What are bone spurs. How do they form. What symptoms do bone spurs cause. Which treatment options are available for bone spurs. How can bone spurs be prevented. When should you see a doctor for bone spurs. What is the outlook for people with bone spurs.

Understanding Bone Spurs: Formation and Common Locations

Bone spurs, also known as osteophytes, are bony projections that develop along the edges of bones. These hard bumps typically form where bones meet each other in joints. While they can occur in various parts of the body, bone spurs are most commonly found in the spine, shoulders, hands, hips, knees, and feet.

The formation of bone spurs is often associated with the body’s attempt to repair itself. As the cartilage that cushions bones begins to break down due to conditions like osteoarthritis, the body may respond by creating extra bone to compensate for the loss. This process can lead to the development of bone spurs.

Common Locations for Bone Spurs

• Spine (vertebrae)
• Shoulders
• Hands and fingers
• Hips
• Knees
• Feet, especially the heel (calcaneal spurs)

Do bone spurs always cause symptoms? Not necessarily. Many people have bone spurs without experiencing any discomfort. However, depending on their location and size, bone spurs can cause pain, inflammation, and restricted movement in some cases.

Causes and Risk Factors of Bone Spur Development

The development of bone spurs is often linked to various underlying conditions and factors. Understanding these can help in prevention and early intervention.

Primary Causes of Bone Spurs

1. Osteoarthritis: The most common cause of bone spurs
2. Aging: Natural wear and tear on joints over time
3. Joint injuries or trauma
4. Excessive stress on joints (e.g., from repetitive movements)
5. Obesity: Increased pressure on weight-bearing joints
6. Genetic predisposition

Can certain occupations increase the risk of developing bone spurs? Indeed, jobs that involve repetitive movements or place excessive stress on specific joints may heighten the risk. For example, construction workers, athletes, and dancers might be more prone to developing bone spurs in areas subjected to frequent strain.

Recognizing Symptoms: When Bone Spurs Become Problematic

While many bone spurs remain asymptomatic, some can cause significant discomfort and impairment. The symptoms often depend on the location of the bone spur and whether it’s pressing on nearby tissues or nerves.

Common Symptoms of Bone Spurs

• Pain in the affected area, especially during movement
• Stiffness or reduced range of motion
• Numbness or tingling if the bone spur presses on nerves
• Weakness in the affected limb
• Visible bump or swelling
• Difficulty walking (if in the foot or ankle)

How can you differentiate between bone spur pain and other joint-related discomfort? Bone spur pain is often more localized and may worsen with specific movements. However, a proper diagnosis from a healthcare professional is crucial, as symptoms can mimic other conditions.

Diagnostic Approaches for Identifying Bone Spurs

Accurate diagnosis of bone spurs is essential for appropriate treatment. Healthcare providers employ various diagnostic tools and techniques to identify and assess bone spurs.

Common Diagnostic Methods

1. Physical examination
2. X-rays: The most common imaging technique for bone spurs
3. CT (Computed Tomography) scans: For more detailed images
4. MRI (Magnetic Resonance Imaging): To assess soft tissue involvement
5. Bone scans: In cases where other imaging is inconclusive

Is a single diagnostic method sufficient to confirm the presence of bone spurs? While X-rays are often the primary diagnostic tool, some cases may require multiple imaging techniques for a comprehensive assessment. The choice of diagnostic method often depends on the suspected location and severity of the bone spur.

Conservative Treatment Approaches for Bone Spurs

In many cases, bone spurs can be managed effectively through non-invasive treatments. These conservative approaches aim to alleviate symptoms and improve quality of life without surgical intervention.

Non-Surgical Treatment Options

• Rest and activity modification
• Physical therapy and targeted exercises
• Over-the-counter pain relievers (NSAIDs)
• Ice or heat therapy
• Orthotic devices or supportive footwear
• Corticosteroid injections for inflammation
• Weight management to reduce joint stress

How effective are conservative treatments for bone spurs? Many individuals find significant relief through these non-invasive approaches. However, the effectiveness can vary depending on the location and severity of the bone spur, as well as individual patient factors.

Surgical Interventions: When Conservative Treatments Fall Short

While conservative treatments are often successful, some cases of bone spurs may require surgical intervention. Surgery is typically considered when non-invasive methods fail to provide adequate relief or when bone spurs cause severe limitations.

Surgical Options for Bone Spur Removal

1. Arthroscopy: Minimally invasive procedure using small incisions
2. Open surgery: Traditional approach for larger or more complex bone spurs
3. Endoscopic surgery: Using a thin, flexible tube with a camera
4. Radiofrequency ablation: Using heat to destroy nerve tissue and reduce pain

What factors determine the need for surgical intervention? The decision to pursue surgery often depends on the severity of symptoms, impact on daily activities, and the patient’s overall health. Surgeons carefully weigh the potential benefits against the risks before recommending surgical treatment.

