the patient. Depending on the results of the examination, patients are offered two types of treatment – conservative and surgical.
How to cure tarsal canal syndrome?
Anti-inflammatory drugs are used with NS tarsal canal.
Surgical dilatation of the tunnel canal – as in the case of carpal tunnel syndrome – is performed to relieve compression (decompression) of the nerves. After a successful operation, all symptoms of tunnel neuralgia gradually disappear.
Foot pain in children and adolescents
Foot pain in children occurs for various reasons. Typically, children complain of foot pain in minor injuries, such as twisting their feet or hitting their toes.Plantar warts on the sole of the foot are also the cause of pain.
If a child complains of pain in bones, muscles and joints, it is recommended to pay attention to other factors.
If the pain in the foot is so severe that the child cannot step on the foot, it is necessary to go to the emergency room. During a diagnostic examination, qualified doctors will determine the presence of structural damage or fractures in the foot.
Pain in the foot due to an acute inflammatory process that manifests itself during growth in a person (apophysitis)
Pain in the foot in children and adolescents, as a rule, is not associated with structural changes in bones, tendons and joints.
Often, foot pain occurs due to an imbalance between skeletal growth and muscle growth. As a result of the growth process, irritation of the tendon bases is observed – for example, insertional tendinopathy, enthesopathy and tendinitis. In the foot, this pathology affects the place of attachment of the Achilles tendon to the heel. In children, the bone growth zone is located here, namely the bone fusion, in which the foot grows. First of all, pain in the heels, namely at the base of the Achilles tendon of the calcaneus, is one of the signs of a child’s growth.
How to cure growing pain in children and adolescents?
In adolescents who are actively involved in sports, pain in the foot and in the heel may be associated with Haglundostosis.
After orthopedic examination and correct diagnosis, complaints of foot pain in adolescents can be cured by physical and manual therapy
Ankle pain due to osteochondritis dissecans (Koenig’s disease)
Osteochondritis dissecans or osteochondrosis dissecting is a metabolic disorder in the cartilaginous and bone tissue just below the cartilaginous plane.Affected, as a rule, are the areas of the talus that are most prone to physical exertion. That is why osteochondritis dissecans in the foot is noted in sports-active children and adolescents.
This disease is characterized by loss of blood circulation in a separate area of the bone under the joint. At the first stage of the disease, slight pain appears in the foot of uncertain localization and a focus of osteonecrosis is established. In the second stage, pain in the foot increases and synovitis appears.
At the third stage, incomplete separation of the necrotic body occurs, which leads to pinching of the joint and the formation of the so-called articular mouse.At the last stage, the necrotic body is completely separated, and the pain in the foot increases.
Treatment of osteochondrosis dissecans in adolescents
If an orthopedic surgeon diagnoses osteochondrosis dissecans, then, as a rule, the patient is prohibited from playing sports for a long time.In children, osteonecrosis of the bone goes away if all the doctor’s prescriptions are followed. With age, the patient’s chances of curing foot pain decrease conservatively, and therefore, starting from the age of 18, osteochondrosis dissecans is treated with surgical methods. When separating bone fragments, an operation of osteochondrosis dissecans is necessary. Autogenous transplantation (bone replacement) – by taking a graft from the iliac crest of the pelvic bone contributes to the complete recovery of the patient.
Pain and deformities in the foot due to bone fusion: tarsal coalitions
Planovalgus foot deformity in children is one of the stages of development. However, parents perceive it as a deformity in the foot and begin an active search for a specialist. By natural development, the longitudinal arch of the foot in children is straightened up to 4-6 years. Normal development in the foot is also facilitated by activity and walking barefoot.
If, with a planovalgus installation of the feet, children complain of pain in the foot and muscle spasm radiating to the lower leg, parents need to look for a qualified orthopedist.Often, foot pain limits the child’s mobility while walking and is a cause of premature fatigue. In the presence of these symptoms, there is a danger of bone fusion in the foot, which, as a rule, must develop separately. Pain in the foot resulting from bone fusion is noted in children from the age of 12. The reason for this is a spasmodic flat foot (planovalgus deformity), which did not straighten during the development of the child’s foot.
