Heel spurs on back of heel: Heel Spur Treatment, Symptoms & Pictures
The 2 Common Types of Heel Spurs
Bone spurs can develop on almost any bone, including the heel, and sometimes produce pain and other symptoms. Two painful heel conditions are associated with the formation of bone spurs:
- Heel spur syndrome involves the formation of a bone spur at the bottom of the heel, on the sole of the foot. People who have a common foot condition called plantar fasciitis can develop these spurs, which are often referred to as heel spurs or calcaneal spurs.
- Insertional Achilles tendonitis can be associated with bone spurs at the back of the heel, where the Achilles tendon inserts into the bone.
Two painful heel conditions are associated with the formation of bone spurs. Dorsal spurs are commonly related to insertional Achilles tendonitis, and plantar spurs are normally associated with heel spur syndrome.
Bone spurs that develop with plantar fasciitis or Achilles tendonitis are sometimes called by their medical name, enthesophytes.
See Plantar Fasciitis Diagnosis
Bone spurs are common, and the likelihood of developing them increases with age.1
See What Is a Bone Spur?
Heel Spur Syndrome
Plantar spurs are hook-like and are normally associated with heel spur syndrome.
Heel spur syndrome is a condition associated with heel spurs, bony protrusions that grow on the bottom of the heel. A heel spur forms where the plantar fascia—band of fibrous tissue stretching along the bottom of the foot—connects to the heel bone. The spur grows in the direction of the plantar fascia and often forms a hook-like shape.
See Is Heel Pain Caused by Heel Spurs or Plantar Fasciitis?
Heel spurs develop as a bone’s response to stress from:
- Straining foot muscles and ligaments
- Over-stretching the plantar fascia
- Repeated tearing of the thin lining of the heel bone
There is good news as it relates to these heel spurs. The vast majority of heel spurs usually do not cause pain. In fact, only 5% of people with heel spurs have foot pain.2 Heel spurs often occur in athletes participating in sports involving running and jumping. They are also associated with age, obesity, and osteoarthritis.
See Common Running Injuries: Foot Pain
Insertional Achilles Tendonitis
Dorsal spurs are commonly related to insertional Achilles tendonitis.
Insertional Achilles tendonitis affects the back of the heel, where the Achilles tendon inserts into the heel bone. The bone spur gradually develops around the tendon where it inserts into (attaches to) the bone.
See Achilles Tendonitis and Tendon Injuries
The bone spur can irritate the Achilles tendon, potentially causing more tendon damage and pain. In addition, the inflamed and/or damaged portion of the Achilles tendon can calcify, or harden.
See Causes and Risk Factors for Achilles Tendon Damage
Insertional Achilles tendonitis is associated with decreased ankle range of motion and increasing age—people who are affected are often in their 40s, 50s, or 60s.3 Achilles tendonitis usually develops gradually and is not linked with a single incident or trauma. Jumping and running can exacerbate this condition, along with negotiating stairs, making inflammation and heel pain worse.
See Diagnosing Achilles Pain
Insertional Achilles tendonitis is different than non-insertional Achilles tendonitis, which causes pain in the lower calf, where the Achilles tendon and calf muscle meet.
See Achilles Tendon Conditions Signs and Symptoms
- 1.Bone Spur. Reed Group MD Guidelines website. http://www.mdguidelines.com/bone-spur Accessed July 8, 2016.
- 2.Plantar Fasciitis and Bone Spurs. American Academy of Orthopedic Surgeons website. http://orthoinfo. aaos.org/topic.cfm?topic=A00149&webid=23D4 Last reviewed June 2010. Accessed July 8, 2016.
- 3.Insertional Achilles Tendinitis. American Orthopaedic Foot & Ankle Society.https://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Insertional-Achilles-Tendinitis.aspx Accessed May 6, 2016.
Heel spur | Causes and treatment
Do you get heel pain with every step? You might have a heel spur.
When your foot strikes the ground, you feel like you’ve stepped onto a thumb tack.” That’s how some people describe their heel spur symptoms. Most mornings, you have heel pain when you get up. The pain from a heel spur subsides during the day. That’s because moving relaxes the muscular and fascial tissue in the soles of your feet and your calves. If you fail to act in time, that initially dwindling heel pain can develop into a heel spur. You’ll continually have sharp pain in your heel, and it restricts your daily life.
What is heel a spur?
A heel spur is a pointed, bony growth that can develop on your heel bone. Usually, it happens because the tissue running along the sole of your foot (the plantar fascia) becomes irritated. That’s why it is also known as plantar fasciitis. When your Achilles tendon is put under too much strain, it makes this kind of bone growth more likely – in this case, it grows on the upper part (back) of the heel bone. The constant extra strain pulls on the membrane around your bones (periosteum), resulting in bony growths and deposits known as “heel spurs”. Heel spurs are not necessarily visible to the naked eye – they only show up on an X-ray.
There are two types of heel spur:
- Lower heel spur (underside of foot; plantar area): this is a bony protrusion on the underside of the heel. A lower (or inferior) heel spur is caused by too much strain on the plantar fascia.
- Rear heel spur (on back of heel): this is a bony growth where the Achilles tendon attaches to the bone. In this case, you’ll get pain in the back of your heel. A rear (or posterior) heel spur is caused by too much strain on the Achilles tendon.
What are the symptoms of a heel spur?
- You have stabbing pain in your heel when you put weight on it.