Lifestyle Modifications and Prevention Strategies

While not all bone spurs can be prevented, certain lifestyle changes and preventive measures can help reduce the risk of their formation or minimize their impact.

Preventive Measures and Lifestyle Adjustments

• Maintaining a healthy weight to reduce joint stress
• Regular low-impact exercise to improve joint flexibility and strength
• Proper posture and ergonomics in daily activities
• Wearing supportive, well-fitting shoes
• Avoiding repetitive stress on joints when possible
• Incorporating a balanced diet rich in calcium and vitamin D

Can dietary changes help prevent or manage bone spurs? While diet alone cannot prevent bone spurs, maintaining a healthy, balanced diet can support overall bone and joint health. Adequate calcium and vitamin D intake is particularly important for maintaining bone density and strength.

Long-Term Outlook and Management of Bone Spurs

Understanding the long-term prognosis and management strategies for bone spurs is crucial for individuals affected by this condition. While bone spurs are generally permanent once formed, their impact on quality of life can often be effectively managed.

Key Aspects of Long-Term Management

1. Regular follow-ups with healthcare providers
2. Ongoing pain management strategies
3. Adapting lifestyle and activities as needed
4. Monitoring for progression or development of new bone spurs
5. Addressing underlying conditions (e.g., osteoarthritis)

Do bone spurs continue to grow over time? While bone spurs can potentially increase in size, this growth is often slow and may not necessarily lead to worsening symptoms. Regular monitoring and proactive management can help address any changes effectively.

The outlook for individuals with bone spurs varies widely. Many people can manage their condition effectively with conservative treatments and lifestyle adjustments, maintaining a good quality of life. In cases where bone spurs cause persistent problems, advanced treatments or surgical options can provide relief and improved functionality.

Emerging Research and Future Directions in Bone Spur Treatment

The field of bone spur treatment is continually evolving, with ongoing research exploring new therapeutic approaches and technologies. These advancements aim to provide more effective, less invasive options for managing bone spurs and their associated symptoms.

Promising Areas of Research

• Regenerative medicine techniques (e.g., stem cell therapy)
• Advanced imaging technologies for early detection
• Novel drug therapies targeting bone formation processes
• Minimally invasive surgical techniques
• Wearable technologies for pain management and mobility support

How might future treatments change the landscape of bone spur management? Emerging therapies could potentially offer more targeted, personalized approaches to treating bone spurs. For instance, regenerative medicine techniques might help repair damaged cartilage, potentially slowing or preventing bone spur formation in some cases.

As research progresses, individuals with bone spurs may have access to a broader range of treatment options, potentially improving outcomes and quality of life. However, it’s important to note that many of these approaches are still in the experimental stages and require further study before becoming widely available.

Psychological Impact and Coping Strategies for Living with Bone Spurs

The physical symptoms of bone spurs can have a significant psychological impact on affected individuals. Chronic pain, reduced mobility, and limitations in daily activities can lead to stress, anxiety, and even depression. Addressing these psychological aspects is crucial for comprehensive care and improved quality of life.

Coping Strategies and Support

1. Seeking support from mental health professionals
2. Joining support groups or online communities
3. Practicing stress-reduction techniques (e.g., meditation, yoga)
4. Setting realistic goals and expectations
5. Engaging in enjoyable activities within physical limitations
6. Communicating openly with family and friends about challenges

How can individuals maintain a positive outlook while managing bone spurs? Developing a strong support system, staying informed about the condition, and focusing on achievable goals can help maintain a positive perspective. Additionally, working closely with healthcare providers to manage symptoms effectively can contribute to improved mental well-being.

It’s important to recognize that the emotional impact of living with bone spurs is a valid aspect of the condition. Addressing both physical and psychological needs can lead to more effective overall management and a better quality of life.

Navigating Healthcare Systems: Seeking Appropriate Care for Bone Spurs

Effectively managing bone spurs often involves navigating complex healthcare systems. Understanding how to access appropriate care, work with different specialists, and make informed decisions about treatment options is crucial for optimal outcomes.

Key Considerations in Seeking Care

• Choosing the right healthcare providers (e.g., orthopedists, rheumatologists)
• Understanding insurance coverage and treatment costs
• Coordinating care among multiple specialists
• Advocating for your health needs
• Staying informed about treatment options and advancements

When should you seek a second opinion for bone spur treatment? If you’re unsure about a diagnosis or recommended treatment plan, or if conservative treatments aren’t providing relief, seeking a second opinion can be valuable. This can provide additional insights and ensure you’re exploring all appropriate options.

Navigating healthcare systems can be challenging, but being proactive and informed can lead to better care and outcomes. Don’t hesitate to ask questions, seek clarification, and actively participate in decision-making regarding your bone spur management.