The human foot consists of 26 bones.In the hindfoot and tarsus, these bones are stable and connected. Improper development of bones, namely their fusion during the growth of the foot, can lead to serious complications. According to statistics, about 1% of children have such tarsal coalitions.
By virtue of their experience, the specialists of the Gelenk Clinic in Freiburg note the regularity of the following intergrowths:
New in heel spur treatment
Bone growths in the form of a thorn or beak in the area of the plantar surface of the calcaneus tuberosity or at the place of attachment of the Achilles tendon are usually called heel spurs .Most often, heel spurs are a consequence of involutive processes in the human body and are found as an anatomical feature in middle-aged and elderly people .
According to medical statistics, about 10 percent of patients seeking help with diseases of the musculoskeletal system are patients with heel spurs. One main symptom compels these people to see a doctor – pain in the heel region. The pain occurs at the beginning of walking, when getting up from a chair, out of bed.Then, during the day, the pain subsides somewhat, but in the evening it intensifies again. Over time, pain can become permanent and worsen the patient’s condition, not only when moving, but also at rest. This disease occurs at any age, but women over 40 are most susceptible to it .
A heel spur in 90% of cases develops against the background of flat feet . The fact is that with flat feet, the distribution of the load on the structures of the feet changes, the tendons are overstretched, and in especially severe cases, some tendon fibers even break off from the underlying bones.As a result, not only the tendons themselves become inflamed – the inflammation of the superficial layer of bone tissue underneath them begins .
In addition to flat feet, the causes of spur formation can be acute and chronic trauma to the heel bone, diseases associated with metabolic disorders (gout), as well as significant circulatory disorders of the legs in people with poor vascular patency (atherosclerosis of the vessels of the lower extremities, obliterating endarteritis, etc.) [ 2].
In addition, inflammation of the heel area is a consequence of a number of chronic inflammatory diseases of the joints: ankylosing spondylitis, arthritis, polyarthritis.In all these cases, long and persistent treatment is required, aimed at combating the underlying disease. The participation of a doctor in solving this problem becomes mandatory. And of course, in no case should you self-medicate.
The clinical picture of with a heel spur is typical. Most often, patients complain of the so-called starting pain. Those suffering from this ailment are most difficult for the first steps after sleep, prolonged sitting. Pain with a heel spur can be burning, sharp when resting on the heel, defined by patients as a feeling of a nail in the heel.Pain can spread over the entire heel area or be localized along the inner surface of the heel. Pain can appear suddenly and be acute or develop gradually, becoming chronic. Patients involuntarily try to relieve the heel .
When examining the heel area, as a rule, pathological changes are not detected. When pressing on the tubercle of the calcaneus from the side of the sole and when squeezing the heel from the sides, pain is determined. With a posterior calcaneal spur, there is soreness at the place of attachment of the Achilles tendon when walking and pressure from the back of the shoe.Edema of this area, callousness of the skin is possible.
The intensity of the pain does not depend on the size of the spur, determined on the radiograph. Quite often, spurs, sharp in shape and large in size, are an accidental X-ray finding. At the same time, severe pain in the heel area is possible with a normal X-ray picture .
Thus, the clinical symptoms of a heel spur are primarily caused not by the presence of the spur itself, but by changes in soft tissues: inflammation of deep mucous bags (calcaneal bursitis, achillobursitis), phenomena of periostitis, and most often plantar fasciitis.
Plantar fasciitis is an inflammation of the plantar fascia. The plantar fascia is a wide strip of fibrous tissue that runs along the sole of the foot from the heel to the forefoot. There is a justified opinion that plantar fasciitis is primary in the development of the heel spur. The inflammation causes a reactive osteoblastic process, as a result of which the heel spur develops .