- In the mornings, you get pain when you first start moving. You’ll especially notice this for the first few steps you take after getting up.
- The heel pain radiates from your foot to your lower leg.
- The inflammation this causes leads to the heel spur swelling up, and your heel will feel warm.
- You might feel or see a small protrusion on your heel.
- Often, though, a heel spur goes unnoticed because it doesn’t always cause symptoms.
In the past, physicians would usually operate on a heel spur, but this only rarely offered long-term improvements for the pain. Here’s the good news: surgery is only necessary in the rarest of cases. In fact, you can alleviate heel spur pain with the tips provided below.
What causes a heel spur?
The most common cause of heel spur is excessive or unevenly distributed pressure when walking or running.
- Inflammation of the plantar fascia or, more rarely, of the Achilles tendon, as a cause of heel spurs:
Putting too much pressure on your heels by standing for a long time or doing sport over a longer period can cause unphysiological stresses. You may also get small tears and inflammation in your heel. This is your body’s response as it adapts to the improper stresses and strains. With the increased strain, calcium starts to get deposited in the affected area where the connective tissue attaches to the bone (the enthesis). This is the body’s attempt at making the heel more resilient and restoring its natural tensile characteristics. But it’s not the protruding bone itself that causes the pain. The strong pulling force on the membrane around your bones (periosteum) leads to the discomfort, along with a chronically inflamed plantar fascia in advanced cases. In rarer cases, increased tension and inflammation of the Achilles tendon can also cause heel pain.
- Lack of mobility in the sacroiliac joint (SIJ) as a cause of heel spurs
the sacroiliac joint connects the sacrum to the iliac bone, meaning it connects the back of your pelvic area to your spine. You might be wondering how poor mobility in your pelvis can cause heel problems. It’s quite simple: lack of mobility in the SIJ, which usually affects one side, causes your pelvis to become misaligned. The altered tension along the back myofasciae means that the legs are different lengths. As a result, your weight is unevenly distributed across your feet. On the side where the load is heavier, the calf and foot muscles become overly strained. The heel starts to sit in an unnatural position, stretching the plantar fascia too much and causing inflammation.
Dr. Torsten Pfitzer, Holistic Pain Therapist and Health Coach:
“In general, the human body is designed for endurance running. Unfortunately, our feet nowadays barely get enough exercise. Rigid footwear and sitting for long periods in everyday life mean we don’t use the muscles and fascia in our foot arches enough. At the same time, we often end up doing too much standing up or sport while we have these imbalances. These extra strains start to cause heel pain and heel spurs.”
What can you do if you have a heel spur?
There are treatments available for heel spurs and heel pain. What’s important is that you restore the natural tensile characteristics of your connective tissue, and strengthen your foot muscles.
- Ease pressure:
in the early stages, what counts is protecting the affected area. Avoid movements that are very demanding on your feet (standing for long periods, jogging, running and jumping). Ideally, take a break from sports for now.
- Cold or heat therapy:
cooling helps alleviate pain caused by inflammation. Heat helps to loosen up overly strained muscles and fascia. Just give it a try and see what feels best for you.
do a self-massage on your plantar fascia and calf muscles. This can really help with your mobility and ease muscle tension. When doing a fascia massage on the sole of your foot, remember: roll as close as possible to the heel spur. Only apply light pressure on the painful area. Next, you should mobilize your sacroiliac joint (SIJ).
- Strength along the length of your foot and calf muscles:
activation exercises using stretched positions help alleviate shortening of your foot and calf muscles. This provides a stimulus to regenerate your connective tissue.
- Comfortable footwear:
if you have a tendency to get heel spurs, you should wear comfortable shoes or temporarily wear (gel) insoles to relieve pressure on the area with the heel spur. An orthopedist can recommend which insole is right for you depending on what kind of misalignment you have in your foot. You shouldn’t use this as a permanent solution, because it often ends up further reinforcing the misalignment. A better, longer-lasting way is to balance out tension using exercises.
If the pain is more severe and persists even with the exercises, we recommend you visit your doctor. They will be able to prescribe you the right medicine, ointment, shockwave therapy or radiotherapy, if needed. Even so, you’ll only be able to get rid of the pain for the long term if you change your lifestyle and ease tension in your muscles and fasciae.
Here’s how you can prevent a heel spur:
- Choose the right footwear and replace your running shoes as often as you can. Worn shoes, or shoes that are worn very unevenly (the height is different between the heel and the forefoot) make a heel spur more likely.
- Make sure that the surface you’re running on isn’t too hard.
- Keep an eye on your weight: if you’re overweight, this often puts too much pressure on your heels.
- Run barefoot: slowly start to try out barefoot running. It will help you to avoid landing with your weight on your bones and joints, landing instead on the muscles and fasciae. This option is especially suited to warmer months, if you’re able to run on different surfaces. Some of the best options include grass, moss and sand.
- Mobilize and activate your foot muscles regularly.
Go to heel spur exercises
You might also be interested in:
6 Reasons You Shouldn’t Assume Foot Pain Is a Heel Spur – Health Essentials from Cleveland Clinic
If you feel pain in your heel, you might think you have a heel spur. It’s a common assumption — and a heel spur can cause foot discomfort. However, only 50% of people who have heel spurs actually feel any pain because of it.
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“A heel spur can be an incidental finding on an X-ray. You can have one even if you don’t have heel pain,” Dr. Davis says. “When we’re treating people, we don’t focus on the spur because often the spur doesn’t have to go away for the pain to resolve,” says orthopaedic foot and ankle surgeon Alan Davis, MD.
