Bone spur remedy: Plantar Fasciitis: Symptoms, Causes, Diagnosis, Treatment
Bone spurs – Diagnosis and treatment
During the physical exam, your doctor might feel around your joint to pinpoint your pain. Your doctor might also order X-rays or other imaging tests to view your joints and bones.
If your bone spurs cause pain, your doctor might recommend over-the-counter pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others).
Preparing for your appointment
You’ll likely first see your family doctor, who might refer you to a doctor who specializes in the diagnosis and treatment of joint disorders (rheumatologist).
Here’s some information to help you get ready for your appointment.
What you can do
- List your symptoms and how long you’ve had them.
- Write down key medical information, including other conditions you have, all medications and supplements you take, and family history of bone or joint disease.
- Note recent injuries that affected a joint.
- Write down questions to ask your doctor.
Here are some questions to ask your doctor. Don’t hesitate to ask others.
- What’s the most likely cause of my signs and symptoms?
- Are there other possible causes?
- What tests do I need?
- What treatment do you recommend, if any?
- I have other health problems. How can I manage them together?
- Is surgery an option in my case? Why or why not?
- What self-care measures can I take to help manage symptoms?
What to expect from your doctor
Your doctor is likely to ask you questions, including:
- How severe is your pain?
- Are you having trouble moving the affected joint or joints?
- Are your symptoms affecting your ability to complete daily tasks?
- If you’ve tried at-home treatments so far, what, if anything, has helped?
- What is your typical exercise routine?
Oct. 17, 2019
- Doherty M, et al. Clinical manifestations of osteoarthritis. https://www.uptodate.com/contents/search. Accessed Jan. 15, 2018.
- Firestein GS, et al., eds. Pathogenesis of osteoarthritis. In: Kelley and Firestein’s Textbook of Rheumatology. 10th ed. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Jan. 15, 2018.
- What is spinal stenosis? National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.catalog.niams.nih.gov/detail.cfm?pubid=1851. Accessed Jan. 16, 2018.
- Is your back pain caused by OA? Arthritis Foundation. http://www.arthritis.org/about-arthritis/types/back-pain/articles/oa-and-back-pain.php. Accessed Jan. 15, 2018.
- Imboden JB, et al. Osteoarthritis. In: Current Diagnosis & Treatment: Rheumatology. 3rd ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://accessmedicine.mhmedical.com. Accessed Jan. 16, 2018.
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How to Get Rid of Bone Spurs in Feet, Neck, Shoulder & Spine
What are bone spurs?
A bone spur is a small, sharp outgrowth of bone. They can come from local trauma to the bone, cartilage or tendon near where a bone spur has formed. Inflammation, like that caused by arthritis, can also cause the formation of bone spurs. Often, bone spurs are not painful or uncomfortable. They only require treatment when they start causing pain or discomfort.
What are home remedies for bone spurs?
Home remedies to soothe the symptoms of bone spurs includes application of ice packs and taking over-the-counter pain medications like ibuprofen and other non-steroidal antiinflammatory medications.
What is the treatment for bone spurs?
Bone spurs are treated only if they are causing symptoms. Initial treatment is directed toward decreasing inflammation and avoiding reinjury when possible. Local cold application can help when the location of the bone spur is accessible. Anti-inflammatory medications, administered both orally (over-the-counter NSAIDs) and by local steroid injection (Kenalog, Depomedrol, Celestone), are commonly used, depending on the location of the spur. Local mechanical measures, such as orthotics, or shoe inserts, and local bone spur pads might be considered, depending on the location of the bone spur.
Bone spurs that are causing irritation of nerves, tendons or ligaments and that are resistant to conservative measures can require surgical operations for treatment.
What kind of doctor treats bone spurs?
An orthopaedic surgeon, a doctor who corrects congenital or functional abnormalities of the bones with surgery, casting, and bracing in cases of bone spurs. Podiatrists also treat bone spurs and other injuries to the foot and ankle.
Doherty, Michael, and Abhishek, Abhishek. “Patient Education: Osteoarthritis Symptoms and Diagnosis (Beyond the Basics). ” UpToDate.com. Nov. 2018. .
Kasper, D.L., et al., eds. Harrison’s Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.
Bone Spurs | Cedars-Sinai
Not what you’re looking for?
About bone spurs
In spite of their name, bone spurs are smooth, bony growths that form over a long period of time. They are a growth of normal bone that tends to occur as we age.
The spurs themselves are not painful. Their effect on nearby structures, such as nerves and the spinal cord, can cause pain.
The spine is made up of 33 bones (vertebrae) designed to protect the spinal cord. Gel-filled discs between the bones serve as shock absorbers. The discs also allow us to bend forward and backward and twist our backs in a variety of directions.
Behind each disc and under each joint are openings that allow a part of nerve roots to leave the spinal cord to go to other parts of the body. These tiny openings, called foramen, enclose the nerve and are just large enough for the nerve to go through.
Bone spurs, also known as osteophytes, can be a problem if they develop in the openings for the nerve roots. They make the space narrower and press on the nerve. This is called foramen stenosis.
What are causes and risk factors for bone spurs?
A variety of factors contribute to bone spurs. These include:
- Aging. As our discs wear down, ligaments get looser and don’t hold the joints as stable as they should. The body tries to thicken the ligaments to hold the bones together. Over time, the thickened ligaments start forming flecks of bone. The thickened ligaments and new bone around the spinal cord and the nerve roots cause pressure.
- Disc and joint degeneration.
- Injuries, including sports-related and motor vehicle accidents.
- Poor posture.
- Structural problems that a person is born with.
In addition, certain conditions can make it more likely that bone spurs will develop, including:
- Spinal stenosis
In persons 60 and older, bone spurs are common. A little more than 40 percent of the population will develop symptoms that require medical treatment as a result of bone spurs.
What are symptoms of bone spurs?
Back or neck pain is the most common sign of bone spurs. The joint becomes inflamed (swollen and tender) and the back muscles become tender.
Common symptoms are:
- Burning or tingling (pins and needles in the hands or feet)
- Dull pain in the neck or lower back when the person stands or walks
- Loss of coordination in a part of the body
- Muscle spasms or cramps
- Muscle weakness
- Radiating pain in the buttocks and thighs
- Radiating pain into the shoulders or headaches
Activity tends to make the pain worse. Rest tends to make it better. If the symptoms affect the back, the person may feel better leaning forward and bent at the waist as in leaning over a shopping cart or cane.
If there is severe pressure on the nerves, a person may have problems controlling his or her bladder or bowels.
How are bone spurs diagnosed?
After taking the patient’s medical history and performing a physical examination, physicians can rule out conditions that may have similar symptoms but different causes.
Tests that a doctor may order include:
- Electroconductive tests. These show the degree and seriousness of the spinal nerve injury.
- Computed tomography scans.
- Magnetic resonance imaging.
- X-rays to highlight any bone changes.
How are bone spurs treated?
Several approaches can be taken to treatment depending on the severity of the symptoms.
A conservative approach for persons with mild or moderate pressure on the nerves or spinal cord might include:
- Steroid shots to help reduce joint swelling and pain. The effects of these are temporary and may need to be repeated up to 3 total in a year.
- NSAIDS to reduce swelling, relieve pain and relax muscles for four to six weeks.
- Physical therapy and manipulation of joints to restore flexibility and strength, improve posture and reducing the pressure on the nerves.
If this approach isn’t successful, surgery may be needed, such as a laminectomy to remove bone spurs.
- Bone spurs are smooth, bony growths that form over a long period of time. They are a growth of normal bone that tends to occur as we age.
- The spurs themselves are not painful. Their effect on nearby structures, such as nerves and the spinal cord, can cause pain.
- Factors that contribute to bone spurs include aging, heredity, injuries, poor nutrition and poor posture.
- Treatments can include medication, physical therapy and rest. If those don’t work, surgery may be needed.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.
Not what you’re looking for?
Can you get rid of heel spurs? Treatment options and exercises
It is not possible to get rid of heel spurs without surgery. However, some figures suggest that heel spurs only cause pain in 5% of cases. If someone is experiencing heel pain, there may be another cause.
According to the American Academy of Orthopaedic Surgeons (AAOS), the most common cause of heel pain is plantar fasciitis, which occurs when the tissue that supports the arch of the foot becomes inflamed.
In this article, we look at what heel spurs are, how they relate to heel pain, and the treatments for heel pain.
Heel spurs are bony growths that extend from the heel bone to the arch of the foot. According to the AAOS, only 1 in 20 people with heel spurs will experience pain.
However, heel spurs do cause pain in some people. The symptoms of a heel spur can include:
- a bony protrusion
- tenderness on the bottom of the foot
Plantar fasciitis and heel spurs often co-occur. In 2012, researchers found that 89% of people with plantar fasciitis had heel spurs. Additionally, the authors of a 2015 review suggest that heel spurs may develop as a reaction to plantar fasciitis in some cases.