Bone Spurs in Special Populations: Considerations for Different Age Groups

While bone spurs can affect individuals of all ages, their presentation, impact, and management can vary significantly across different age groups. Understanding these differences is crucial for tailored care and effective treatment strategies.

Age-Specific Considerations

1. Children and Adolescents:
   • Less common but can occur due to growth-related issues
   • Focus on preserving growth and development
   • Conservative management often preferred
2. Adults (20-50 years):
   • Often related to injuries or occupational stress
   • Balance between symptom management and maintaining activity levels
   • Emphasis on preventive measures and lifestyle modifications
3. Older Adults (50+ years):
   • More common due to age-related degenerative changes
   • Consider comorbidities in treatment planning
   • Focus on maintaining mobility and quality of life

How does the approach to bone spur treatment differ in older adults compared to younger individuals? In older adults, treatment often focuses more on symptom management and maintaining functionality, considering potential comorbidities and medication interactions. Younger individuals may have more aggressive treatment options aimed at preserving long-term joint health and preventing further degeneration.

Tailoring bone spur management to the specific needs and circumstances of different age groups can lead to more effective outcomes and improved quality of life across the lifespan.

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fersenschmerzen oder plantarfasziitis konzept. hand zu fuß wie entzündung fuß problem der sever krankheit oder schließen apophysitis leiden. – bone spurs stock-fotos und bilder

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Heel spur – causes, symptoms, diagnosis and treatment

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• Directory of diseases
• Heel spur

Arthritis

Plantar fasciitis

Osteophytes

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June 28

Heel spur: causes, symptoms, diagnosis and treatment.

Definition

Heel spur, or plantar fasciitis, is a disease of the feet with a characteristic chronic aseptic (without bacterial agent) inflammation in the area of ​​attachment of the large ligament on the sole of the foot (plantar aponeurosis, or fascia) to the calcaneus. Plantar fasciitis usually forms on the back or underside of the heel bone, resembling a spur, hence its name.

Causes of heel spurs

The plantar fascia is a bundle of fibers that connects the calcaneal tuberosity to the phalanges of the fingers. It helps to maintain the shape of the foot and arch of the foot. The normal anatomy of the foot is designed so that a person does not feel pain when walking – for this there is a plantar aponeurosis, which plays the role of a shock absorber (bridge) for the arch of the foot.

One of the modern theories explaining the formation of heel spur syndrome is that the inflammation is caused by chronic microtraumatization of the aponeurosis when it is stretched.

As a result of the incorrect position of the bones of the foot relative to each other during walking, a constant overstretching of the ligament occurs, leading to the appearance of small tears, swelling and pain. As a result of repeated ruptures, inflammation and shortening of the fibers of the plantar aponeurosis occur, they lose their elasticity. Pathological feedback is switched on: the more microtears, the stronger the inflammation, the shorter the ligaments, the more often microtears. Forced protection of the body from injuries and ruptures is the strengthening of the fibers of the plantar aponeurosis in the area of ​​​​attachment to the calcaneus. The next stage is the formation of osteophytes on the calcaneus, which are called “calcaneal spur”. Thus, the growth on the calcaneus itself is only a reaction of the body to inflammation, but not the root cause of pain.

Predisposing factors for the development of spurs are flat feet, overweight, excessive overload of the foot, very high or low arch of the foot, congenital and acquired deformities of the feet, scoliosis, osteochondrosis, deforming arthrosis of the hip or knee joints, arthritis of various etiologies, diabetes mellitus.

The disease is often diagnosed in professional athletes, runners and dancers, as well as in people whose work is associated with a long stay in a standing position, with prolonged walking on a hard surface, and frequent carrying of weights.

Heel spurs are more common in women over the age of 40-45.

Perhaps this is due to the regular wearing of high-heeled shoes. In 90% of cases, the disease develops against the background of flat feet, in which the distribution of the load on the foot changes and overstretching of the plantar fascia occurs.

Classification of the disease

According to the international classification of diseases ICD-10, heel spur (M77.3) refers to diseases of the musculoskeletal system and connective tissue. Heel spurs can be unilateral or bilateral, that is, on the soles of one or both feet.

Heel spur symptoms

The disease has such characteristic symptoms that it is simply impossible not to notice it or confuse it with any other pathology. Typical symptoms of plantar fasciitis:

• burning, stabbing pain in the heel;
• the focus of pain is deep, right in front of the heel and more often on the inside of the heel;
• the pain is more acute in the morning and at the end of a tiring day;
• the pain increases with prolonged standing, sitting;
• the first steps after sleep are especially painful, and as you walk, the pain subsides a little;
• worries more when walking barefoot, in flat shoes without a heel;
• pain may be present in both feet, but usually one leg hurts more;
• wrong turn of the foot, clubfoot.