A heel spur won’t trouble you
unless it is prominent beneath your foot, and you can feel it under the
skin. If you concentrate too much on a heel spur, you could miss the true
underlying problem, he says.
does the pain start?
The foot is a complex
structure of ligaments, tendons and bones. So heel and foot pain can come from
a variety of sources, Dr. Davis says.
“Oftentimes, it’s not related to having a heel spur. Plantar fasciitis or any other condition that causes inflammation around the heel can cause heel pain,” Dr. Davis says.
Dr. Davis says the first step
is to understand where in the foot you feel the most pain: Is it in the heel, arch or toes?
It’s important for the diagnoses and treatment to understand where a person
feels the most tenderness.
causing your foot pain?
- Repetitive overuse. This is a leading cause of heel pain. People at risk are those who walk heavily on their feet, run long distances, or carry extra weight. You are also susceptible to heel bone inflammation and discomfort if you have a tight Achilles tendon, which connects the calf muscle to the heel bone.
- Impact injuries. These can cause deep bruises on either the fat pad or the ball of the foot that make it feel like you’re walking on a pebble. Heel bone fractures — either from a fall from a significant height or new, rigorous or repetitive overuse — can also cause pain.
- Running, jumping or other strenuous activities. These can cause discomfort and inflammation in the ball of the foot.
- Wearing high heels. Morton’s neuroma, most commonly found in women who wear high heels, is a thickening of tissue around the nerve between the bases of the toes. It leads to foot pain, and sensations of pain numbness in the ball of the foot.
- Arch pain. Arch pain, most often from plantar fasciitis, affects the heel and arch of the foot. Pain is usually more noticeable first thing in the morning or when one starts to walk after sitting for long periods of time, which is also called “start-up pain.”
- Other assorted causes. Inflammation and swelling from arthritis can often cause pain. Arthritis typically affects the middle part of the foot and big toe joint. However, bunions, hammer toe, claw toe, turf toe and ingrown toenails can also cause discomfort.
back on your feet
Full recovery from heel pain
takes, on average, six months to resolve with appropriate treatment, Dr. Davis
says. But the odds are in your favor – only about 5% of people fail to improve
with some form of treatment. You can help yourself by following these tips:
Stretch. “Most heel pain syndromes have
similar treatment – the mainstay is a home stretching program,” Dr. Davis
says. “We teach people to stretch daily with good technique and frequency.”
Using a night splint to keep the ankle at 90 degrees can help the morning pain,
and make the first morning stretching session easier.
shoes for your activity. “If
you’re going running, wear running shoes. If you’re going on a hike, wear
hiking shoes,” Dr. Davis says. “Wear the appropriate
footwear for whatever activity you’re doing to help support your foot
Buy the right shoes. Choose shoes that don’t rub over any
part of the foot or against any bunions or bone prominence. Use extra padding
or arch support to alleviate sore bones and relieve pressure.
Show your feet some
anti-inflammatories and ice your foot for pain. Wear over-the-counter arch
supports to cushion your feet and absorb the shock of each step.
If these tactics don’t work, Dr. Davis recommends minimizing impact loading activity as much as possible. Immobilization boots can take stress off the foot and ankle, and crutches or a cane can reduce the weight you put on your feet.
Still no better? There are minor office interventions like injections that can help decrease inflammation, he adds.
Achilles Spur – Podiatry, Orthopedics, & Physical Therapy
Robert H. Sheinberg, D.P.M., F.A.C.F.A.S., D.A.B.F.A.S.
Below is an x-ray demonstrating a lateral view of the heel bone where one can see spurs on the bottom of the heel near the origin of the plantar fascia and at the origin of plantar foot muscles. There is also a spur at the back of the heel where the Achilles attaches. These occur over a long period of time because of excess stress applied to the areas due to tight ligaments and muscular structures.
- Inflammation can be related to a Haglund deformity (postero-superior prominence – normal variant) which causes overlying bursitis.
- The prominence of the posterior superior calcaneal tuberosity contributes to inflammation of the overlying tissues and the Achilles tendon.
- Most often occurs in women and is related to shoe wear with rigid heels or heel counters.
- Patients note posterolateral prominence and tenderness.
- Useful to determine if there are distinct degenerative areas within the tendon (Achilles tendinosis), which might require debridement if resection of the Haglund’s deformity were indicated.
- Nonoperative treatment consists of heel cord stretching, change in shoe wear, NSAIDs.
- Raising the heel out of the shoe with a heel insert shifts the contact against the heel and often relieves symptoms.
- Excision of the Haglund prominence can be effective in chronic cases.
- Excision must be kept proximal to the Achilles insertion.
- Lateral approach is easier but care must be taken to avoid sural nerve.
- The posterior calcaneal tuberosity is removed and the Achilles tendon is debrided and reattached using bone anchors.
- Calcium deposits are removed from the Achilles tendon if they are present.
- Patients are immobilized for six weeks.
These are intraoperative pictures of removal of a painful spur in the back of the heel bone that failed conservative treatment.
This is an intraoperative pic of a heel spur in the back of the heel prior to resection. It is next to the instrument on the bottom right. The spurs cause pain, as it irritates the Achilles tendon.
This is the bone cut performed to remove the spur and bone that causes pain.
This is a picture of the bone that is removed. Underneath the bone is the void left after removal.