Signs of plantar fasciitis are well detected by ultrasound examination (US) of the soft tissues of the foot.It is advisable to perform ultrasound of the soft tissues of the foot before choosing a method for treating a heel spur.
Treatment of heel spurs is conservative and depends on the cause of the disease and the stage of the process. A complex of therapeutic measures aimed at eliminating the inflammatory process is recommended. Prescribed non-steroidal anti-inflammatory drugs drugs (NSAIDs), topical gels and ointments with anti-inflammatory and absorbable effect, phonophoresis with hydrocortisone, cryotherapy .
The most important condition for the effectiveness of treatment is to provide unloading of the painful area. To do this, with a heel spur, according to indications, individual orthopedic insoles are prescribed with the layout of the inner and outer longitudinal arches, a depression and a soft pad under the heel. As a temporary measure, the use of a heel pad with a recess or a hole in the center is recommended – the so-called unloading device for a heel spur. These devices are sold in orthopedic salons.Unloading with the help of orthopedic shoes with a depression in the heel is considered the most complete. With a back spur, a recess is made in the heel. As a temporary measure in the treatment of heel spurs, wearing shoes without a heel can be recommended. The complex of treatment for heel spurs includes warm baths with sea salt, soap, soda, therapeutic exercises, massage of the muscles of the foot and lower leg. These measures are aimed at improving the blood supply to the tissues of the foot .
After the inflammatory process subsides, which should be confirmed by ultrasound diagnostics, shock wave therapy (SWT) is prescribed.The use of shock wave therapy techniques in combination with drug injections has yielded sustained positive results in the treatment of heel spurs, but this therapy is not always available, since not all hospitals have a SWT device. In addition, patients with a diagnosis of heel spur in most cases do not reach specialized hospitals and receive help at the polyclinic stage in the form of NSAIDs injected and topically.
I would like to propose a treatment regimen for the heel spur with Chondrocerin.Chondrocerin is a well-known chondroprotector based on diacerein with an independent analgesic and anti-inflammatory effect; chondroprotector for long-term treatment of degenerative diseases of the joints and spine, accompanied by pain and impaired joint mobility. It has an anabolic, anti-catabolic effect on articular cartilage. The mechanism of anti-inflammatory action is not due to the effect on COX or lipoxygenase. Diacerein inhibits the production of IL-1 by macrophages and synoviocytes, inhibits the production of myeloperoxidase, beta-glucuronidase and elastase, reduces the content of metalloproteinases in cartilage, stimulates the synthesis of proteoglycans, glycosaminoglycans and hyaluronic acid.Reduces the severity of inflammation of the synovium and cartilage damage. The effect develops after 6 weeks. from the start of treatment and lasts for 2-3 months. after canceling it.
Patient M., in whom the diagnosis of a heel spur was radiographically confirmed, suffered from severe pain in the left heel bone for 3 months, received topical NSAIDs, as well as physical procedures, but did not notice the effect of treatment. The patient was offered to take Chondrocerin according to the scheme: 1 capsule at night for 10 days, then 2 capsules for 1.5 months.The patient felt an analgesic effect after 2 weeks of taking Chondrocerin. I was able to step freely on the heel, the pain syndrome became less intense. Gradually returned to full life.
Thus, 2 capsules of Chondrocerin per day will stop the progression of the heel spur, relieve pain and restore the ability to live a full life. In addition, when taking the drug for 6 months, the effect will persist for at least 2 months after you stop taking Chondrocerin.
1. Blokhin V.N., Vinogradova T.P. Calcaneal spurs // Orthopedics and Traumatology. – 1997. – No. 1. – P. 96.
2. Korzh A.A., Mezhenina E.P., Pechersky A.G., Ryndenko V.G. Handbook of Traumatology and Orthopedics / Ed. A.A. Korzha, E.P. Mezhenina. – K .: Zdorov’ya, 1980 .– 216 p.
3. Lashkovsky V.V., Ignatovsky M.I. The role of dynamic pedobarography in assessing the biomechanical characteristics of the foot in normal conditions and with its planovalgus deformity // Journal of the Grodno State Medical University.- 2010. – No. 2. – P. 47-50.