The symptoms of plantar fasciitis include:
- pain on the bottom of the foot, near the heel
- pain after a long period of rest or after sleep
- pain that gets worse when flexing the foot
- greater pain after, but not during, exercise
The only way to get rid of heel spurs entirely is by having surgery to remove the growths. However, doctors typically reserve surgery for cases that do not respond to any other treatments. According to the AAOS, surgery is a last resort because it can lead to chronic pain.
However, there are things that people can do to reduce heel pain and inflammation, such as:
- Rest: Activities in which a person’s feet hit a hard surface can make heel pain worse. A person with plantar fasciitis may temporarily need to reduce or stop activities such as running or aerobics.
- Cold therapy: Applying ice packs or rolling the foot over a cold water bottle for 20 minutes can help with foot pain by numbing the area and reducing swelling. A person can do this three to four times daily.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter (OTC) medications, such as aspirin or ibuprofen, can help with acute pain, but these drugs are not suitable for long-term pain relief. NSAIDs are not safe for everyone, so it is best to check with a doctor before taking them.
- Exercises: A doctor may be able to recommend some exercises and stretches to relax tight muscles in the feet and calves. If these are ineffective, they may make a referral to a physical therapist, who can devise a specific exercise routine for relieving heel pain.
- Supportive shoes: A person with heel pain may benefit from cushioned shoes, silicone heel pads, or custom-made orthotics. A podiatrist can provide supportive shoe inserts.
- Corticosteroid injections: A doctor may recommend steroid injections to help reduce inflammation and pain. However, too many injections can cause further problems, such as chronic pain.
More than 90% of people with plantar fasciitis improve within 10 months using nonsurgical therapies. If plantar fasciitis is the cause of a person’s heel pain, they may find that these nonsurgical approaches help.
A doctor can diagnose the cause of heel pain by performing a physical examination and X-ray to rule out other conditions, such as arthritis or fractures.
According to a 2015 review, physical therapy can help people with heel spurs improve their range of motion and keep their joints mobile. The AAOS recommend trying the following exercises for 4–6 weeks, under the supervision of a doctor.
To perform this stretch:
- Sit on the floor with the legs straight out in front.
- Wrap a towel around the ball of one foot and pull gently inward until there is a stretch.
- Hold the stretch for about 30 seconds and repeat 3 times.
- Repeat on the other foot.
Heel cord stretch
For this stretch:
- With the hands on a wall, place one leg forward with a slight bend in the knee.
- Place the other leg slightly behind the body and keep it straight.
- The heels should remain flat on the ground.
- Press the hips forward to feel a stretch in the calf and heel of the back leg.
- Hold the stretch for about 30 seconds.
- Switch the legs and repeat.
For this stretch:
- Sit on the floor with the feet flat on the ground and place a small towel in front of the feet.
- Grab the towel using the toes on one foot and bring it closer to the body.
- Relax the foot and then repeat 4 more times.
- Switch to using the other foot.
Golf ball roll
For this exercise:
- Sit in a chair and roll a golf ball under the painful foot.
- Continue for several minutes, without extending the leg too far from the chair.
- If the pain is in both feet, repeat with the other foot.
To perform this exercise:
- Sit in a chair with the feet not touching the floor.
- Write out the letters of the alphabet with the feet, using only small movements in the foot and ankle.
- Perform this exercise in one foot and then the other.
According to the American Podiatric Medical Association, heel spurs occur due to muscle and ligament strain in the foot. Repeatedly tearing or damaging the membrane that covers the heel bone leads to hard calcium deposits building up over time.
Heel spurs can happen as a result of the repetitive stress that some high impact exercises, such as running, place on the feet. Other causes and risk factors include:
- Biomechanical imbalance: Tight muscles in the calf or foot, high arches, and gait abnormalities can lead to heel spurs. Shoes that do not support or fit the foot well may also contribute to their development.
- Obesity: A review article notes that two meta-analyses found that a higher body mass index (BMI) and heel spurs are associated with chronic heel pain.
- Age: According to a 2014 study, large heel spurs are more common in people over the age of 40 years.
- Other conditions: Heel spurs are associated with arthritis and ankylosing spondylitis, as well as plantar fasciitis.
People can reduce the risk of heel pain by:
- wearing supportive shoes that fit well
- wearing shock-absorbing shoes when exercising
- warming up and stretching the legs and feet before exercise
- maintaining a moderate weight
Surgery is the only way to get rid of heel spurs entirely. However, as people with heel pain often have other conditions that cause pain, such as plantar fasciitis, they may find relief by following the general recommendations for reducing heel pain.
Rest, ice, NSAIDs, and physical therapy can help people with heel pain, and cushioned pads and shoes can reduce the impact of walking on the feet. In more severe cases, doctors may prescribe steroid injections or surgery.
People with heel pain should discuss their symptoms with their doctor, who can diagnose the cause of the pain and recommend the best approach.
Bone Spur | Michigan Medicine
What is a bone spur?
A bone spur (osteophyte) is a bony growth formed on normal bone. Most people think of something sharp when they think of a “spur,” but a bone spur is just extra bone. It’s usually smooth, but it can cause wear and tear or pain if it presses or rubs on other bones or soft tissues such as ligaments, tendons, or nerves in the body. Common places for bone spurs include the spine, shoulders, hands, hips, knees, and feet.
What causes bone spurs?
A bone spur forms as the body tries to repair itself by building extra bone. It typically forms in response to pressure, rubbing, or stress that continues over a long period of time.
Some bone spurs form as part of the aging process. As we age, the slippery tissue called cartilage that covers the ends of the bones within joints breaks down and eventually wears away (osteoarthritis). Also, the discs that provide cushioning between the bones of the spine may break down with age. Over time, this leads to pain and swelling and, in some cases, bone spurs forming along the edges of the joint. Bone spurs due to aging are especially common in the joints of the spine and feet.
Bone spurs also form in the feet in response to tight ligaments, to activities such as dancing and running that put stress on the feet, and to pressure from being overweight or from poorly fitting shoes. For example, the long ligament on the bottom of the foot (plantar fascia) can become stressed or tight and pull on the heel, causing the ligament to become inflamed (plantar fasciitis). As the bone tries to mend itself, a bone spur can form on the bottom of the heel (known as a “heel spur”). Pressure at the back of the heel from frequently wearing shoes that are too tight can cause a bone spur on the back of the heel. This is sometimes called a “pump bump,” because it is often seen in women who wear high heels.
Another common site for bone spurs is the shoulder. Your shoulder joint is able to move in a number of directions due to its complex structure. Over time, the bones, muscles, tendons, and ligaments that make up your shoulder can wear against one another. The muscles that allow you to lift and rotate your arm (called the rotator cuff) start at your shoulder blade and are attached to your upper arm with tendons. As these tendons move through the narrow space between the top of your shoulder and your upper arm, they can rub on the bones. Bone spurs can form in this narrow area that, in turn, pinch the rotator cuff tendons, resulting in irritation, inflammation, stiffness, weakness, pain, and sometimes tearing of the tendon. This condition, rotator cuff disorder, commonly occurs with age and/or repetitive use of the shoulder. It is also common in athletes, especially baseball players, and in people such as painters who frequently work with their arms above their heads.
What are the symptoms?
Many people have bone spurs without ever knowing it, because most bone spurs cause no symptoms. But if the bone spurs are pressing on other bones or tissues or are causing a muscle or tendon to rub, they can break that tissue down over time, causing swelling, pain, and tearing. Bone spurs in the foot can also cause corns and calluses when tissue builds up to provide added padding over the bone spur.
How are bone spurs diagnosed?
A bone spur is usually visible on an X-ray. But since most bone spurs do not cause problems, it would be unusual to take an X-ray just to see whether you have a bone spur. If you had an X-ray to evaluate one of the problems associated with bone spurs, such as arthritis, bone spurs would be visible on that X-ray.
How are they treated?
Bone spurs do not require treatment unless they are causing pain or damaging other tissues. When needed, treatment may be directed at the causes, the symptoms, or the bone spurs themselves.
Treatment directed at the cause of bone spurs may include weight loss to take some pressure off the joints (especially when osteoarthritis or plantar fasciitis is the cause) and stretching the affected area, such as the heel cord and bottom of the foot. Seeing a physical therapist for ultrasound or deep tissue massage may be helpful for plantar fasciitis or shoulder pain.
Treatment directed at symptoms could include rest, ice, stretching, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Education in how to protect your joints is helpful if you have osteoarthritis. If a bone spur is in your foot, changing footwear or adding padding or a shoe insert such as a heel cup or orthotic may help. If the bone spur is causing corns or calluses, padding the area or wearing different shoes can help. A podiatrist (foot doctor) may be consulted if corns and calluses become a bigger problem. If the bone spur continues to cause symptoms, your doctor may suggest a corticosteroid injection at the painful area to reduce pain and inflammation of the soft tissues next to the bone spur.
Sometimes the bone spurs themselves are treated. Bone spurs can be surgically removed or treated as part of a surgery to repair or replace a joint when osteoarthritis has caused considerable damage and deformity. Examples might include repair of a bunion or heel spur in the foot or removal of small spurs underneath the point of the shoulder.