This is a picture of the size of the bone removed. The top portion should have glistening white cartilage. It is yellowish and devoid of cartilage due to constant irritation from the Achilles. The spur is at the bottom 30% portion of the bone.
This is a picture of the suture placement in the Achilles tendon to reattach the tendon to bone. There are anchors in the bone that have the suture already attached. The anchors are driven into the bone to allow the Achilles tendon to reattach to the heel. These sutures are then tightened down for an intimate bone to tendon apposition.
Resection of hypertrophic heel spur in the back of the heel that is removed.
In this pic, the Achilles can be seen on the right being pulled from the back of the heel. The Achilles becomes irritated due to chronic pressure against the heel bone
This is the piece of bone removed from the back of the heel.
These are the sutures going through the Achilles to reattach to the back of the heel bone.
Pre and PostOp Heel Spur resection with reattached of Achilles.
Pre and postop heel spur resection with reattachment of Achilles.
Postop bilateral calcaneal spur resection.
Postop x-ray after spur resection with reattachment of Achilles with the G2 anchor.
Intraop Pics of Posterior Achilles Spur Excision and Reattachment of Achilles Tendon
Heel Spur Surgery: Preparation, Recovery, Long-Term Care
Calcaneal spur reduction is a procedure used to remove all or parts of a heel spur—a painful outgrowth on the heel bone (calcaneus) that causes pain, inflammation, and swelling. Heel spur surgery is done when conservative therapies fail to provide relief.
There are two approaches to the surgery: one that targets inferior spurs on the bottom of the heel and another that targets posterior spurs on the back of the heel. Heel spur surgery can be highly effective, but it may take up to three months for some patients to fully recover.
Ralf Liebhold/Getty Images
What Is Heel Spur Surgery?
Heel spur surgery can be performed as either open surgery (involving a scalpel and large incision) or endoscopic surgery (using “keyhole” incisions with a narrow scope and operating tools). Open surgery is better able to remove the entire spur.
- Inferior heel spur resection: Inferior heel spurs typically develop in the presence of plantar fasciitis (inflammation of the plantar fascia ligament, located on the bottom of the foot) and are often referred to as plantar fasciitis bone spurs. In many cases, the removal of spurs will immediately follow plantar fasciotomy, also known as plantar fasciitis release surgery. Once the ligament is partially or fully severed (“released”), the surgeon will remove any large or suspect spurs.
- Posterior heel spur resection: This less common approach targets posterior heel spurs located near the Achilles tendon on the back of the foot. Also referred to as Achilles bone spurs, these generally develop at the point where the tendon attaches to the heel bone. It is not uncommon for spurs to also develop in the tendon itself. Simple spurs on the bone are relatively easy to remove, but those imbedded deep in the Achilles tendon may require the detachment and reattachment of the tendon (Achilles tendon repair), making spur resection more complicated.
Heel spur surgery is performed on an outpatient basis, allowing you to return home as soon as the surgery is complete. Depending on the aims of the surgery and other factors, the procedure may involve local, regional, or general anesthesia.
According to research, heel spur surgery is effective in around 69% of cases, with another 25% reporting a moderate improvement of symptoms.
There are few absolute contraindications to heel spur surgery. The surgery should be approached with caution in people with severe bleeding disorders, diabetes co-occurring with peripheral artery disease, or a history of deep vein thrombosis (DVT). These relative contraindications need to be assessed on a case-by-case basis.
One absolute contraindication for heel spur surgery is the absence of symptoms. If a spur is accidentally found on an X-ray, it should not be removed just because it is there. Doing so not only exposes the individual to unneeded surgery but may cause serious and potentially permanent injury.
As with all surgeries, there are risks associated with heel spur surgery, including the use of anesthesia. Common complications specific to this procedure include:
- Temporary or permanent heel pain
- Temporary or permanent nerve injury (including foot numbness)
- Acquired pes planus (fallen arches) and flat-footedness
- Tendinitis (tendon inflammation)
- Metatarsalgia (pain in the ball of the foot)
- Foot cramps
- Foot instability
- Development of hammertoes or claw toes (due to the contraction of the plantar fascia ligament)
- Heel fracture
Compared to open surgery, endoscopic surgery is associated with a faster resolution of symptoms and less postoperative pain and complications.
Purpose of Heel Spur Surgery
Heel spurs are essentially the abnormal accumulation of calcium, most commonly caused by repetitive foot strain. Repeated injury can lead to changes in the foot as scar tissue develops and calcium released from microfractures and bone degeneration begins to accumulate into bony outgrowths.
The size or shape of a spur has nothing to do with the incidence or severity of symptoms. Large spurs can often cause no pain, while tiny ones can cause excruciating pain and extreme loss of mobility.
Heel spur surgery is not used because a bone spur is large—or simply because it’s there—but rather because it is causing refractory (treatment-resistant) pain.
Luckily, more than 90% of people with heel spurs experience spontaneous recovery without surgery. By committing to a holistic, non-surgical treatment plan, you may find that your heel spur symptoms resolve on their own. It’s when they don’t that surgery can play a role in treatment.
Heel spur surgery is generally considered a last resort, and the American College of Foot and Ankle Surgeons (ACFAS) recommends it be considered if symptoms fail to resolve with non-surgical treatments after 12 months.
In some cases, the pain is not associated with the spur itself but the condition that gave rise to it.
Heel spurs associated with plantar fasciitis do not point downward but rather forward toward the toes. Because of this, the pain in the heel is usually not caused by the spur but rather the persistent inflammation of the ligament at its attachment point at the heel.