Pain occurs in the central and medial parts of the plantar surface of the heel region during palpation, with pressure on the tubercle of the calcaneus, with compression of the heel on both sides. Thumb extension can also cause increased heel pain.

With a posterior heel spur, pain is observed at the site of attachment of the Achilles tendon when walking and pressure with the back of the shoe.

There is no relationship between spur size and symptom severity. Many large spurs are asymptomatic, small spurs can cause unbearable pain, and many patients present with severe complaints, although there is no evidence of spurs on x-rays.

Heel spur diagnosis

Evaluation of patients with heel pain begins with an assessment of general health (including history of heel pain treatment), occupation, hobbies, weight change, or coincidence of onset of symptoms with increased physical activity.

To clarify the diagnosis of heel spurs, various instrumental methods are used:

• X-ray of the heel region is necessary to exclude a fracture if there are indications of trauma in the anamnesis. In the early stages of formation, the heel spur is not visualized on the radiograph.

X-ray of the bones of the foot

X-ray examination of the foot in two projections allows diagnosing injuries and other pathological changes, including flat feet.

RUB 2,390

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MRI of soft tissues of one limb segment

Magnetic resonance imaging is a study that allows you to study the structure of soft tissues in detail, detect pathological changes, assess the degree of their development…

6,590 rubles

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Ultrasound diagnostics can be used to assess the condition of the soft tissues of the foot, identify a possible abscess, and monitor the effectiveness of treatment.

Ultrasound of soft tissues

Examination of soft tissues to detect pathological changes and diagnose neoplasms.

RUB 1,790

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Additional examination methods include:

• general and biochemical blood tests to detect inflammation, assess the level of uric acid;

C-reactive protein (CRP, CRP)

C-reactive protein is an acute phase protein, a sensitive indicator of tissue damage during inflammation, necrosis, trauma.
Synonyms: Blood test for CRP; C-jet …

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Uric acid (in the blood)

The study of uric acid is used in the diagnosis and control of the treatment of gout, the assessment of the risk of urolithiasis.

Synonyms: Blood test for urinary…

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Ultrasound of the veins and arteries of the lower extremities (doppler)

Comprehensive ultrasound scanning of the vessels of the lower extremities for the diagnosis of circulatory disorders.

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Which doctors to contact

Traumatologists-orthopedists and surgeons deal with foot pathology. The necessary list of physiotherapeutic procedures, massage and therapeutic exercises is prescribed by a physiotherapist. In the presence of concomitant diseases, appropriate laboratory and instrumental studies, consultations of narrow specialists may be required.

Heel spur treatment

One of the main goals of heel spur treatment is to control pain and relieve inflammation. The real effect can be obtained only with an integrated approach.

Foot unloading method . The most effective way of treatment is to return the foot to the correct position when walking, restore the arch of the longitudinal arches and reduce pressure on the heel region. It is considered rational to wear orthopedic shoes that prevent overstretching of the plantar ligament and have the maximum shock-absorbing effect, creating comfort while walking.

One of the most affordable options is the manufacture of individual instep supports that make it possible to physiologically position the foot.

Drug therapy . Currently, drugs from the group of non-steroidal anti-inflammatory drugs in the form of ointments and creams are used to treat heel spurs. tablet or injectable forms. It is worth noting that this is a symptomatic method of treatment that does not give a persistent analgesic effect and does not affect the course of the disease, and also has many undesirable side effects.

Corticosteroids are commonly used to reduce pain and inflammation. Although plantar fasciitis is a degenerative rather than an inflammatory process, as evidenced by the short-term therapeutic effect of corticosteroids. The most common in the treatment of heel spurs are injections of hormonal drugs.

Tension of the calf muscles aggravates the course of the disease and increases heel pain, so muscle relaxants can be used to reduce it.

In combination with analgesics, they significantly increase the effectiveness of treatment and reduce the dose of painkillers.

Physiotherapy:

• electrophoresis with hyaluronidase or 5% calcium chloride solution: introduction of drugs into the thickness of tissues using electric current;
• sonophoresis with hydrocortisone: treatment of tissues with ultrasonic waves that improve the penetration of drugs;
• ultrasonic therapy: heating of tissues and reduction of inflammatory reactions with the help of ultrasonic waves;
• magnetotherapy;
• mud and mineral baths;
• laser therapy: heating the deep layers of tissues with a laser helps locally improve blood flow.

Shock wave therapy is a non-invasive method of treatment that allows you to reduce or completely remove pain in a short time. The technique is based on the impact of ultrasonic waves of a certain frequency in order to destroy calcium deposits, reduce inflammation and relieve swelling, and activate tissue regeneration. Under the influence of the shock wave, blood circulation increases, the permeability of cell membranes changes and cell ion exchange is restored, thereby providing anti-inflammatory and anti-edematous effects.