4. Romanov N.A., Dorosevich A.E. Russian terminology of tarsal bones in the 18th – 20th centuries. // Morphology: scientific and theoretical medical journal. – 2005. – T. 128 (6). – S. 77-81.
5. Samoilovich V.A. The use of acetic acid electrophoresis in the complex treatment of heel spurs in a sanatorium // Likarska sprava. – 2007. – No. 5/6. – S. 97-99.
6. Singh D., Silverberg M.A., Milne L. Plantar Fasciitis in Emergency Medicine, Oct 2008.
Treatment of heel spur UHT
A calcaneal spur is a hook-shaped or subulate bony outgrowth on the calcaneus, characterized by local inflammation of the tendons.
Bone growth usually forms on the plantar surface of the heel at the site of attachment of the long plantar ligament and the Achilles tendon, constant trauma to these tendon formations leads to a local inflammatory process that causes the patient to intense pain when walking and resting on the heel.Therefore, the patient often changes his gait in order to spare the affected leg, he is forced to step on the toe. 82% of patients with heel spurs have flat feet.
A good effect with a heel spur is achieved by conservative (non-surgical) methods. Surgical treatment is rarely used.
Heel spur is a fairly common disease, the main symptom of which is severe pain. Some people endure it for years, trying more and more folk remedies, however, relief does not come.If you feel pain in the heel area, do not waste time, see your doctor right away. In the clinic of Professor Gorbakov, you will receive qualified advice and complete treatment that will return you comfort and good mood.
A calcaneal spur, or plantar fasciitis, is a hook-shaped or styloid bony outgrowth on the calcaneus, characterized by local inflammation of the tendons.
Bone growth usually forms on the plantar surface of the heel at the insertion of the long plantar ligament and the Achilles tendon.Permanent injury to these tendon formations leads to a local inflammatory process, which causes intense pain in a person when walking and resting on the heel. Therefore, the patient’s gait often changes, since in order to spare the affected leg, he is forced to step on the toe. 82% of patients with heel spurs have flat feet.
The most intense pain occurs immediately after waking up, or after the patient has spent some time in a sitting position.
If you have discovered the following pathological conditions, then in the event of a sharp unexplained pain in the heel, immediately contact the specialists of the clinic of Professor Gorbakov:
- flat feet;
- rheumatoid arthritis and its complications;
- disorders of adequate blood supply to the extremities;
- metabolic disorders;
- the presence of a viral infection;
- Acute or chronic heel injury.
The most common combination of symptoms is obesity and flat feet. If the patient also suffers from rheumatoid arthritis, this further increases the risk of plantar fasciitis.
Usually a heel spur is fairly easy to diagnose. For this, it is enough for an experienced specialist to examine the patient’s limb and listen to him about the nature of the pain that occurs. Already at this stage, an appropriate diagnosis may well be made.
X-ray can be taken as confirmation. Plantar fasciitis is often found on x-rays, characterized by a specific x-ray picture or simply bone growth, sometimes even in those patients who do not experience any discomfort.
In this case, it is recommended to carry out preventive treatment to eliminate risk factors that can provoke the appearance of pain.
In order to determine how much inflammation has affected nearby soft tissues, the doctor may recommend an ultrasound examination of the foot.
Previously, the surgical method was widely used to treat the heel spur, but it was characterized by sufficient trauma, a long rehabilitation period and did not always lead to the complete disappearance of pain in the heel area.
The development of new conservative therapies, such as shock wave therapy, with excellent results, has made it possible to heal the heel spur without surgery.
When using shock wave therapy (SWT) for the treatment of a heel spur, there is a mechanical effect of acoustic waves of a certain frequency on the damaged area, which leads to a rapid resorption of calcifications (salts) and elimination of pain symptoms.This is an effective method of treatment that allows not only to eliminate the symptoms, but also to achieve the disappearance of the growth on the bone itself.