Such heel spurs may be removed anyway when a surgeon suspects that they could become problematic.
Heel spurs are most easily detected on X-ray while standing. Even if spurs are identified, every effort should be made to ascertain whether the pain is the result of the spurs or an associated condition. Heel spur surgery is not only difficult to recover from but can cause more problems than it solves if not used appropriately.
The presence of a spur, even a large one, doesn’t necessarily mean that it is the cause of the pain. Consulting with an experienced podiatric surgeon or foot and ankle orthopedist is essential to getting a correct diagnosis. Either one of these specialists can perform the surgery, if needed.
Heel spur surgery is often considered when heel spurs are accompanied by severe plantar fasciitis or Achilles tendinitis (both of which may benefit from surgery).
On the other hand, there may be “clues” that cast the viability of heel spur surgery into doubt. One such example is bilateral heel pain, in which the pain in both heels may be the result of systemic diseases or infections rather than any spurs the doctor may find.
To this end, doctors will typically conduct a differential diagnosis to exclude other possible causes before heel spur surgery is recommended. These may include:
How to Prepare
If heel spur surgery is recommended, you will meet with the surgeon to review the lab and imaging reports and discuss how the operation will be performed. You will also discuss pre-operative and post-operative procedures you need to follow to better ensure the intended result.
The surgical approach used will be determined by the underlying cause and location of a spur. Neither procedure is inherently “better” than the other at providing relief, although recovery times tend to be shorter with endoscopic surgery.
Do not hesitate to ask the surgeon why a particular surgery was chosen. While open surgery is associated with a greater risk of complications, there may be reasons why it is a better approach in your case. Keep an open mind and seek a second opinion if needed.
Heel spur surgery is performed in the operating room of a hospital or specialty surgical center. The operating room will be equipped with standard surgical equipment, including an anesthesia machine, surgical table, an electrocardiogram (ECG) machine to monitor your heart rate, and a mechanical ventilator to deliver supplemental oxygen if needed.
For endoscopic surgery, there will also be a rigid fiberoptic scope called an endoscope that delivers live images to a video monitor. Specialized surgical equipment that can access the foot through tiny incisions will also be there.
What to Wear
Depending on the extent and location of the surgery, your foot may be bandaged, placed in an ankle splint or walking boot, or covered with a cast afterward. To accommodate for this, wear baggy shorts or loose-fitting pants (e.g., yoga or pajama bottoms) that slip easily over the foot. Skirts also work, or you can cut the side seam of an old pair of pants to widen the leg opening.
In addition to changing into a hospital gown before surgery, you will be asked to remove contacts, hairpieces, dentures, hearing aids, and tongue or lip piercings prior to the surgery. Leave any valuables at home, including jewelry and watches.
Food and Drink
You will be advised to stop eating at midnight the night before your procedure. On the morning of the surgery, you can take a few small sips of water to take your morning medications. Within four hours of surgery, you should not consume any food or liquid.
Your doctor will advise you to stop taking certain medications that promote bleeding and slow wound healing, including anticoagulants (blood thinners) and nonsteroidal anti-inflammatory drugs (NSAIDs).
You may need to stop taking certain drugs for anywhere from one day to two weeks before surgery and discontinue use for up to a week or two after surgery.
Among the drugs commonly avoided prior to surgery:
To avoid drug interactions and complications, always let your doctor know about any medications you are taking, whether they are prescription or over-the-counter. The same goes for herbs and supplements.
What to Bring
You will need to bring your driver’s license (or some other form of government ID), your insurance card, and an approved form of payment if copay or coinsurance costs are required upfront. (Be sure to call the office beforehand to confirm that they accept your insurance and are in-network providers.)
You will also need to bring someone to drive you home and, ideally, to stay with you for a day or two to help you out and monitor for any adverse symptoms.
What to Expect on the Day of Surgery
Depending on the scope of the operation, the surgeon may be accompanied by an anesthesiologist, operating nurse, endoscopic technician, and surgical scrub.
Before the Surgery
Upon your arrival at the hospital or surgical facility, you will register, fill out medical information forms, and sign consent forms confirming that you understand the aim and risks of the surgery. You will then be led to the back to change into a hospital gown.
A nurse will take your weight, height, vital signs, and a sample of blood to check your blood chemistry. An intravenous (IV) line is then inserted into a vein in your arm to deliver medications and fluids. (Even if the procedure is performed under local anesthesia, an intravenous sedative is typically used to induce “twilight sleep.”)
In addition, EGC leads are attached to your chest to monitor your heart rate, while a pulse oximeter is clamped to your finger to monitor your blood oxygen levels.
During the Surgery
Once you are prepped, you are wheeled into the operating room. The appropriate form of anesthesia will be administered:
- If general anesthesia is used, the medications are delivered through the IV line to put you completely to sleep.
- If regional anesthesia is used, the anesthetic may be injected in the spine (spinal epidural block) or a shallow bundle of nerves behind the knee called the popliteal fossa. An intravenous sedative, also known as monitor anesthesia care (MAC), typically accompanies the regional block.
- If local anesthesia is used, it is delivered by injection in and around the surgical site. MAC is also commonly used.
You will be positioned on the surgical table in either a supine (downward-facing) or lateral decubitus (sideways-facing) position, depending on how the heel spur(s) are best approached.