Therapeutic exercise and massage . In the subacute period, when the intensity of pain has decreased, physical exercises are added to the treatment aimed at stretching the calf muscles of the lower leg and plantar fascia, improving the mobility of the ankle joint, as well as strengthening the muscles responsible for the correct positioning of the foot during movement. Massage improves metabolic processes in tissues, removes pain associated with reflex muscle spasm.

Therapeutic physical training and massage are aimed at correcting the biomechanics of the body, which can significantly alleviate the course of the disease and is the prevention of its relapse.

Surgical treatment . The only way to get rid of a large heel spur is through surgery. When choosing the classic version of the operation, the surgeon cuts the fascia completely and removes the bony protrusion. A more modern and sparing technique is radiofrequency microtenotomy. The essence of the operation is to eliminate damaged tissues using radiofrequency waves.

Local injection of hormones (corticosteroids) at the site of inflammation and surgery are extreme measures, which are resorted to only in cases where other methods of treatment have not brought the desired result.

In complex cases characterized by a long and recurrent course, surgical treatment is the only method.

Complications

The main complication of heel spurs is a deterioration in the quality of life associated with pain and the inability to lead an active lifestyle. In patients, sleep is often disturbed, anxiety and irritability increase. They are forced to avoid relying on a sore heel and transfer weight to a healthy limb. This negatively affects gait and posture and increases the risk of damage to the joints of the loaded limb. With a pronounced pain syndrome, asymmetry of posture appears, which leads to the progression of osteochondrosis and the occurrence of pain in the lumbar region. As a result, the patient is forced to limit motor activity.

Other complications such as avulsion of the fascia and suppuration are rare.

Heel spur prevention

The development of a heel spur is preventable in most cases. It is recommended to provide regular rest for the feet in combination with the right exercises, take breaks to warm up at work, if it is associated with a constant load on the feet.

Shoes should be comfortable, and in the presence of flat feet – orthopedic.

It is useful to wear individual orthopedic insoles that are adjacent to the foot over the entire area – they allow you to restore the normal height of the arch of the foot and, thus, reduce the tension of the plantar fascia already in the first weeks of constant wear.

To reduce the severity of pain in the heel region and reduce the load on the plantar aponeurosis, you should take shorter steps, do not walk barefoot, avoid running, dancing, wearing irrational shoes.

Sources:

1. Reznik L.B., Erofeev S.A., Silantiev V.N., Turushev M.A., Kuznetsov N.K. The current state of the problem of surgical treatment of plantar fasciosis (literature review). Orthopedic genius, magazine. T. 24. No. 4, 2018. S. 515-520.
2. Bone spurs. Big Medical Encyclopedia (BME), edited by Petrovsky B.V., 3rd edition, volume 27.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories can use different research methods and units of measurement to perform the same analyzes.

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symptoms, photos, diagnosis and treatment in Moscow

Heel spur is a disease characterized by inflammation of the plantar fascia, resulting in the accumulation of osteophytes in the area of ​​the calcaneal tuberosity. According to statistics, recently there has been an increase in the diagnosis of heel spurs in the population. Most often, the disease affects women over 40 years of age. This is due to the long wearing of uncomfortable shoes with high heels. In addition, there are a number of predisposing factors that increase the risk of developing a heel spur. To diagnose the pathology, it is necessary to perform an x-ray of the foot. Typically, heel spurs are unilateral. For the treatment of growths in the heel area, a set of measures is used, including conservative therapy and surgery.

Moscow Yusupov Hospital has been diagnosing and treating heel spurs for many years. The latest equipment and experienced staff make it possible to identify the disease in the shortest possible time and begin timely effective treatment.

What is a heel spur?

A heel spur is a disease in which the ligaments, muscles and tendons of the heel area are affected. In connection with the traumatization of the plantar fascia, the center of gravity is redistributed to the foot. The rupture of the ligament activates the inflammatory process, in response to which calcium salts begin to be deposited in the area of ​​the heel tubercle. Thus, a heel spur is formed, the minimum size of which can cause an acute attack of pain. The main clinical sign of heel spurs is pain, which worsens in the morning and evening. Diagnosis of the disease is not difficult. To do this, it is enough to perform an x-ray examination of the foot. Treatment for heel spurs includes conservative therapy and surgery. The operation to excise the calcaneal spine is performed in 5% of cases of treatment of the disease. This is due to the sufficient effect of medication and physiotherapy.

In the international classification of diseases ICD-10, the heel spur has the code M77.3.

Expert opinion

Author:

Alexander Borisovich Tarasov

Doctor in the direction of orthopedic rehabilitation

Plantar fasciitis (which is popularly called heel spur) is caused by inflammatory and degenerative changes in the plantar fascia, which contributes to the growth of bone tissue, the formation of a characteristic growth.