In addition to treating the heel spur, the method of shock wave therapy is successfully used for recovery from injuries, as it contributes to:
- accelerate tissue regeneration;
- improving microcirculation;
- relieve inflammation and pain symptoms.
Shockwave therapy proved to be quite effective for the treatment of radicular syndrome in osteochondrosis and herniated intervertebral discs.
Contraindications to UVT
Contraindications to the use of the method are:
- pathology of blood coagulation;
- the presence of malignant neoplasms.
In most cases, shock wave therapy is well tolerated by patients without causing discomfort or disrupting the usual rhythm of life;
The specialists of the clinic of professor Gorbakov will offer you the most effective methods of heel spur treatment.Extensive experience in the treatment of this pathology allows us to choose an adequate therapy and refrain from surgical intervention.
No need to endure pain, make an appointment with a specialist!
Heel pain (inflammation of the Achilles tendon) in the Dnieper
Heel pain is a common condition that occurs when the large Achilles tendon, which runs down the back of the lower leg, becomes irritated and inflamed.
The Achilles tendon is the largest tendon in the body.It connects your calf muscles to your heel bone and is used when you walk, run, climb stairs, jump, and stand on your toes. While the Achilles tendon can withstand heavy loads from running and jumping, it is also prone to tendonitis, a condition associated with overuse and wear and tear of the tendon.
Pain in the Achilles tendon may occur within the tendon itself or at the point where it attaches to the heel bone.
Simply put, tendonitis is an inflammation of a tendon.Inflammation is the body’s natural response to injury or illness and often causes swelling, pain, or irritation.
There are two types of Achilles tendonitis, depending on which part of the tendon is inflamed.
Tendonitis, which affects the tendons, pain can occur at any time, even in inactive patients. However, this is most often due to years of overuse (distance runners, sprinters, soccer players, sprinters, etc.).
Heel spur or calcification of the plantar fascia)) is a similar type of disease, but it develops from the plantar part of the foot.
Achilles tendonitis is usually not associated with a specific injury. The problem arises from repetitive stress on the tendons. This often happens when we force our bodies to do too much, too early, but other factors can increase the likelihood of developing tendonitis, including:
- A sudden increase in the amount or intensity of exercise — for example, an increase in the distance you run each day by several miles, preventing your body from adjusting to the new distance.
- Dense calf muscles. Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon
- Bone spur – extra bone growth in which the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain
Bone spur that developed where the tendon attaches to the heel bone.
Common symptoms of Achilles tendonitis include:
- Pain and stiffness along the Achilles tendon in the morning
- Pain along the tendon or back of the heel, aggravated by physical activity
- Severe pain the next day after training
- Tendon thickening
- Bone spur (insertional tendonitis)
- Swelling that is present all the time and worse during the day from activity
If you experience a sudden “flinch” in the back of your calf or heel, you may have broken (torn) your Achilles tendon.See your doctor right away if you think you may have torn a tendon.
See your doctor:
After you describe your symptoms and discuss your concerns, your doctor will examine your foot and ankle. The doctor will look for these signs:
- Swelling along the Achilles tendon or at the back of the heel
- Thickening or expansion of the Achilles tendon
- Bone spurs at the bottom of the tendon behind the heel (insertional tendonitis)
- Point of maximum tenderness
- Pain in the middle of the tendon (noninsertive tendonitis)
- Pain in the back of the heel at the bottom of the tendon (insertional tendonitis)
- Limited range of motion at the ankle, in particular reduced ability to bend the leg
Your doctor may order imaging tests to make sure your symptoms are caused by Achilles tendinitis.
X-ray tests provide clear images of bones. X-rays can show if the lower part of the Achilles tendon is calcified or hardened. This calcification indicates insertional Achilles tendonitis. In cases of severe noninsertive Achilles tendonitis, calcification may also occur in the midsection of the tendon.