Treating bone spurs in the shoulder is difficult. Even with surgery. – Caring Medical Florida
Ross A. Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C
Treating bone spurs in the shoulder is difficult
In our clinic, we attack the problem of bone spurs in the shoulder non-surgically. How we do this is by addressing the problems of the shoulder that is causing the formation of the bone spur in the first place. Shoulder instability. This is a shoulder looseness causing unnatural, destructive hypermobility in the shoulder leading to a situation of rapid degenerative osteoarthritis.
How the bone spur got there in the first place
- The shoulder forms bone spurs in a vain attempt to keep your shoulder from moving in a way it is not supposed to.
- When the shoulder becomes unstable or weak, bone spurs will form to help prevent the shoulder from hyper-extending, dislocating, or subluxing (falling out of place) and causing more damage to itself.
- The bone spurring is occurring as the body’s means to try to protect the shoulder.
Unfortunately, over time, the bone spurs themselves become the problem as they continue to grow and impede function. It is at this time, surgery is often recommended to shave down the bone spurs or a shoulder replacement surgery is considered.
Like many of the conditions that we see here at our clinic, bone spurs in the shoulder are the end result of years of degenerative shoulder disease and advancing osteoarthritis.
Like many of the conditions that we see here at our clinic, bone spurs in the shoulder are the end result of years of degenerative shoulder disease and advancing osteoarthritis. An MRI with a bone spur will also show, among many things, varying size tears of the different rotator cuff tendons, shoulder labrum tearing, and other abnormalities. The patient themselves will describe, years and years of doctor visits and an array of pain killers of varying strengths and potencies, chiropractic care, acupuncture, cortisone injections, and a daily diet of over-the-counter anti-inflammatories and painkillers. They will also tell us that they do not sleep, they function most of the day with one arm if they describe themselves as “lucky enough that it is in only one shoulder.” Some will also tell us that shoulder replacement is the last option and one that they have been putting off for years because they are primary care or support providers. They tell us about the disappointment in the failure of their physical therapy sessions. They tell us that once physical therapy fails and cortisone does not help, shoulder replacement is then “given the green light.”
Treating the bone spurs or the “osteophytes” on my MRI
I have learned to function without lifting my arms over my head.
Many people that contact our center are very educated and researched in their shoulder problems. They will have typically spent countless hours researching their shoulder problems. If they are like you, most of your online research came on days of particular discomfort or basically the bad days. They will also come on days following a doctor’s visit and a desire to better understand the doctor’s recommendations. What many do, like many with any injury, is alter the way they do things. How they sleep, how they function at work or in domestic chores to limit the amount of arm movement that will cause them pain or functional limitation.
For many people, this re-education of arm movements does help and over time, reduces pain. In some, the reduction of the movements that caused the bone spurs in the first place may result in the bone spur that stops growing. This is when physical therapy would be its most successful. Learning new movements and getting the strength to function in this new way.
Is arthroscopic surgery for bone spur removal and shoulder clean-up the way to go when physical therapy fails?
For some people, arthroscopic surgery for bone spur removal is highly successful. We usually do not see these people in our clinic. We see the ones that arthroscopic surgery for bone spur removal was not very successful and has made their situation worse. This article is for those people and to explains to people suffering from shoulder pain how this can happen. Here are some typical patient stories:
I had a cleanout surgery
I had a cleanout surgery, the main goal was to shave down the bone spurs. After the surgery, my shoulder pain was worse. I was told that my surgery was successful, the bone spurs were shaved down. My pain continued and now includes numbness all the way into my fingers. My shoulder subluxated constantly. Because of the numbness, I am bouncing back and forth between orthopedists and neurosurgeons. No one seems to have any answers for me.
The bone spurs are gone, but the shoulder pain remains
I lost a lot of range of motion, putting on my clothes, combing my hair, all big problems for me.
I lost a lot of range of motion, putting on my clothes, combing my hair, all big problems for me. My x-ray revealed that I had a lot of shoulder damage. The treatment plan was for cortisone and physical therapy. After a few months, I had no improvement. I was recommended to a shoulder specialist and not surprisingly I was told surgery should be considered because I had massive bone spurs. I agreed. Following the surgery, I had less use of my arm than before and now my shoulder routinely popped out of place. A return visit to the surgeon offered another recommendation for surgery. This time a reverse shoulder replacement.
Let’s point out again that many people obtain a great benefit from arthroscopic surgery for bone spur removal. These are not the people we see. The people we see are the ones with the stories.
I had surgery for bone spur removal. There is now nothing wrong with my shoulder except it is very painful
I had surgery and the bone spurs were removed from my shoulder. Following physical therapy, massage therapy, and a cortisone injection, I have a lot of post-surgical pain. Nothing my doctors are offering me now seems to be helping or will help. Now they are looking at me like I am crazy because my MRI is “beautiful” nothing is wrong. Nothing except my now limited range of painful motion.
For many people, are the only things holding the shoulder together are the bone spurs
What is happening here? Why didn’t the surgery work for these people? Simply the bone spurs, for many people, are the only things holding the shoulder together. When you remove the bone spurs, the shoulder has “nothing to hang on.” Below we will make a treatment recommendation of Prolotherapy injections that regenerate and strengthen the shoulder capsule soft tissue.
Treating bone spurs in the shoulder is difficult, as judged by the many surgical recommendations trying to solve the problem
Here is a brief list of surgical recommendations published by doctors at the University of California at Los Angeles (UCLA) in the journal Clinics in Sports Medicine. (1) In the first sentence of this paper, the doctors note: “The management of glenohumeral osteoarthritis is difficult in young, active individuals.”
Here are the summary learning points:
- After nonoperative management fails, arthroscopic debridement with concomitant procedures such as:
What you see in these treatments is “cutting away,” “removing,” “scraping, drilling.” You do not see repairing. This is why treating bone spurs in the shoulder is difficult with surgical treatments.
Bone Spurs and Shoulder Instability
A bone spur (more technically known as osteophyte) is an abnormal bony overgrowth that extends out from the normal bone.
The shoulder reacts in many ways to its own instability.
- First, the joint can swell in order to help keep everything in place.
- When that no longer works long-term, the body then recruits nearby muscles to help stabilize the joint. These muscles can be in a constant state of contraction as they try to stabilize the joint, but then also have to allow for regular movement. In the process, patients can develop painful muscle spasms (as it is not the muscle’s job to constantly contract to stabilize joints) from the extra load of work they are incurring.
The muscles may then start to degenerate and the body is left with one other option for stabilization: to start to overgrow bone tissue as a permanent way to stabilize the joint. This overgrowth of bone is the “bone spur” (as it typically spurs out from the joint). If left untreated, bone spurs can become very large and very painful. They may cause pain with certain motions (i.e. a shoulder bone spur could cause pain when it pinches on tissue every time you raise your arm over your head) or significantly limit your range of motion due to pain.
Shoulder Bone Spurs Treated with Prolotherapy at Caring Medical
What are we seeing in this image?
In this x-ray, a large bone spur in the shoulder is revealed. This x-ray is of a patient who is only in their thirties. This patient has significant pain and limitations in their range of motion or ability to move their arm around. Of note in this x-ray is that the patient has a lot of cartilage in the shoulder. While Prolotherapy injections may help with pain, the presence of the bone spur may require a recommendation for arthroscopic surgery.
Can Prolotherapy injections help?
Are these injections realistic in helping a bone spur without surgical intervention?
Recently, we had a young man come to see us at Caring Medical with shoulder pain and limited range of motion. His pain could be explained by various tendon and ligament injuries of the shoulder but the restriction of motion could not, thus an x-ray was ordered. As you can see on the x-ray (above), he has a huge bone spur on the bottom of his humeral head (essentially the “ball” that helps the shoulder rotated around the way it does). This could explain why his range of motion was so limited. The extra bony growth prevented him from fully moving his shoulder. While Prolotherapy can resolve pain in cases like this, some patients still may end up needing surgery to remove the bone spur and get back the full range of motion.
At Caring Medical, we see many patients whose only desire is to get out of pain. Had this been the case with this gentleman, Prolotherapy would be a great solitary treatment option by itself. However, at such a young age, he also desires a full range of motion to stay active for the rest of his adult life. In this case, surgery may be warranted to allow him greater motion while Prolotherapy will ease pain and treat the underlying cause: joint instability.
Prolotherapy is always a great option when it comes to chronic joint pain but if you have a significant restriction of motion in a joint, a plain and inexpensive x-ray may provide valuable information. It illustrates that “yes” sometimes surgery is needed! However, if you don’t treat the underlying cause of the bone spur (the joint instability), it will most likely come back.
If you have a bone spur in your shoulder, as evidenced by an x-ray or MRI, you have a few treatment options.
- If you do not have any pain associated with the spur, you can do nothing. Not all bone spurs are painful and require treatment.
- If you do have pain, however, you can take medications and/or do physical therapy to manage the pain.
