What are bone spurs. How do bone spurs form. What causes bone spurs. What are the symptoms of bone spurs. How are bone spurs diagnosed. What treatments are available for bone spurs. Can bone spurs be prevented.

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, such as in the spine, shoulders, hands, hips, knees, and feet. But why do these bony outgrowths occur?

The formation of bone spurs is often a natural response to wear and tear or pressure on the bones over time. As the body attempts to repair itself, it may create extra bone tissue, resulting in these protrusions. While bone spurs can develop in various locations, they are particularly common in weight-bearing joints and areas subject to frequent stress or movement.

Common Locations for Bone Spurs

• Spine (vertebrae)
• Heel (calcaneal spur)
• Knee
• Hip
• Shoulder
• Fingers and toes

Are bone spurs always painful? Not necessarily. Many people have bone spurs without experiencing any symptoms. However, when these bony projections press on nerves, tendons, or other structures, they can cause discomfort and functional limitations.

Causes and Risk Factors of Bone Spur Development

Understanding the underlying causes of bone spurs is crucial for both prevention and treatment. While the exact reason for their formation can vary, several factors contribute to the development of these bony outgrowths.

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. Injuries: Trauma to joints or bones
4. Genetic predisposition: Some individuals may be more prone to developing bone spurs
5. Obesity: Excess weight puts additional stress on weight-bearing joints

Does physical activity contribute to bone spur formation? While regular exercise is generally beneficial for joint health, certain high-impact activities or repetitive motions may increase the risk of developing bone spurs, especially if proper form and protective measures are not maintained.

Recognizing Bone Spur Symptoms: When to Seek Medical Attention

Identifying the symptoms associated with bone spurs is essential for early detection and management. While some individuals may remain asymptomatic, others may experience a range of discomforts that can significantly impact their quality of life.

Common Symptoms of Bone Spurs

• Pain in the affected area, especially during movement
• Stiffness or reduced range of motion in joints
• Numbness or tingling sensations if nerves are compressed
• Weakness in the affected limb
• Visible bumps under the skin (in some cases)

When should you consult a healthcare professional about potential bone spurs? If you experience persistent pain, reduced mobility, or any of the above symptoms that interfere with your daily activities, it’s advisable to seek medical evaluation. Early intervention can prevent further complications and improve outcomes.

Diagnostic Approaches for Bone Spurs: Imaging and Clinical Evaluation

Accurate diagnosis of bone spurs is crucial for developing an effective treatment plan. Healthcare professionals employ various diagnostic techniques to identify and assess these bony projections.

Common Diagnostic Methods

1. Physical examination: Assessing pain, tenderness, and range of motion
2. X-rays: Visualizing bone structure and identifying spurs
3. CT scans: Providing detailed cross-sectional images of bones and surrounding tissues
4. MRI: Offering comprehensive views of soft tissues and potential nerve compression
5. Ultrasound: Useful for evaluating soft tissue involvement and guiding injections

How do doctors differentiate bone spurs from other conditions? Through a combination of clinical evaluation, patient history, and imaging studies, healthcare providers can distinguish bone spurs from similar conditions such as bone tumors, fractures, or other joint abnormalities. This comprehensive approach ensures an accurate diagnosis and appropriate treatment strategy.

Conservative Treatment Options for Bone Spurs: Managing Pain and Improving Function

For many individuals with bone spurs, conservative treatment approaches can effectively manage symptoms and improve quality of life. These non-invasive methods focus on alleviating pain, reducing inflammation, and enhancing joint function.

Non-Surgical Treatment Strategies

• Rest and activity modification
• Physical therapy and targeted exercises
• Over-the-counter pain relievers and anti-inflammatory medications
• Ice or heat therapy
• Orthotic devices or supportive footwear
• Weight management to reduce stress on joints
• Corticosteroid injections for temporary pain relief

Can conservative treatments completely eliminate bone spurs? While these approaches may not remove the bone spur itself, they can significantly reduce pain and improve function in many cases. Conservative treatments aim to manage symptoms and prevent further progression of the condition, often allowing individuals to avoid more invasive interventions.

Surgical Interventions for Bone Spurs: When Conservative Methods Aren’t Enough

In some cases, conservative treatments may not provide sufficient relief from bone spur-related symptoms. When pain persists or functionality is severely impaired, surgical intervention may be considered as a last resort.

Surgical Options for Bone Spur Treatment

1. Arthroscopy: Minimally invasive procedure to remove bone spurs and repair damaged tissues
2. Open surgery: Traditional approach for more extensive bone spur removal or joint repair
3. Joint replacement: In severe cases, particularly for weight-bearing joints like hips or knees
4. Laminectomy: Spinal procedure to relieve pressure on nerves caused by bone spurs

What factors determine the need for surgical intervention? The decision to pursue surgery depends on various factors, including the severity of symptoms, the location of the bone spur, the patient’s overall health, and the impact on daily activities. Healthcare providers carefully weigh these factors against the potential risks and benefits of surgery to determine the most appropriate course of action.

Preventing Bone Spurs: Lifestyle Modifications and Proactive Measures

While it may not be possible to prevent all bone spurs, adopting certain lifestyle habits and preventive strategies can reduce the risk of their formation and minimize associated complications.

Preventive Strategies for Bone Spur Development

• Maintaining a healthy weight to reduce stress on joints
• Engaging in low-impact exercises to strengthen muscles and improve joint flexibility
• Practicing proper posture and body mechanics
• Wearing supportive, well-fitting footwear
• Using protective equipment during sports and physical activities
• Managing underlying conditions such as osteoarthritis or diabetes
• Avoiding repetitive stress injuries through proper ergonomics and technique

Is it possible to reverse existing bone spurs through lifestyle changes? While lifestyle modifications may not eliminate existing bone spurs, they can help prevent further growth and reduce associated symptoms. These proactive measures can also improve overall joint health and function, potentially slowing the progression of conditions that contribute to bone spur formation.

Living with Bone Spurs: Coping Strategies and Long-Term Management

For individuals diagnosed with bone spurs, developing effective coping strategies and long-term management plans is crucial for maintaining quality of life and preventing further complications.

Strategies for Long-Term Bone Spur Management

1. Adhering to prescribed treatment plans and follow-up appointments
2. Incorporating regular stretching and low-impact exercises into daily routines
3. Using assistive devices when necessary to reduce joint stress
4. Exploring alternative therapies such as acupuncture or massage (with medical approval)
5. Joining support groups or seeking counseling to address emotional aspects of chronic pain
6. Maintaining open communication with healthcare providers about symptom changes
7. Staying informed about new treatment options and research developments

How can individuals with bone spurs balance activity and rest? Finding the right balance between staying active and allowing for adequate rest is key to managing bone spur symptoms. Working closely with healthcare providers and physical therapists can help develop personalized activity plans that promote joint health without exacerbating symptoms.

By understanding the nature of bone spurs, their causes, and available treatment options, individuals can take proactive steps to manage this condition effectively. Whether through conservative measures, surgical interventions, or lifestyle modifications, there are numerous approaches to addressing bone spur-related challenges and maintaining an active, fulfilling life.

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Heel spur – causes, symptoms, diagnosis and treatment

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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.

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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.