The open or endoscopic procedure is then performed:
- Open reduction: An incision is made either along the bottom of the foot (to access a plantar bone spur) or down the back of the heel (to access an Achilles bone spur). If plantar fasciotomy or Achilles tendon repair is needed, it is performed first. The heel spurs can then be cut away in a secondary procedure, flush to the bone.
- Endoscopic reduction: For this procedure, a tiny incision (usually about an inch in length) is made on the side of the heel to insert the endoscope. A second incision is made to insert a cutting instrument to reduce the spur. Because endoscopic surgery does not remove as much of a spur, it is generally reserved for combination surgeries in which heel spurs are involved.
Finally, the incision is closed with sutures or adhesive strips, and the foot is bandaged. An ankle splint, walking boot, or a cast may be used to immobilize the foot and/or ankle if needed.
After the Surgery
After the surgery is complete, you are wheeled into recovery and monitored by a nurse until you awaken. This can take anywhere from 10 minutes for local anesthesia with IV sedation to 45 minutes for general anesthesia. Food and drink are usually provided when you are fully awake.
It is not uncommon to experience pain and discomfort around the surgical site. You will be given the appropriate painkiller and a nurse will administer anti-nausea medication if you feel ill from the anesthesia.
Once your vital signs normalize and you are steady enough to change into your clothes, you can be taken home by a friend or family member.
The doctor will give you a prescription for a short course of an opioid like Vicodin (hydrocodone plus acetaminophen) to help you manage pain.
When you arrive home from surgery, you should relax for the rest of the day with your foot propped up on pillows. Do not bathe or shower for the first day.
If there is any pain, you can either take Tylenol (acetaminophen) or the pain medication prescribed by your doctor. If there is any pain, bruising, or swelling, you can apply an ice pack to the affected area for no more than 15 minutes several times a day. Do not apply the ice directly to the skin.
Stay off your feet as much as possible for the first few days after surgery as well. To avoid placing any strain on the foot, your doctor may provide you with a pair of crutches or a hands-free knee crutch. Use whatever is provided, even if you feel confident without it.
Until the wound is amply healed and the stitches removed, you will need to keep the foot dry. This applies whether you are icing the area or washing yourself. When showering, you can either cover the foot with a plastic bag (secured with a rubber band) or ask your doctor about using a watertight cast cover.
The wound dressing should be changed daily with sterile gauze and an alcohol-free topical antiseptic. Check daily for any abnormal changes in the wound or skin.
When to Call Your Doctor
Call your surgeon if you experience any of the following after undergoing heel spur surgery:
- Increasing pain, redness, and swelling around the incision site
- High fever (100.5 degrees F) with chills
- A yellowish-green and/or foul-smelling ooze from the wound
- Nausea and vomiting
- Wound dehiscence (an opening incision)
After seven to 10 days, you will visit your surgeon to have the sutures removed and check on how your wound is healing. An X-ray or computed tomography (CT) scan may also be ordered, especially if other procedures were performed along with heel spur removal.
Based on the findings, the doctor will have a better idea of your prognosis and the appropriate rehabilitation plan. If needed, you may be referred to a physical therapist.
The duration of rehabilitation varies not only by the surgery used but your general health and adherence to the treatment program. Broadly speaking, it takes around six weeks to recover from plantar heel spur surgery and up to three months for Achilles heel spur surgery with tendon repair.
Most people with office-based jobs can return to work in two weeks with a walking boot or crutches. Those who work on their feet may need to wait for at least four weeks unless their doctor says otherwise.
Coping With Recovery
Your surgeon will want to see you again when it is time to have your cast removed or to step you down from crutches to a walking boot.
As you are gradually stepped down to walking shoes, physical therapy may again be needed to teach you how to walk correctly and how to stretch your arches to compensate for any tissue retraction.
During the recovery period, it is not unusual to feel pain and aggravation as you challenge muscles and tissues that have laid dormant for weeks. With persistence and adherence to your rehabilitation plan, you will improve. Support from family and friends can help this process tremendously.
During follow-up appointments, your doctor will want to check for improvements in your symptoms. Not everyone who undergoes heel spur surgery experience the complete resolution of symptoms, but many do. Be patient with your body as it heals.
Possible Future Surgeries
If you still have pain, inflammation, and swelling after rehabilitation, let your doctor know. In some cases, revision surgery may be needed. At other times, further investigations may be needed to explore other possible explanations for your symptoms.
A Word From Verywell
Surgery is a less common treatment for heel spurs but one that may be necessary if nothing else is able to relieve pain and loss of mobility. Even so, heel spur surgery is not a “quick fix.”
Before seeking heel spur surgery, ask your doctor if all treatment options have been explored, including therapeutic ultrasound and extracorporeal shockwave therapy (ESWT). At the same time, ask yourself if you have been adherent to your doctor’s treatment recommendations, including routine exercise, weight loss, and the consistent use of night splints and orthotics.
Heel Pain & Plantar Fasciitis Treatment
Heel pain is a stressful condition that affects day to day activities. Stress on the heel is often created from running and walking because the heel hits the ground first and takes on the body’s entire weight.
One of the main causes of heel pain is a condition known as plantar fasciitis. The plantar fascia is a band of tissue that extends along the bottom of the foot, from the toe to the bottom of the heel. A rip or tear in this ligament can cause the inflammation of these tissues, resulting in heel pain. People who do not wear proper fitting shoes are often at risk of developing this condition. Unnecessary stress from ill-fitting shoes, weight change, excessive running, and wearing non-supportive shoes on hard surfaces are all causes of plantar fasciitis.