- You also may get a surgical consult and possibly receive surgery to shave the bone spurs, resurface the bone, or replace the shoulder joint. This may be necessary depending on the size and/or the number of spurs.
- Lastly, you can receive Prolotherapy treatments to help stabilize the shoulder and ease pain. Prolotherapy is an injection technique used to stimulate the healing of injured tissue. While Prolotherapy itself cannot get rid of a spur, it can treat the underlying cause: joint instability. It can help to alleviate pain and allow for better shoulder range of motion as well, depending on the size and location of the spur. Physical therapy is also a great adjunct treatment to Prolotherapy for the proper management and treatment of bone spurs.
Platelet Rich Plasma Therapy (PRP) and shoulder instability
Danielle R. Steilen-Matias, MMS, PA-C narrates the video and is the practitioner giving the treatment:
- PRP or Platelet Rich Plasma treatment takes your blood, like going for a blood test, and re-introduces the concentrated blood platelets and growth and healing factors from your blood into the shoulder. The treatment is explained further below.
- In the shoulder treatment, I treat all aspects of the shoulder including the ligament and tendon injections to cover the whole shoulder.
- The patient in this video is not sedated in any way. Most patients tolerate the injections very well. The treatment goes quickly. However, we do make all patients comfortable including sedation if needed.
- This patient in particular comes to us for a history of repeated shoulder dislocations. His MRI findings showed multiple labral tears and rotator cuff problems.
- The patient complained of shoulder instability typical of the ligament and tendon damage multiple dislocations can do.
- With the patient laying down, treatment continues to the anterior or front of the shoulder. The rotator cuff insertions, the anterior joint capsule, and the glenohumeral ligaments are treated.
- PRP is introduced into the treatment and injected into the front of the shoulder. PRP is a form of Prolotherapy where we take concentrated cells and platelets from the patient’s blood and inject that back into the joint. It is a more aggressive form of Prolotherapy and we typically use it for someone that has had a labral tear, shoulder osteoarthritis, and cartilage lesions.
- PRP is injected into the shoulder joint and the remaining solution is injected into the surrounding ligaments in this case it was in his anterior shoulder attachments to address the chronic dislocations.
Questions about our treatments?
If you have questions about your pain and how we may be able to help you, please contact us and get help and information from our Caring Medical staff.
Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C
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1 Takamura KM, Chen JB, Petrigliano FA. Nonarthroplasty Options for the Athlete or Active Individual with Shoulder Osteoarthritis. Clinics in Sports Medicine. 2018 Oct 1;37(4):517-26. [Google Scholar]
This article was updated April 5, 2021
Treating Heel Spurs & Bone Spurs | Foot Health
- Health & Wellness
- Body, Mind & Spirit
What is a heel spur?
A bone spur (or osteophyte) is a small bony growth or collection of bony growths on or near the joints. When a bone spur occurs on heel, it is called a heel spur. They may or may not cause pain, and patients often confuse heel spurs with a related condition known as plantar fasciitis – inflammation of the band of tissue that stretches from the ball of the foot to the heel, forming the arch. Many people have a bone spur without ever knowing it, and about 70 percent of patients with plantar fasciitis who do have discomfort will also be found to have a heel spur when observed via X-ray. It is likely that a bone spur forms as the body tries to repair itself from repeated injury by laying down extra bone at the site of trauma. Plantar fasciitis is typically another result of such trauma. Heel spurs are most often seen in middle-aged men and women, but can be found in all age groups.
What are the symptoms of heel spurs?
Although they rarely cause pain on their own, bone spurs in the feet can lead to callus formation as tissue builds up to provide added cushion over the area of stress. Over time, wear and tear on joints may cause these spurs to compress neighboring ligaments, tendons or nerves, thus injuring tissue and causing swelling, pain, and tearing resulting in a bone spur.
When a patient has plantar fasciitis, on the other hand, the area underneath the foot becomes irritated and inflamed with swelling, local tenderness, and pain that comes with standing or walking – although any activities that involve weight bearing or stretching of the foot can cause problems. Symptoms are typically worse in the morning as the fascia of the foot often tightens overnight. As a matter of fact, the classic sign of plantar fasciitis involves pain with the first few steps after walking along the front and bottom of the heel. Pain can often move around the foot and worsen if people try to walk on the balls of their feet, since walking on the forefoot causes more tension in the fascia, which pulls on the heel and creates more discomfort.
What causes heel spurs?
Heel spurs can form when calcium deposits build up as a result of repeated strain placed on foot muscles and ligaments, as well as from abnormally stretching the band of tissue connecting the heel and ball of the foot. Repeated injury to the membrane that lines the heel bone can also cause problems as can repeated tight pressure on the back of the heel. The causes can range from excessive walking (especially if unaccustomed to walking), running or jumping to improperly fitted or worn-out shoes. Runners, volleyball players, and tennis players, people who do step aerobics or stair climbing for exercise, those with flat feet, pregnant women, the obese, diabetics, and those who wear poorly fitting shoes are all prone to developing heel spurs (and plantar fasciitis) more readily.
What are the conventional treatments?
Bone spurs rarely require treatment unless they are causing frequent pain or damaging other tissues. Because heel spurs and plantar fasciitis are so closely related, they are usually treated the same way. Symptomatic treatment involves rest, especially from the activity that is contributing to the condition and making symptoms worse (although this may not be easy to identify, as problems can manifest several hours or days after the harmful activity has occurred). If you discover the offending activity, ice is recommended immediately following it. Stretching of the calf muscles after a short warm-up is also a good idea and can be helpful. Stretching exercises that gently lengthen the calm muscle will relax the tissue surrounding the heel and should be done several times a day, especially in the morning and after prolonged sitting.
Another temporary treatment for spurs is taking over-the-counter or prescription-strength anti-inflammatory medications, but these can cause side effects with prolonged use, particularly gastrointestinal upset, ulcers, and bleeding. Deep tissue massage, taping, and other physical therapy modalities can also be helpful. Arch support is highly recommended, either with shoe inserts or custom orthotics made by podiatrists. If pain continues, a steroid injection at the site of pain may be recommended; however, many physicians do not like injecting around the heel. The side effects of steroids injected in this area can be serious and worsen symptoms. Complications can include fat necrosis (death of fatty tissue) of the heel and rupture of the plantar fascia.
Sometimes a bone spur can be surgically removed or an operation to loosen the fascia – called a plantar fascia release – can be performed. This surgery is effective in the majority of people who do not get relief with conservative treatment, but symptoms may return if preventative measures (wearing proper footwear, shoe inserts, stretching, etc.) are not maintained.
What therapies does Dr. Weil recommend for heel spurs?
- Exercise: If you think your pain is exercise-related, change your exercise routine, environment, or footwear, and emphasize movements and/or body parts that do not cause pain.
- Mind/Body: Occasionally foot pain can be related to stress. The body may respond with generalized tension that contributes to pain in many areas, including the feet. Hypnosis and guided imagery are worth exploring if an anatomical problem is not apparent.
- Supplements: Natural anti-inflammatories can be just as effective as ibuprofen or other over-the-counter pain relievers with fewer side effects. Try one of the following:
- Ginger (Zingiber officinale) standardized to 5-6 percent gingerols and 6 percent shogoals, take one to two 500 mg tablets three to four times daily
- Turmeric (Curcuma longa) standardized to 95 percent curcuminoids, take 400-600 mg three times daily.
You can also take the pressure off your heel with a donut-shaped heel cushion or a heel-raising pad placed in your shoe. Wearing properly fitted shoes appropriate for each activity and purchasing new footwear when necessary are key.
Reviewed by Benjamin S. Gonzalez, M.D., May, 2016.
Heel spur treatment
So what is a heel spur?
Nothing more than inflammation of the fascia (hence the name – plantar fasciitis), which connects the calcaneus and metatarsal bones. Thanks to this design, our foot retains its correct shape and smoothly absorbs while walking, softening the gait.
Causes contributing to the appearance of a “heel spur”:
- flat feet , this pathology leads to a redistribution of the load on the arch of the foot, resulting in inflamed plantar fascia at the point of attachment to the heel.
At the Ram-Clinic Pain Treatment Center, flat feet are detected in the early stages, corrective treatment is carried out to further the correct positioning of the foot and the prevention of such diseases as “heel spur” and other pathologies of the musculoskeletal system.
- overweight , this pathology leads to a significant load on the foot;
- Excessively intense physical activity , which are received by athletes-runners for long distances, amateur tourists, practicing hiking long distances without rest and in the wrong shoes;
- various inflammatory, vascular, degenerative diseases of the lower extremities : deforming arthrosis, diabetic polyneuropathy, rheumatoid arthritis, etc.
All these negative phenomena lead to microscopic tears in the place where the plantar fascia attaches to the calcaneus. Repeated microtrauma of the fascia (especially the point of its attachment to the calcaneus) leads to a chronic inflammatory process as a result of which a pathological bony outgrowth of the calcaneus appears – the heel spur, which causes pain.