The disease proceeds without external signs, although the bone outgrowth can be palpated. Patients complain of pain when walking, physical exertion, transferring body weight to one leg. But folk methods of treatment are ineffective, and people are in no hurry to seek qualified help. No need to endure pain for years, because the treatment of spurs in the Yusupov hospital is carried out in one session.

Diagnosis is by physical examination and x-ray. After that, the patient has a wide choice of treatment methods, among which are not only invasive. Perhaps drug treatment, laser exposure, shock wave therapy. If there are medical indications, then the surgeons of the Yusupov hospital perform a minimally invasive removal of the heel spur using the endoscopic method or a microscalpel, painlessly.

Causes and mechanisms of heel spur development

The number of detected heel spurs is increasing every year. Most often, women over 40 years of age face a similar problem. Among the main reasons for the development of pathology are:

• Flat feet. It is considered the most common cause of heel spurs. Due to the incorrect distribution of the load on the foot, the center of gravity shifts to the foot.
• Injuries. Any injury to the bones of the heel increases the risk of developing a heel spur.
• Concomitant pathology of the musculoskeletal system. The formation of a heel spur is preceded by certain diseases of the joints and bones. These include:
• Rheumatoid arthritis. Autoimmune diseases trigger the body’s aggression against its own connective tissue. In this case, the joints are destroyed and osteophytes are formed.
• Psoriatic arthritis.
• Osteoarthritis. Inflammation in the area of ​​​​the joints provokes a redistribution of the load when walking on the heels. This increases the risk of developing heel spurs.
• Ankylosing spondylitis.
• Gout. The deposition of uric acid salts occurs in the region of the calcaneal tuber, causing destruction of the plantar ligament.
• Obesity. Excess weight increases the load on the heel bone. As a result, the risk of developing spurs increases.
• Infections. Some infectious diseases provoke a hidden course of the heel spur. Clinical manifestations of the disease may occur after several months.
• Age. The most common heel spur is diagnosed in women over 40 years of age. This is due to a slowdown in the processes of regeneration of damaged ligaments, deterioration of blood circulation and nutrition of the injured area.
• Excessive load on the feet. Standing for a long time during the day, performing heavy physical work, as well as wearing high-heeled shoes contribute to the formation of a heel spur.

The mechanism of development of the heel spur is associated with constant traumatization of the plantar fascia, which supports the arch of the foot. The greatest tension of the fascia occurs at the site of its attachment to the calcaneal tuberosity. In connection with trauma to the ligament, the inflammatory process is activated. In response, calcium salts are deposited, forming bone growths. This is how a heel spur develops.

Symptoms and signs of a heel spur

The main and only symptom of a heel spur is pain. In the initial stage, the disease may be asymptomatic. As the osteophytes grow, a sharp sharp pain appears in the heel area. Pain syndrome worries in the morning, after rest. Therefore, this syndrome is called “starting pain”. During the first steps after waking up, the pain returns. During the day, the severity of the symptom decreases, but by the evening the acute pain reappears. There were no visible changes indicating the presence of a heel spur. In rare cases, hyperemia of the skin in the heel area may occur due to the development of the inflammatory process.

Localization of the main sign of a heel spur can be local or spread throughout the heel region. Pain during walking provokes the appearance of lameness and a change in gait. A person tries to step on the toe or the outer part of the foot, avoiding the load on the heel.

Heel spur: photo

X-ray of the foot. In the region of the calcaneal tuber, a spike is determined.

Schematic illustration of a heel spur.

Heel spur x-ray

Diagnosis

To identify a heel spur, a comprehensive approach to the diagnosis of the disease is required. To do this, the following activities are carried out:

• Collection of complaints and anamnesis of the disease. The main complaints, the time of their appearance are clarified. In addition, the presence of predisposing factors is clarified.
• General analysis of blood and urine. Thanks to laboratory diagnostics, the presence of an inflammatory process in the body is established. This increases the number of leukocytes and ESR.
• Biochemical blood test. This study allows you to identify or exclude rheumatological diseases. For this, blood is donated for rheumatoid factor, uric acid and C-reactive protein.
• Radiography. It is the main method for diagnosing heel spurs. On the radiograph of the heel in the area of ​​​​the calcaneal tubercle, a spike is determined. Its size depends on the age of education. However, even the smallest size of the spike can provoke severe pain.

Yusupov Hospital has a full range of diagnostic services needed to identify heel spurs. Modern equipment and highly qualified personnel are the undoubted advantage of the Yusupov hospital. Thanks to many years of experience in diagnosing and treating heel spurs, the specialists of the clinic in the shortest possible time identify the disease of the heel tubercle and prescribe the correct individual treatment.