Magnetic resonance imaging (MRI)
Although magnetic resonance imaging (MRI) is not necessary for the diagnosis of Achilles tendonitis, it is important for planning surgery.An MRI can show how severe the damage to the tendon is. If surgery is necessary, your doctor will choose a procedure based on the amount of damage to the tendon.
In most cases, nonsurgical treatment options will provide pain relief, although symptoms may take several months to resolve completely. Even with early treatment, pain can last longer than 3 months. If you have had pain for several months before seeking treatment, it may take 6 months for treatments to take effect.
Rest. The first step in reducing pain is to reduce or even stop the activities that make the pain worse. If you regularly do high-impact exercises (like running), switching to low-impact exercises will put less stress on your Achilles tendon. Cross-training like cycling, elliptical exercise, and swimming are low-impact options that will help you stay active.
Ice. Putting ice on the most painful area of the Achilles tendon is helpful and can be done as needed throughout the day.This can be done up to 20 minutes and should be stopped sooner if the skin becomes numb.
Non-steroidal anti-inflammatory drugs. Medicines such as ibuprofen and naproxen reduce pain and swelling. They do not, however, reduce the thickening of the degenerated tendon. You should consult your doctor about using the medicine for more than 1 month.
Exercise. The following exercise can help strengthen your calf muscles and reduce stress on your Achilles tendon.
The calf is stretched. Lean forward against the wall with one straight knee and heel on the ground. Place your other leg forward with your knee bent. To stretch your calf muscles and heel cord, push your hips against the wall in a controlled manner. Hold this position for 10 seconds and relax. Repeat this exercise 20 times for each leg. During stretching, you should feel a strong tension in the calf (calf muscle)
Physiotherapy.Physical therapy is very helpful in treating Achilles tendonitis. It turned out to work better for non-insistent tendinitis than for insertional tendinitis.
Exercise therapy for the home.
Fall on the heel
- Bilateral heel drop. Stand on the edge of a ladder or on a stable raised platform with the front half of your foot on the ladder. This position will allow your heel to move up and down without hitting the stairs. Care must be taken to ensure that you are balanced correctly to prevent falls and injuries.Be sure to hold onto the railing to help balance.
- Raise your heels off the ground, then slowly lower your heels to the lowest point possible. Repeat this step 20 times. This exercise should be done in a slow, controlled manner. Moving quickly can create a risk of injury to the tendon. As the pain improves, you can increase the difficulty level of the exercise by keeping a small weight in each hand.
- Fall of the heel on one leg. This exercise is performed in the same way as a bilateral heel drop, except that all your weight is concentrated on one leg.This should only be done after the double-sided heel drop has been mastered.
Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory agent. Cortisone injections into the Achilles tendon are rarely recommended because they can rupture the tendon.
Supportive footwear and orthopedics. Pain from insertional Achilles tendonitis is often relieved with certain shoes and orthopedic aids. For example, shoes that are softer at the back of the heel can reduce tendon irritation.In addition, heel lifts can relieve tension from the tendon.
If your pain is severe, your doctor may recommend a walking boot for a short time. This gives the tendon a chance to rest before starting any therapy. Long-term use of boots is not recommended, however, because it can weaken your calf muscles.
Extracorporeal shock wave therapy (ESWT). During this procedure, high energy shockwave pulses stimulate the healing process of the damaged tendon tissue.
Surgical treatment should be considered for relief of Achilles tendonitis only if pain persists after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the tendonitis and the extent of the tendon injury.
Neutralization and restoration (the tendon has less than 50% damage). The purpose of this surgery is to remove the damaged portion of the Achilles tendon. After the unhealthy part of the tendon has been removed, the remaining tendon is repaired with sutures or sutures to complete the repair.
For insertional tendinitis, the bone spur is also removed. Tendon surgery in these cases may require the use of metal or plastic anchors to help attach the Achilles tendon to the heel bone where it attaches.
After hair removal and recovery, most patients are allowed to walk in removable shoes or in a cast for 2 weeks, although this period depends on the degree of tendon damage.