Symptoms of the “heel spur”: burning, excruciating pain in the heel, many patients describe it “as if stepping on a nail.”After rest, especially after a night’s sleep, relief comes, but the pain returns again with another load on the lower limbs. And the intensity of pain does not depend on the stage of the disease.
If the “heel spur” is not treated, painful sensations begin to appear even with the smallest load on the foot. A person begins to adapt when walking, involuntarily unloading the heel area, thereby overloading the forefoot. In more advanced cases, you can see how patients with such a pathology literally walk on their toes.As a result of uneven load on the foot, the disease can be complicated by transverse flat feet and other problems with the ankle, knee and even hip joints.
Many patients are in no hurry to seek qualified medical help, trying to solve the problem with folk remedies, which aggravates their condition, continuing to injure the plantar fascia.
In the Pain Treatment Center of the PAM Clinics, heel spur treatment is carried out with the most modern method of shock wave therapy (SWT) using equipment with Dornier Aries electromagnetic emitters and a unique system of intelligent wave focusing (Smart Focus) for orthopedics and traumatology.
Let’s see what is the advantage of this method in relation to drug blockade and surgical treatment:
- drug blockade : injection of corticosteroid drugs into the affected area. This method brings relief for a short period of time. Continuous administration of such drugs is contraindicated, because leads to leaching of calcium from bone tissue and, in the future, to osteoporosis and even to aseptic necrosis of bone tissue.And the cause is still not eliminated;
- Surgical treatment in the surgical department of the hospital : The operation is the most radical method of treating a heel spur. But as you know, any operation is a long process of recovery and rehabilitation, and success in such treatment is not always achieved, moreover, relapses often occur.
- Shockwave therapy (SWT) treatment : by far the most effective method, according to statistics, it accounts for more than 90% of ill-treatment compared to other methods and does not have any side effects or contraindications.
How does a shock wave work?
A shock wave is an acoustic wave that delivers energy to a painful area and skeletal muscle tissues in the subacute, subchronic and chronic stages of the disease. Shock waves are characterized by a specific pulse shape and pressure, which usually ranges from 1 to 5 bar, which allows for gentle therapy, while exerting a stimulating effect and launching healing, reparative and restorative processes in biological tissues.
If we consider the treatment of the heel spur specifically, then with the help of a shock wave, the destruction of calcified fibroblasts occurs.
Calcification most often leads to micro tears and other tendon injuries. Shock waves “break” the formed calcifications, which are further removed through the lymphatic system of the body, and, thus, the condition of the tendons improves.
It is also important to note that UHT has not only a point effect on the affected areas, but also has auxiliary healing properties on the body.So, in the zone of influence of waves, metabolic processes are improved, there is a significant stimulation of blood flow, especially in the capillaries, which contributes to a faster resorption of calcium salts, areas of fibrosis and stimulates tissue regeneration, which contributes to the speedy recovery of the patient.
How the procedure itself is carried out:
- a special gel is applied to the area of exposure to the shock wave, a small-sized applicator is installed directly above the affected area at the desired angle, which transmits impulses of sound waves to a depth of 7 cm.
Treatment of a heel spur with UHT usually consists of 5-7 sessions of 15-20 minutes each, which is best done in a regimen with breaks of 2 to 4 days. In 1 out of 10 patients, a temporary increase in pain is possible approximately 6-8 hours after the procedure, however, after 2-3 days, the intensity of pain decreases and further treatment can be carried out.
Advantages of UHT:
- after 1 session there is a significant decrease in pain;
- Good patient tolerance;
- practically has no side effects and contraindications;
- Outpatient treatment without surgical interventions, without the use of non-steroidal anti-inflammatory drugs and corticosteroids, while maintaining social activity;
- High rate of recovery compared to other treatments for plantar fasciitis.
Heel spur treatment with wave therapy
Calcaneal spur is a bone growth, osteophyte in the area of the calcaneus, namely in the lower or lateral part of it. Usually, this growth has the shape of a beak, thorn, tubercle, hook and is determined on an x-ray. Contrary to popular belief, this bone defect is not only a problem for the elderly, but young and middle-aged patients turn to the doctor with it.
The calcaneal spur is a direct consequence of plantar fasciitis, an inflammatory process in the soft tissues at the site of attachment of the plantar aponeurosis (a wide tendon plate that protects the muscles of the foot) to the heel bone.Against the background of inflammatory changes, the aponeurosis coarsens, contracts, injuring the periosteum covering the calcaneal tubercle. Irritation of the periosteum leads to stimulation of local growth of bone cells (bone growth in width is carried out at the expense of the cells of the periosteum), the marginal growth of the bone (osteophyte), otherwise called the heel spur, is formed.
The most common developmental factors are degenerative-dystrophic processes in the musculoskeletal system that develop with age.Their appearance in young and middle-aged people is facilitated by factors such as anatomical features, irritation of the heel bone periosteum during exercise (running, walking using the wrong technique, on a hard surface, prolonged static standing position, high arch of the foot, overweight, narrow uncomfortable shoes etc.), micro-tears of the plantar fascia.
There is a high risk of heel spur formation with existing foot deformities (planovalgus deformity, longitudinal and transverse flat feet), with chronic diseases of the musculoskeletal system – ankylosing spondylitis, gout, arthritis, as well as with specific sports loads.
Symptoms of the heel spur
The main symptom is pain in the heel that appears at the beginning of walking (“starting” pain) after sitting or lying for a long time, for example, after a working day in a sitting position, when getting out of bed after sleep. As you move, the pain subsides somewhat. Over time, heel pains acquire a constant exhausting character, are observed not only during movement, but also at rest, significantly limit motor activity, and reduce the quality of life.
Depending on the prevalence of the inflammatory process and the extent of bone growths, pain can be burning and sharp (patients describe them as a “nail in the heel”) or “spread” over the entire heel and be moderate. Due to constant discomfort, patients try not to step on the heel, therefore, gait changes significantly.
Sometimes heel spurs do not give any symptoms and do not give a person any anxiety.
The listed symptoms are the reason for contacting a surgeon, orthopedist, traumatologist.
The diagnosis is made on the basis of the results of X-ray and ultrasound: the actual bone growths are visible on the X-ray, ultrasound examination of the soft tissues of the foot shows the presence of an inflammatory process.
Heel spur treatment
For pain relief, reduction of edema and inflammation, non-steroidal anti-inflammatory drugs (NSAIDs) are used – for oral administration and local application, but it is not always possible to achieve a pronounced analgesic effect.This is due to the high density of the tissues of the sole and their poor blood supply, which makes it difficult for drugs to penetrate. Injection of hormonal agents (cortisone, hydrocortisone, diprospan, phlosterone) is practiced – heel blockade, but this method of treatment should be combined with physiotherapy.
Physiotherapeutic methods of influence with a heel spur are recommended in the first place, since they are highly effective and, in combination with other measures (exercise therapy, drugs, orthoses), provide the patient with the safety of motor activity.
Among the listed methods, extracorporeal shock wave therapy (ESWT), phonophoresis, laser therapy, magnetotherapy are currently recognized as the most effective for heel spurs.
ESWT is carried out with a confirmed diagnosis of a heel spur (radiographically). The method is based on the action of acoustic shock waves with high amplitude and short pulse duration. The procedure is painful, but at the end, a pronounced analgesic effect is observed, and the full course contributes to a significant improvement in the patient’s condition, since the shock wave effect leads to the destruction of calcifications, tissue regeneration and a decrease in the inflammatory process.In some cases, the procedure provokes an increase in pain, therefore, it is necessary to combine ESWT with blockades or other methods of physiotherapy.
Laser therapy is also indicated for heel spurs. Various pulsed laser emitting heads (of several spectra) are used, some of which operate in the mode of drug administration (lasertophoresis). High-intensity laser therapy (HIL), which has not yet become widespread (due to the high cost of equipment and the need for personnel training), is especially effective.
Phonophoresis – the introduction of drugs using ultrasound. More often, hydrocortisone ointment is used, distributing it over the site of the pathological process with a sensor similar in appearance to the sensor of an ultrasound machine. After the end of the procedure, the foot is isolated for a while with a plastic wrap for the final absorption of the ointment. The technique is absolutely painless.
Magnetotherapy in the local version (low-frequency alternating magnetic field) has a variety of positive effects: primarily analgesic, anti-inflammatory, decongestant.Due to the increased blood flow and metabolic processes in the area of influence, the symptoms of the heel spur decrease from the very first procedures. The advantage of the method is the ability to carry out therapy at home (unlike the others listed above). A pronounced therapeutic effect can be achieved by a combination of magnetic therapy with the use of other methods of physiotherapy, drugs, and special gymnastics.
If the above methods of treatment are ineffective, shortwave X-ray therapy is used.Focused X-ray radiation has a pronounced analgesic effect, but it carries a certain radiation load.
With the ineffectiveness of conservative treatment methods and increased symptoms, surgical intervention is possible. Basically, minimally invasive operations are performed (endoscopic removal of the heel spur under X-ray control, percutaneous removal, using a laser, etc.). Such interventions are successful in the overwhelming majority of cases, relieve pain, but it is often difficult for patients to decide on an operation.