Heel spur: treatment

Heel spurs are treated with medication, physiotherapy and surgery. The choice of method depends on the severity of the symptoms and the stage of the disease.

Medical therapy

Conservative treatment of heel spurs involves the administration of medical treatment. The main objectives of this method of therapy are to reduce the inflammatory process and alleviate pain. For this purpose, the following groups of drugs are used:

• Non-steroidal anti-inflammatory drugs. Due to their action, they reduce the permeability of the vascular wall, removing the edematous syndrome, as well as blocking inflammatory mediators. In this way, an analgesic and anti-inflammatory effect is achieved. Preparations of the NSAID group improve blood circulation in the pathological focus, accelerate trophic processes. The main representatives of non-steroidal anti-inflammatory drugs include:
• Ibuprofen. It has an analgesic and anti-inflammatory effect in the shortest possible time. It is considered the safest drug of the NSAID group.
• Diclofenac. A common drug for relieving acute pain and reducing the inflammatory process. The disadvantage of diclofenac is the side effects. The drug has a strong effect on the gastrointestinal tract. Uncontrolled intake of diclofenac provokes internal bleeding.
• Naizilat. The drug has an analgesic and anti-inflammatory effect, relieves edematous syndrome. The disadvantage of nysilate is a strong effect on the gastrointestinal tract.
• Ketorolac (Ketorol). The appointment of this drug is carried out strictly by the attending physician. Ketorol is a powerful pain reliever.
• Chondroprotectors. Medicines in this group restore the tissues that make up the vertebrae. Due to this effect, blood circulation and nutrition in the affected area improves. Chondroprotectors contribute to the restoration of the plantar ligament, increasing its elasticity and preventing re-traumatization.

The choice of drug treatment is carried out by a doctor depending on the condition, stage of the disease and the presence of concomitant pathology.

Physiotherapy

Physiotherapy methods are effective in relieving pain and reducing inflammation. The heel spur treatment complex includes the following physiotherapeutic procedures:

• Phonophoresis. The technique of the procedure consists in the introduction of hydrocortisone ointment into the body using ultrasound. Due to this, there is an anti-inflammatory effect, microcirculation, trophism and lymph outflow in the affected area improves.
• Laser therapy. With the help of a laser beam, an effect is exerted on the inflammatory focus. The effect of this method of physiotherapy treatment is based on improving blood circulation, reducing edematous syndrome, relieving pain and reducing inflammation. The rendered effect accelerates the healing and recovery of the injured plantar ligament. Laser therapy is a safe and painless treatment method. Contraindications for the procedure are pregnancy, tuberculosis, hematological diseases, acute liver and kidney failure.
• Shock wave therapy. The procedure consists in the impact of an ultrasonic wave in the area of ​​\u200b\u200bbone growths. As a result, pieces of osteophytes are chipped off with their subsequent resorption. Ultrasound treatment improves blood circulation and nutrition in the affected area, relieving pain and inflammation. As a result of therapy, the plantar ligament becomes elastic, which reduces the possibility of its re-injury. Shock wave therapy is indicated in the presence of diseases of the musculoskeletal system, flat feet, heel spurs. Contraindications for this method of treatment are pregnancy, oncological diseases, blood clotting disorders, acute pathologies accompanied by purulent inflammation.
• X-ray therapy. To alleviate the pain syndrome, blocking of nerve endings with a weak dose of radiation is used.
• Magnetic resonance therapy. This method of physiotherapy treatment is used to reduce pain, relieve inflammation and improve blood circulation in the heel area.

To obtain the full effect of physiotherapy treatment, it is necessary to complete a course of therapy. On average, it is 10-15 procedures. The advantage of this method is the absolute painlessness of the sessions.

Surgery

Surgical treatment is indicated in case of failure of conservative therapy within 6 months. Also, an indication for surgical intervention is a decrease in performance due to pain. Surgical treatment of heel spurs is resorted to in 5% of cases.

There are several ways to surgically remove the calcaneal spike:

1. Traditional. It is carried out in the conditions of any hospital. It is considered the most common and traumatic surgical technique. The recovery period after open surgery is up to 2 months.
2. Endoscopic. The operation is performed using endoscopic instruments that are inserted into the heel area through a minimal incision. Endoscopic surgery is the technique of choice due to low trauma and a fast recovery period in the postoperative period.
3. Minimally invasive. The latest treatment for heel spurs. The operation is performed under x-ray control. A thin tube is inserted through the incision into the heel region, at the end of which there is a microscalpel. With its help, the thorn is cut off. Minimally invasive surgery is the least traumatic of all available techniques.

An integrated approach to the treatment of heel spurs is the key to getting rid of the disease as soon as possible. The choice of the method of therapy is determined by the attending physician on the basis of a preliminary diagnosis of bone formation.