Recovery.Most patients have good results after surgery. The main factor in surgical repair is the amount of tendon injury. The more the tendons are involved, the longer the recovery period and the less likely the patient will be able to return to sports.
Physiotherapy is an important part of recovery. Many patients require 12 months of rehabilitation before they become painless.
Complications. Moderate to severe pain after surgery occurs in 20-30% of patients and is the most common complication.In addition, wound infection can occur and the infection is very difficult to heal at that site.
90,000 causes, symptoms, diagnosis, treatment of heel pain
Causes of the heel spur
Calcaneal spur is a thorn-like growth of dense tissue on the back or lower surface of the calcaneus, in connection with which the name “spur” arose.
The formation of a heel spur is usually associated with a single significant injury or frequent minor injuries of the heel area (for example, running on hard ground, etc.). Often, pain in the area of one or both heels appears in patients with a clear metabolic disorder (for example, with obesity) or local inflammatory processes, for example, erythromelalgia.
One of the common causes of the formation of a heel spur is flat feet (longitudinal and transverse), as a result of insufficient amortization capacity of the foot.
Symptoms of the heel spur
Each of the above reasons can lead to the onset of symptoms of the disease: the appearance of the so-called morning pain after getting out of bed.These pains are also called “starting” pains. They are associated with the presence of inflammation in the area of the calcaneus. In this case, plantar aponeurositis is formed: inflammation of the plantar fascia, which is caused by the development of pathological changes in the area of attachment of the plantar aponeurosis to the tubercle of the calcaneus.
Achillodynia (pain in the area of the Achilles tendon), caused by a pathological focus in the area of attachment of the Achilles tendon to the back of the heel, is no less common pathology.
Later, at the site of inflammation, proliferation processes occur (growth of coarse, fibrous, connective tissue), which subsequently become denser, saturated with calcium salts, which causes irritation of the nerve endings from the periosteum of the calcaneal tuberosity, thereby causing severe pain in the heel.
In order to clarify the causes of pain in the foot and heel area, at the Institute of Musculoskeletal Medicine and Neurology (Clinic Meddiagnostika), it is recommended to perform an X-ray of the foot in conjunction with an ultrasound examination of soft tissues and tendons of the feet.
X-ray examination reveals a heel spur, the condition and integrity of the bones of the foot. The size and dimensions of the thorn may be small, but the painful sensations can be very pronounced.
Ultrasound examination allows to clarify the extent of the focus of pathology in the heel spur and to reveal signs of inflammation, tissue edema, to determine the integrity of the tendons and ligaments.
Heel spur treatment
In the past, problems associated with heel spurs were solved with surgical methods.However, the protracted postoperative recovery period gave the patient a lot of trouble and pain, worsening the quality of life.
At the initial stage of treatment, in order to suppress edema and inflammation in the focus of pain, blockade is used using a local injection of a steroid.
One of the most effective, almost painless and non-invasive (non-surgical) methods of getting rid of a heel spur is the method of shock wave therapy (ESWT), which occupies an intermediate place between conservative and surgical treatment, i.e.That is, it acts on the problem without violating the integrity of the skin.
At the Institute of Musculoskeletal Medicine and Neurology, over the past 17 years, the method of shock wave therapy for heel spurs has been improved, which has established itself as a reliable and highly effective means for treating and eliminating the cause of the disease.
Shock waves, penetrating directly into the pathological focus, loosen the formed dense tissue (spur), contribute to its reduction and removal from the tissues.
The patient is offered a specialized treatment regimen consisting of six sessions (supplemented by the German standard treatment regimen), with an interval of one week.
Already, after the first session of shock wave therapy, the patient can feel a noticeable relief in the condition and a decrease in the intensity of pain.
It should be noted that the Piezoson equipment, which is used for shock wave therapy, has a focused version of the acoustic wave, which, in turn, is the most effective for the treatment of heel spurs due to the denser energy flow and its intensity.
Treatment can only be effective if the diagnosis is correct. Diagnosis and treatment of heel spurs is carried out at the Meddiagnostika Center.
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