Special exercises are recommended to improve circulation to the affected area and stretch the plantar fascia. Performed regularly and in accordance with the methodology, the exercises help to improve the patient’s condition, expand the possibilities of movement.
As a result of therapeutic gymnastics, the fascia stretches and becomes more elastic and strong, the likelihood of ruptures and the development of microinflammation decreases.This becomes the basis for pain relief and prevention of plantar fasciitis and heel spur in the future.
Orthopedic devices, including night orthoses, special insoles, tapes, help to find the foot in a certain position (while walking, resting, sleeping), prevent the further development of the pathological process. When choosing orthoses, the help of an orthopedic specialist is needed.
Prevention of the development of a heel spur is considered to be compliance with the general requirements:
- leading an active lifestyle;
- Getting rid of excess weight and other factors that negatively affect the condition of the foot;
- timely treatment of joint diseases;
- correction of foot deformities and movement prevention (exercise therapy).
There are no specific preventive measures. External use of ointments, creams and other drugs with medicinal or biologically active substances does not prevent the development of pathological changes in the musculoskeletal system of the foot.
Heel spurs, heel spur treatment | Spur treatment in Izhevsk
When unpleasant sensations and even acute pains begin to bother in the heel area, treatment of a heel spur is often required. A heel spur is a bony growth on the surface of the heel bone, protruding in the form of a thorn and squeezing soft tissue.
Causes of the heel spur
A heel spur is caused by calcium deposits on the lower part of the calcaneus, as well as due to increased stress on the heel area, muscle and ligament strain, plantar fascia traction and ruptures of the membrane covering the calcaneus. It is in those who experience constant stress on the heel area that spurs form on the heels, the treatment of which is important to start immediately.
It is likely that you may need heel spur treatment if:
- You have flat feet,
- You have an irregular or impaired gait,
- regularly run and jump on hard surfaces,
- wear uncomfortable and low-quality shoes,
- are overweight.
Among the risk factors that provoke the treatment of spurs are old age, diabetes and flat feet.
Symptoms of the disease
The most common symptoms of plantar fasciitis that require treatment for spurs are:
- Heel pain,
- morning pains that subside with movement,
- pain after vigorous physical activity and sports.
The pains are like a pin pricked in the leg.
The most effective methods of treating a disease in which the patient is worried about the heel spur are:
- shock wave therapy,
- taking anti-inflammatory drugs
- reduction in physical activity,
- physical therapy classes,
- special orthopedic shoes,
- laser therapy.
It is shock wave therapy that is highly effective, capable of accelerating the healing process.If you are concerned about spurs on your heels, treatment should be started immediately. In most cases, modern techniques can eliminate the cause of the disease without the need for surgery.
You can make an appointment with a surgeon or orthopedist for the treatment of a heel spur through the window of our website “Appointment” or by phone 8 (3412) 65-51-51.
Plantar (plantar) fascia is a very strong, dense connective tissue membrane that starts from the tuberosity of the calcaneus and attaches to the heads of the metatarsal bones.The function of the plantar fascia is to maintain the longitudinal arch of the foot, just as the bowstring supports the bow in the flexed state. When a person stands on a hard surface, a force is exerted on the plantar fascia approximately equal to half of his body weight. This force is aimed at reducing the curvature of the transverse arch of the foot. According to the laws of biomechanics, the greatest tension of the tissues of the plantar fascia occurs at the place of its attachment to the tubercle of the calcaneus. As a result, micro-tears of the fascia can occur in this area.Normally, such microfractures heal spontaneously and are not accompanied by the development of inflammation and significant morphological changes. However, in some patients, chronic microtraumatization of the fascia leads to the development of aseptic (non-microbial) inflammation and the appearance of chronic pain syndrome. As a compensatory reaction of the body in the zone of chronic inflammation of the fascia, bone outgrowths (heel spurs) can form. On x-ray examination of the heel area, they look like pointed spines.
The appearance of heel pain can be due to several reasons. In some cases, a sufficiently large heel spur, constantly traumatizing the surrounding tissue, can become an immediate source of pain. However, this condition is rare. In most cases, the immediate cause of pain is plantar fasciitis, a chronic inflammation of the plantar fascia. With age, degenerative changes can occur in the plantar fascia.In addition, in older people, the thickness of the subcutaneous fat tissue in the heel area, which is known to have a shock-absorbing function, decreases. Chronic pain can also be caused by irritation of the small nerve trunks that run in the heel area. In many patients, the true cause of pain remains unrefined, since the treatment of heel pain for all these pathological processes is the same.
The main symptom of plantar fasciitis is pain in the heel region, which occurs or worsens when the body weight is transferred to the affected leg.The most severe pain sensations are expressed in the morning, at the first steps after a night’s sleep.
Diagnosis: heel spur
The diagnosis of plantar fasciitis is established after analysis of the patient’s complaints and physical examination. There are several diseases that are manifested by heel pain, therefore, when diagnosing, it is necessary to exclude the presence of these diseases. Radiography allows to exclude stress fracture of the calcaneus, as well as to reveal the presence of heel spurs.In most cases, no other instrumental imaging techniques are required. To exclude some rheumatological diseases (rheumatoid arthritis, Reiter’s syndrome, ankylosing spondylitis), one of the symptoms of which is heel pain, laboratory diagnostic methods are carried out (serological and biochemical blood tests). These rare systemic inflammatory diseases in some cases may debut with heel pain, while other symptoms join later.
Treatment of plantar fasciitis begins with the selection of comfortable shoes. To reduce the pressure when walking on the heel area and maintain the longitudinal arch of the foot, patients are advised to use orthopedic insoles-instep supports and special soft bagel-shaped inserts that are glued to the insole in the heel area. The use of such orthopedic products allows to reduce the load on the plantar fascia, to slow down the development of degenerative changes in it.With severe pain syndrome, the use of non-narcotic analgesics (paracetamol, aspirin, analgin) and non-steroidal anti-inflammatory drugs is indicated. The most effective method of treating plantar fasciitis is a therapeutic blockade with a suspension of glucocorticoid drugs (hydrocortisone, diprospan, kenalog). These drugs have a pronounced anti-inflammatory effect, which leads to a rapid abatement of local inflammation and relief of pain. However, it must be remembered that the unreasonably frequent administration of glucorticoids leads to atrophic changes in the subcutaneous fatty tissue of the calcaneal region, which can lead to the progression of the disease in a few years.
Shock wave therapy
Shockwave therapy is the best today that heals a spur. The procedure significantly reduces pain sensitivity, as well as loosens and eliminates ossified areas and improves blood circulation. Shock wave therapy makes it possible to treat the heel spur effectively and in a short time. In the Likon-Plus clinic, heel spur treatment is carried out on a specialized shock-wave apparatus PiezoWave .The procedure is a hardware method for treating plantar fasciitis. The analgesic effect on the sore point is noted after about 300-500 impulses. Immediately after the procedure, it is recommended to limit physical activity on the affected joint, wearing orthoses during the course of treatment.
A full course of shock wave therapy for the treatment of heel spurs and other diseases is 5-10 sessions.
Strictly as prescribed by a doctor
Heel spur – symptoms, treatment, causes of the disease, the first signs
Heel spur is a spine-shaped bone growth at the site of attachment of the plantar fascia to the heel bone or at the site of attachment of the Achilles tendon.
Approximately 10% of patients who complain of disorders of the musculoskeletal system experience discomfort due to heel spurs. The spurs are “pulled out” following the tendon apparatus of the foot. The arch of the foot is formed by the ligaments: the calcaneonavicular ligament, the plantar aponeurosis and the long plantar ligament. The arch of the foot also includes the muscles of the foot and lower leg, which are active holders of the arch. Ligaments, unlike muscles, are passive holders of the arch of the foot. One of the causes of spurs is chronic trauma.In 90% of cases, heel spurs occur in people with flat feet, in which the distribution of the load on the tendons of the arch of the foot changes. The plantar aponeurosis is in constant tension, and the tendons are known to be poorly stretched. As a result, even the separation of some fibers of dense connective tissue from the heel bone is possible. The more inert bone tissue lends itself to reorganization and is pulled out following the tendons. Athletes who frequently injure the area of attachment of the calcaneal tendon to the heel bone may develop spurs.With a high and prolonged load on the legs, due to the costs of the profession, reorganization of the bone tissue is also likely. Wearing high-heeled shoes for a long time can bring troubles. It is this fact that explains the greater number of complaints among women about discomfort in the area of attachment of the plantar aponeurosis to the heel bone.
Metabolic disorders such as gout also increase the risk of heel spurs. The reorganization of bone tissue also contributes to the deterioration of the blood supply to the lower extremities.Such disorders can be obliterating endarteritis (an inflammatory disease with gradual closure of the artery), the presence of atherosclerotic plaques in the arteries of the lower extremities.
Chronic inflammatory diseases of the joints also contribute to the development of heel spurs. These include: ankylosing spondylitis (ankylosing spondylitis), arthritis and polyarthritis.