Achilles tendonitis is another cause of heel pain. Similar to plantar fasciitis, the inflammation of the Achilles tendon can cause heel pain due to muscle tearing. A lack of flexibility of the ankle and heel is an indicator of Achilles tendonitis. If left untreated, this condition can lead to plantar fasciitis and create even more pain in your heel.
A third cause of heel pain is a heel spur. A heel spur occurs when the tissues of the plantar fascia undergo a great deal of stress, leading to a separation of the ligament from the heel bone entirely. This separation results in a pointed fragment of bone on the ball of the foot, or a heel spur.
Treatments for heel pain are easy and effective as long as problems are addressed quickly. The most common solution for heel pain is simply taking stress off the feet, particularly off of the heel. This will help ease pain and allow the tendons and ligaments to relax. In the case of both plantar fasciitis and Achilles tendonitis, icing will reduce swelling in any part of the foot. Anti-inflammatory medication is highly recommended. Wearing proper-fitting shoes and heel pads or comfort insoles will also reduce the risk of developing heel pain. Stretching before and after exercises will help the foot muscles prepare for stress and decrease the chances of inflammatory pain. In extreme cases, relieving heel pain might require surgery.
Always make sure to discuss these symptoms and treatment options with your podiatrist Dr. Blanken to keep yourself active and pain free.
Heel Spurs with Dr. Suh
You have heel pain, and you’ve just been diagnosed with heel spurs. Safe to assume that the spurs are causing the pain, right? Don’t be so sure. About 95 percent of heel spurs are asymptomatic—they don’t hurt. If you have heel pain, it’s far more likely to be caused by plantar fasciitis, an inflammation of the ligament, known as the plantar fascia, that connects the heel bone (calcaneus) to the bones near the front of the foot.
So what exactly is a heel spur? And, if it doesn’t usually cause pain, why do you need to know? Read on.
What Are Heel Spurs?
Heel spurs are abnormal growths on the front of the calcaneus bone. About half of people who have plantar fasciitis also have heel spurs. But contrary to popular belief, most of the time it’s not the heel spurs that hurt, it’s the plantar fasciitis itself.
Plantar fasciitis is inflammation of the plantar fascia. It’s usually an overuse injury, meaning it develops because you’re on your feet all day, you’ve increased your running miles, things like that. Older people, those who are obese and people with certain foot anatomies like flat arches are more likely to develop plantar fasciitis than others.
The constant pressure on and stretching of the plantar fascia and the inflammation from the plantar fasciitis cause the heel bone to begin to break down. That’s where heel spurs come in. Your body tries to repair the damage to the bone by sending calcium to it. That calcium builds and builds and eventually starts to protrude off the bone. That’s a heel spur.
Other Causes of Heel Spurs
Plantar fasciitis doesn’t always cause heel spurs, and heel spurs aren’t only caused by plantar fasciitis. Here are some other reasons you might have a heel spur.
- You are overweight
- You have arthritis
- You have issues with the way you walk
- You wear flip-flops, or shoes that don’t fit well
Diagnosing Heel Spurs
Heel spurs can be difficult to diagnose by themselves. You generally can’t feel a heel spur under the skin, and if it’s not causing you any pain, you probably won’t know it’s there. If a patient comes to me with plantar fasciitis, I know that there’s a good chance I’ll find a heel spur too.
If I suspect a patient has a heel spur and I feel it’s important to find out for sure, I will have the patient undergo an X-ray or an ultrasound. These are forms of diagnostic imaging that allow me to see under a patient’s skin, so to speak. X-rays are useful for visualizing bone, while ultrasound allows me a better view of the foot’s internal structure.
Heel Spur Treatment
Heel spurs and plantar fasciitis are usually treated together and can often be alleviated without surgery. Because heel spurs rarely cause pain, it’s usually my patients’ plantar fasciitis that is more worrisome.
There are a number of nonsurgical treatments for plantar fasciitis and heel spurs. I typically recommend my patients begin with resting the injured foot and applying ice. Ice the sole of the foot three times a day for 20 minutes at a time.
Shoes can make a big difference to plantar fasciitis pain. Look for comfortable shoes that fit well. Custom orthotics, which are special shoe inserts made for your foot, can further decrease the pain of plantar fasciitis and heel spurs. You can also use splints at night to stretch the foot.
Pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs) can treat the symptoms of plantar fasciitis. Physical therapy aimed at stretching out and strengthening the calves can also help.
If these conservative treatments don’t work, ask your foot and ankle specialist what other options are available. For severe cases of plantar fasciitis, surgery to detach the plantar fascia from the heel bone could be a possible treatment.
If you have heel pain and think you may have a heel spur or plantar fasciitis, request an appointment with me. In my practice, I have treated hundreds of cases of both. I can asses your situation and put you on a treatment plan that’s right for you.
90,000 How to cure foot and heel pain?
- What to do with foot pain?
- When should I see a doctor?
- Pain in the foot and heels in athletes-runners:
Achillodynia, heel spur, marching fracture, bursitis
- Pain in the foot in women:
Neroma Morton, transverse flat feet, metatarsal-valgus deformity in elderly people
- Pain in the foot : Plovalgus deformity, rheumatic arthritis, gout, arthrosis
- Pain in the foot in children and adolescents:
Pain in growth, osteochondrosis, deformities of the arch of the foot,
osteochondroma of the talus
- Frequently asked questions
Foot pain is a biologically important warning signal that indicates foot pathology.Pain in the foot appears as a result of overload, deformation, fractures, pathologies of tendons and joints, or general diseases caused by metabolic disorders.