In order to relieve pain when walking, specialists recommend wearing orthopedic insoles or heel pads during the treatment of heel spurs. The purposes of their application are:

• Lightening the load on the heel.
• Prevention and treatment of flat feet.
• Improvement of blood circulation and trophism in the affected area.
• Strengthening the ligamentous apparatus of the foot.
• Fixation of the muscles and ligaments of the foot.

The selection of the necessary orthopedic products is carried out by an orthopedic doctor based on individual characteristics. The weight and stage of development of the heel spur are taken into account.

Treatment of heel spurs and other diseases of the musculoskeletal system in Moscow is handled by the Yusupov Hospital. In the clinic, it is possible to carry out a complete diagnosis and appropriate treatment of heel spurs. Highly qualified specialists of the clinic have many years of experience in the treatment of such diseases. The doctors of the Yusupov hospital carry out conservative treatment and surgical excision of the thorn in the area of ​​the calcaneal tuberosity.

	Medical therapy	Physiotherapy	Surgery
Methods of treatment	The following groups of drugs are used to treat heel spurs: 1. Non-steroidal anti-inflammatory drugs. Due to their action, they reduce the permeability of the vascular wall, removing the edematous syndrome, as well as blocking inflammatory mediators. In this way, an analgesic and anti-inflammatory effect is achieved. Preparations of the NSAID group improve blood circulation in the pathological focus, accelerate trophic processes. 2. Chondroprotectors. Medicines in this group restore the tissues that make up the vertebrae. Due to this effect, blood circulation and nutrition in the affected area improves. Chondroprotectors contribute to the restoration of the plantar ligament, increasing its elasticity and preventing re-traumatization. The technique of the procedure consists in the introduction of hydrocortisone ointment into the body using ultrasound. Due to this, there is an anti-inflammatory effect, microcirculation, trophism and lymph outflow in the affected area improves. 2. Laser therapy. With the help of a laser beam, an effect is exerted on the inflammatory focus. The effect of this method of physiotherapy treatment is based on improving blood circulation, reducing edematous syndrome, relieving pain and reducing inflammation. The rendered effect accelerates the healing and recovery of the injured plantar ligament. Laser therapy is a safe and painless treatment method. Contraindications for the procedure are pregnancy, tuberculosis, hematological diseases, acute liver and kidney failure. 3.Shock wave therapy. The procedure consists in the impact of an ultrasonic wave in the area of ​​\u200b\u200bbone growths. As a result, pieces of osteophytes are chipped off with their subsequent resorption. Ultrasound treatment improves blood circulation and nutrition in the affected area, relieving pain and inflammation. As a result of therapy, the plantar ligament becomes elastic, which reduces the possibility of its re-injury. Shock wave therapy is indicated in the presence of diseases of the musculoskeletal system, flat feet, heel spurs. Contraindications for this method of treatment are pregnancy, oncological diseases, blood clotting disorders, acute pathologies accompanied by purulent inflammation. 4.X-ray therapy. To alleviate the pain syndrome, blocking of nerve endings with a weak dose of radiation is used. 5. Magnetic resonance therapy. This method of physiotherapy treatment is used to reduce pain, relieve inflammation and improve blood circulation in the heel area.	There are several ways to surgically remove the calcaneal spike: 1.Traditional. It is carried out in the conditions of any hospital. It is considered the most common and traumatic surgical technique. The recovery period after open surgery is up to 2 months. 2.Endoscopic. The operation is performed using endoscopic instruments that are inserted into the heel area through a minimal incision. Endoscopic surgery is the technique of choice due to low trauma and a fast recovery period in the postoperative period. 3. Minimally invasive. The latest treatment for heel spurs. The operation is performed under x-ray control. A thin tube is inserted through the incision into the heel region, at the end of which there is a microscalpel. With its help, the thorn is cut off. Minimally invasive surgery is the least traumatic of all available techniques.
Indications	Drug therapy is included in the complex treatment of diseases of the musculoskeletal system, accompanied by pain and inflammation.	Physiotherapy is indicated for diseases of the musculoskeletal system, flat feet, heel spurs.	Surgery is indicated if conservative therapy fails within 6 months. Also, an indication for surgical intervention is a decrease in performance due to pain.
Contraindications	Restrictions for drug therapy are acute fever, gastrointestinal bleeding, individual intolerance to the components of the drug.	Contraindications for physiotherapeutic procedures are pregnancy, tuberculosis, hematological diseases, acute liver and kidney failure.	Restrictions for surgical intervention are: § Acute conditions, accompanied by an increase in body temperature. § Purulent inflammation of any localization. § Severe comorbidity.

Heel spur treatment in Moscow

Moscow Yusupov Hospital deals with the diagnosis and treatment of heel spurs and other diseases of the musculoskeletal system. Modern equipment, highly qualified doctors and attentive attitude to each patient are the advantages of the clinic.