In 20% of patients, heel spurs are bilateral.
Patients with heel spurs often complain of burning pain when walking. This feeling has been compared to the feeling of a nail in the heel. And the above phenomenon was called calcanodyne. A characteristic feature of the disease under consideration is “starting pain”. This symptom is manifested by severe pain when loading the feet after sleep, prolonged sitting. Then the pain syndrome decreases, but by the end of the day the pain becomes stronger than the daytime. Pain can appear unexpectedly, often paroxysmal, then become chronic.
During a medical examination of the calcaneal region, no pathological formations and processes were detected visually and palpably. Only after pressing on the plantar part of the heel and squeezing the heel bone does the patient complain of pain.
Localization of pain can be different: the whole heel region or only part of it can hurt, exclusively from the outside of the calcaneus region. The involvement of the branches of the tibial and sural nerves in the inflammatory process can aggravate the pain syndrome.
Patients try to relieve the heel when walking. In this case, the load is transferred to the socks or to the outer side of the foot.
The size of the heel spur does not affect the intensity of pain. The evidence is patients in whom changes in the calcaneus were discovered by chance during X-ray studies, while the spurs could be large.
It follows from this that the pain syndrome and clinical manifestations depend not on the presence and size of the heel spur, but on the inflammatory process in the soft tissues of the foot.These processes include: inflammation of the deep bursae, inflammation of the plantar fascia, etc. The inflammation causes the remodeling of bone tissue and, as a result, the appearance of a heel spur.
The diagnosis of a heel spur is advanced on the basis of clinical data and the results of X-ray and ultrasound studies.
Studies using ultrasound can determine one of the possible reasons for the development of bone remodeling.With the help of ultrasound of the soft tissues of the foot, the signs of plantar fasciitis are well determined. Its role in the development of heel spurs has been described above.
X-ray images show the result of the reorganization of the calcaneus bone tissue, which take on various shapes: hook-shaped, subulate.
Currently, conservative therapy is the priority treatment for patients with heel spurs.It includes the use of non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy (magnetic, laser therapy, and phonophoresis with hydrocortisone). Another important aspect in conservative treatment is the unloading of the painful area of the arch of the foot. To do this, you need to purchase individual orthopedic insoles with internal and external longitudinal arches, as well as a soft heel pad. You can purchase a temporary remedy: a heel pad with a recess or a hole in the center.Treatment is aimed at eliminating inflammatory processes. It is carried out on an outpatient basis.
In case of ineffectiveness of conservative therapy, they resort to more serious methods of treatment. These include injections of hormonal drugs directly into the focus of inflammation, namely, at the place of attachment of the plantar ligament or Achilles tendon to the heel bone (depending on the localization of the inflammatory process, determined by ultrasound). This therapy can lead to serious complications.The most unpleasant of them is soft tissue necrosis at the injection site.
Extracorporeal shock wave therapy (SWT) is a new effective method of treatment. Considered as an alternative to surgical removal of spurs. Ultrasound of a certain frequency affects exclusively bone formation. The procedure is effective even in the later stages of the disease. Extracorporeal shock wave therapy reduces the intensity of pain, destroys the salt deposits that form the spur, improves blood circulation in the fascia, and helps to reduce the intensity of the inflammatory process.There are also a number of contraindications: pregnancy, acute infectious diseases, cancer, thrombophlebitis of the veins of the lower extremities, injuries of the heel region. After the third procedure, in 90% of patients, the disease goes into remission and does not bother for a long time.
This section contains several examples of medicines used in the treatment of this disease. Please follow the recommendations and prescriptions of your doctor.
Ketoprofen – route of administration: intravenous injection. Non-steroidal anti-inflammatory, analgesic and antipyretic agent. Does not affect the function and structure of the joints. It penetrates well into the synovial fluid, which is an indisputable advantage for eliminating the inflammatory process in the joints and ligamentous apparatus.
Diclofenac – available in a convenient topical form (gel). Non-steroidal anti-inflammatory agent. Well eliminates the inflammatory process.
Cortisone – used for local injections. Glucocorticosteroid. The anti-inflammatory effect is due to the inhibition of phospholipase A 2 , which is involved in the synthesis of inflammatory mediators.
The following remedies from the people are a kind of physiotherapy carried out at home. Do not ignore the therapy prescribed by your doctor.
- One way is to warm it up with laundry soap.First, you need to grate a bar of soap on a fine grater, melt in a water bath. Then put the resulting mass on a bandage and wrap in polyethylene. We fix the product on the leg and wrap it in a warm thing. The procedure must be repeated daily until the pain stops.
- Warming agent again, but with salt. The salt must be heated in the oven, then poured into a cloth bag. Apply to the area of concern until the contents of the bag have cooled completely.
- Warm cakes made from clay or from a mixture of honey and salt can also help relieve heel spur symptoms.It is recommended to steam your legs well before the procedure.
The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, see your doctor.
- 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 s
- KASINETS S.S. Department of Internal Medicine FPO State Institution “Lugansk State Medical University”.- New in the treatment of heel spur 2012.
- Vorotnikov A.A. Extracorporeal shock wave therapy in the treatment of tendopathies of the upper and lower extremities in patients with aggravated somatic status / A. A. Vorotnikov, A. N. Tsymbal, A. D. Konchevskaya // Med. vestn. North Caucasus. – 2012. – No. 2. – P. 73–75.
- Blokhin V. N. Calcaneus spurs / V. N. Blokhin, T. P. Vinogradova // Orthopedics and Traumatology. – 1997. – No. 1. – P. 96.
- Tsymbal A.N. Complex treatment of heel pain syndrome.N. Tsymbal, A. V. Tsymbal // Postgraduate Doctor. – 2012. – T. 5, No. 2. – P. 256–261.
Your comments on symptoms and treatment
Plantar fasciitis (heel spur)
Plantar fascia attaches to the calcaneus and five metatarsals of the forefoot. The fascia has two functions: to support the longitudinal arch of the foot and to prevent over-pronation.
If the pronation of the subtalar joint is impaired, the plantar fascia, which is tightly stretched even in a normal state, is further stretched and twisted, trying to prevent excessive pronation.
Excessive loading over time leads to the “pulling” of the bone membrane – the periosteum – from the bone itself. This disease is called periostitis (inflammation of the periosteum). When you get out of bed in the morning, the pain can be sharp. This is because the periosteum resembles a velcro fastener. The day before, the periosteum tore off the calcaneus. At night, while you sleep, she tries to join her again, but at the first morning step she starts to come off again. If this happens regularly, it hurts so much that you cannot do without medical attention.Depending on the qualifications and experience of the doctor, you can be given different diagnoses – from plantar fasciitis to (oh, horror!) Heel spurs. We’ll talk about it later.
Imagine trying to pull out a tuft of hair. This is a direct analogy to the discomfort experienced with plantar fasciitis.
Plantar fasciitis usually develops when the plantar fascia is overstretched, causing the periosteum to “tear” away from the heel bone. This is an attempt to prevent excessive pronation of the foot.However, impaired pronation is not the only reason for this condition. A foot with a high arch, with impaired mobility, creates additional problems for the plantar fascia. In addition, in older people, plantar fascia loses its elasticity, increasing the load on the area where the fascia meets the calcaneus. With inflammation of this part of the foot, plantar fasciitis develops.
Plantar fasciitis is often confused with a heel spur.
People do not suffer from a heel spur because a heel spur does not hurt.Spurs appear as a reaction to a painful situation, as an attempt to reduce discomfort.
A heel spur is not a spur at all. On closer inspection, it looks more like a scallop, although on a 2D X-ray it may look like a spur. Regardless of its appearance, its development is explained by a simple theory of muscle movements – kinesiology. The bone conforms to the load it is subjected to.
If the plantar fascia is tightly pulled in the area of attachment to the heel bone, the bone begins to grow over time in the direction of the pull.
This is a natural way to protect the bone from periosteal strain. Thus, the inflammation around the problem area disappears. Unfortunately, this is not always the case.
In any case, it is the periosteum area that hurts, not the bone, because there are no nerve endings in the bone tissue. Studies show that if there are spurs on both legs, pain is less pronounced with a longer outgrowth.
A classic characteristic of plantar fasciitis is pain in the inflamed area on the first attempt to step on the foot in the morning.After a few minutes of walking, the pain decreases and normal daily activities are possible without much discomfort.
However, if you sit down or lie down for long periods of time during the day, the pain will return when you step on your foot again. This is because the plantar fascia will again begin to pull the periosteum away from the bone.
Remember the Velcro analogy? One part of it (periosteum) overnight reattaches to the fibers of the other part (plantar fascia) during the natural healing process.Then in the morning one step and – break! The two pieces are torn apart again. The periosteum tries to connect to the bone whenever the foot is not on the ground. The healing process is grossly disrupted every time the patient stands on his leg, transferring weight to the problem area. The periosteum breaks off again, causing severe pain. After a very painful first moment, the pain subsides somewhat, becoming quite bearable when walking. Compared to the first steps, further pain is perceived as a trifle.
There is also a second theory. At night, with complete rest, the plantar fascia contracts. Therefore, they are very tense and painful during the first morning exercises. Then they naturally stretch, the tension on the periosteum decreases, the pain subsides, and the person continues to walk. This is another plausible explanation for why the pain goes away after a few minutes of walking.
Plantar fasciitis treatment is a dual procedure. On the one hand, you need to deal with inflammation.On the other hand, to eliminate the cause of the disease. In simple cases, it is enough to remove the cause of irritation, and the inflammation will go away on its own. If the inflammation is severe, it requires more vigorous action.
For many years, it has become common to treat plantar fasciitis with cortisone injections and local anesthetics. This often provides short-term relief for 6 to 12 weeks, then the illness returns because the cause has not been eliminated. Due to the side effects of cortisone, these injections are given in less than 5% of cases.In addition, it is now common to prescribe anti-inflammatory pills rather than cortisone and similar steroids. However, all anti-inflammatories have side effects that may outweigh the benefits in the long term. Moreover, no anti-inflammatory agent will change impaired pronation. However, if plantar fasciitis is the result of an injury, anti-inflammatory medication will help because the patient does not have an underlying biomechanical disorder of the foot.
In many cases where anti-inflammatory drugs are undesirable, physiotherapy can help.The most commonly recommended shockwave therapy and TR – therapy. However, physiotherapy alone does not solve the problem. In those few cases, when the imperfection of biomechanics does not require special orthopedics, a medical orthosis – an instep support to support the arch of the foot makes movement quite possible during the recovery period.
But over-pronation remains the culprit in most cases of plantar fasciitis. And the treatment here is an individual selection of orthopedic aids.
90,000 prices, reviews, indications and contraindications – CDB RAS
Shock wave therapy is a method of treating pathologies and injuries of the musculoskeletal system.
Shock wave therapy is used in orthopedics, traumatology, cosmetology, cardiology and urology. The course can be from 3 procedures, if rehabilitation after an injury is needed, and up to 9, if a chronic disease is being treated.
How does the method work, and when is it shown to be used?
The method was developed relatively recently, initially it was developed in Switzerland. Shockwave therapy is an alternative to surgical and other ineffective methods.
The method is based on the use of a shock wave resulting from high-frequency vibrations and exposure to individual areas. The impact force is an adjustable value.
The method is based on the use of a shock wave resulting from high-frequency vibrations and exposure to individual areas.The impact force is an adjustable value.
UHT therapy can be used to remove excess calcium salts, which occurs in degenerative pathologies, inflammatory processes and injuries.
What gives the use of the technique:
- Promotes the restoration of the motor ability of the joints;
- Relieves pain syndrome;
- Increases muscle endurance;
- Improves blood circulation in problem areas;
- Destroys fibrous formations.
Currently, the list of diseases amenable to treatment thanks to the use of shock wave therapy has expanded. Now it is used:
- For crushing kidney stones;
- Treatment of joints;
- Elimination of cellulite.
In urology, this technique is also used – with prostatitis, the prostate gland is freed from the stuck secretion.
In cardiology, atherosclerotic plaques are destroyed and blood circulation is restored.
The apparatus for creating a shock wave is used by doctors of sports teams.
How is the musculoskeletal system treated?
The technique is used in the treatment of:
- Common inflammatory processes;
- Arthrosis and osteochandrosis;
- Calcium deposits – they become loose when blood circulation in the joint area is activated.
The use of shock wave therapy is especially effective in eliminating calcium deposits in the process of restoring the function of the knee joint:
- The pain stops;
- Damaged tissues are normalized;
- Edema is eliminated;
- Salt deposits are minimized or eliminated.
Reviews of patients who were treated for osteochondrosis show that during therapy, the pain first decreases, then disappears, metabolism and microcirculation return to normal.
The problem of the development of osteochondrosis occurs with a herniated disc. In this case, the treatment is directed:
- For the elimination of inflammation and pain;
- To restore lymph flow;
- For the gradual reduction of hernial formation;
- To reduce trauma to the nerves in the spine.
Elderly patients note that, thanks to the course of treatment, they can live without surgery, since the pain in a short period of time diminished and then disappeared altogether.
Indications for the use of UVT
The technique gives positive results in scoliosis, lordosis and curvature of the spine. Tissues after the shock wave effect are quickly restored, rehabilitation is actively underway, the patient regains strength, and his working capacity is quickly restored.
- Shockwave therapy for the treatment of heel spurs gives tangible results after the first manipulation. After another month, the patient steps on the heel without pain. Positive dynamics is noted by 97 out of 100 patients.
- The limitation of the joint’s motor ability recedes within a day after using this technique. Moreover, after the second procedure, the patient’s condition may worsen, but the therapy should be continued without hesitation and the improvement should not be long in coming.
- This technique is currently being used effectively for the treatment of Peyronie’s disease. The process should be regarded as a conservative treatment option. Course – 4 sessions of 15 minutes – one per week.
- This is the current best treatment for gout. UHT allows you to eliminate pain and inflammation without medication, relieve swelling and remove the deposition of lactic acid salts.
- The technique can effectively heal pathological conditions of muscles, tendons, bone structures and bone growths.
- Shockwave therapy treats all types of bursitis, including bursitis of the elbow, shoulder and knee joints.
- SWT sessions are effective for all types of fractures, even those that heal poorly.
You can also hear negative feedback from patients when significant pain does not make it possible to continue treatment. In this case, you should refrain from using the method.
Contraindications to the use of the method
It is not recommended to use the shock wave therapy method if the patient has:
- Ulcers on the skin in the problem area;
- If tumors and carcinomas are present;
- Cortisone therapy was performed for up to two months before the appointment of the manipulation;
- Young age.
Method not shown:
- Pregnant women;
- Patients with fragile vessels and low coagulability;
- Patients with malignant tumors;
- Patients with an installed pacemaker;
If it is necessary to use therapy for the treatment of adolescents and children, recommendations are given by the doctor, individually in each case, after a preliminary examination.
Rehabilitation after surgery is quick if shock wave therapy devices are used to restore patient mobility.
In the field of orthopedics, a positive trend is observed in 95% if a course of shock wave therapy was carried out.
Shockwave therapy for cellulite removal
This is an effective method for getting the perfect figure. Therapy is applied to problem areas – legs, thighs, buttocks and abdomen. The procedure is performed as follows: a gel is applied to the skin, along which a sensor is guided. Skin trauma does not occur, painful sensations are absent.
You should refrain from the procedure if you have varicose veins, thrombosis, liver disease, kidney failure, ulcers and skin rashes.
UHT can be used as an adjunct to exercise and diet.
Stretch marks cannot be eliminated in this way.
The application of the method in combination with laser resurfacing and massage gives good results.
The method is not used for weight loss.
Using the method to eliminate trophic ulcers
A trophic ulcer is an open wound when the skin or mucous membrane is broken. The process develops as a result of changes in blood circulation and rejection of dead tissue. Most often, ulcers form on the legs or feet and are the result of a medical condition.
Treatment of the disease with shock wave therapy aims to:
- Promotion of recovery processes;
- Acceleration of metabolism;
- Improvement of blood microcirculation;
- Growth of the microcapillary network in the pathological zone, which restores blood flow, restores blood supply and heals ulcers.
The UHT procedure stimulates the process of rapid wound cleansing, its granulation and epithelialization. The result is more effective healing than other treatments. According to statistics, process efficiency exceeds 90% .
Positive points: no need for a course of antibiotics and side effects.
Treatment of trophic ulcers using UHT has been carried out for almost 10 years.Most of the reviews of patients who underwent a course of shock wave therapy at the Central Clinical Hospital of the Russian Academy of Sciences indicate its reliability and painlessness.
About the UHT procedure (video)
Shockwave therapy – expert reviews
Doctors of the Central Clinical Hospital of the Russian Academy of Sciences are observing the positive dynamics of treatment with this method, which is new for Russia. The main advantages of using it:
- No need for special preliminary training;
- No side effects;
- No rehabilitation period.
Shock wave therapy in cosmetology
Using the technique in this area, cellulite is eliminated regardless of the stage and the skin is restored after plastic surgery and chemical peeling. According to doctors, this method is effective and reliable.
In sports, shock wave therapy is used as a way to stimulate the increase in endurance and quick recovery of athletes from injuries.
The opinion of doctors unanimously boils down to the fact that the use of UHT helps people recover as quickly as possible from injuries, heal many diseases and return to normal life.
Where to do this procedure?
Depending on the diagnosis, the number of sessions and the cost of treatment will be different. On average, if the disease is not too advanced, the patient can be limited to five procedures. Complex cases require up to ten sessions.
Since there are contraindications, the specialist must accurately determine the intensity of the impact on the problem area and the duration of the course. Call (499) 400-47-33 to find out the cost of the procedure and make an appointment with a shock wave therapy specialist at the Central Clinical Hospital of the Russian Academy of Sciences in Moscow.