In order to establish the correct diagnosis, the specialists at the Gelenk-Klinik in Freiburg need to know under what circumstances the pain in the foot has occurred.
Pain in the foot can appear as a result of increased training, improper load distribution and injuries. In addition, there are other diseases that manifest themselves as pain in the foot, but have nothing to do with orthopedics.
How to avoid foot pain?
For sudden or chronic pain, do not wait until the last. See a specialist before pain in your foot worsens and causes permanent damage.
Foot pain can be treated in stages: Pain in the heels or in the Achilles tendon is characteristic of the hindfoot, while pain in the foot, instep and internal lateral pain is characteristic of the midfoot.
Pain in the toes, often as a consequence of transverse flat feet, occurs in the anterior part of the foot.
You don’t always need to see a doctor with these complaints: Sometimes, in order to successfully treat pain in the foot, you just need to change your shoes, reduce the load in the foot or change your walking technique.
Anatomy of the foot. Anatomy of the foot. Pain can occur in any part of the foot. The ankle joint connects it to the knee. A strong heel bone is the ankle support. The tarsus is partly responsible for the vertical mobility of the foot. The skeleton of the foot consists of three sections: the tarsus, metatarsus, and toes.The arch from the calcaneus to the toes forms the longitudinal arch of the foot. When rolling from heel to toe, the heads of the metatarsal bones transfer force to the floor and, together with the toes, form the forefoot. © Viewmedica
When should I see a specialist?
- For painful swelling in the foot or ankle, lasting more than five days.
- For open and purulent wounds.
- In the presence of stabbing and cutting pain.
- For repeated complaints.
- If the pain in the foot continues for several weeks in a row.
- If, in addition to cuts in the foot, you have a fever.
- For structural changes in the foot, calcaneus or ankle.
Pain in the foot and heels in athletes-runners
In athletes involved in active sports, foot pain has orthopedic reasons. “Orthopedic” means damage to bones, joints, tendons, muscles and ligaments. During training and competition, the legs are most exposed to stress, which is interpreted as the basis of most injuries in the foot.In this case, the severity falls on all tissues in the foot: tendons, bones, cartilage and periarticular bursa (bursa). Excessive or improper exercise can lead to foot fractures, tendon inflammation, and muscle tears.
How is foot pain treated in athletic runners?
Not only intensive training, but also deformation of the heel bone can cause overloading of the Achilles tendon. Incorrect position changes the course of the tendons attached to the calcaneus (see figure on the right).The result is twisting, which leads to excessive weight on some parts of the tendon. © Dr. Thomas schneider
Not only athletes, but also other patients suffering from pathologies in the foot, are advised to listen to their body and stop or reduce the load if pain in the foot appears. Trained orthopedic specialists advise you to consult your doctor first before taking pain relievers. In this way, a person can prevent long-term diseases and pain in the foot.In case of pain in the tendons, in no case should you take painkillers, while maintaining the same load in the foot. Competition and strength training while taking pain relievers can wreak havoc on an inflamed Achilles tendon.
Tendon diseases: Inflammation of the Achilles tendon (Achillodynia)
Symptoms of Achillodynia
- Stitching pain in the foot at the beginning of the movement.
- Thickening 3 cm. above the tendon attachment site.
- Redness and overheating of the skin.
- Crepitation – crunch of tendons.
- Early stage: Pain in the foot under exertion.
- Late stage: Foot pain at rest / persistent pain.
The Achilles tendon is anchored across the full width of the calcaneus and is responsible for transferring the load from the calf muscles to the hindfoot.
Achillodynia often appears in the heels as a stitching pain in the foot at the beginning of a movement or at the beginning of a workout. However, this is quite misleading: Even if during the training itself the pain in the foot passes, the Achilles tendon is still subjected to stress and becomes more fragile, which, sooner or later, will lead to its rupture.
How is Achillodynia Treated?
Reduce foot loads. For acute inflammation, use antirheumatic pain relievers (eg ibuprofen).
- Resting and “unloading” the Achilles tendon
- Anti-inflammatory drugs
- Special insoles (increased instep in the foot, protection against excessive pronation)
- Physiotherapy: exercises to minimize deviations of the axes of the lower extremities
- Special exercises for stretching 9000 calf muscles 9000 Shock wave therapy
- Surgical removal of inflamed tissue
- Reconstruction surgery
heel tendon rupture: plasty of the Achilles tendon
The lower heel spur is characterized by a cutting pain in the heel on the sole in the sole area. Most often, poor-quality shoes or overstrain in the foot are the basis of inflammatory processes in the plantar tendon.
During exercise, the pain in the foot decreases or disappears altogether.
The area of attachment of the plantar tendon in the heel spur is very sensitive with pressing pain. In addition, the plantar tendon is a tendon plate that extends from the heel bone under the sole of the foot. The lower heel spur often occurs in people who are overweight or in people who are tall.Athletes, runners, as well as people who are fond of other sports, often complain of stabbing pain in the plantar region of the foot.
The upper heel spur is characterized by pain in the heel area. The Achilles tendon, which originates at the junction of the medial and lateral heads of the gastrocnemius and soleus muscles, becomes inflamed and causes pressing pain in the foot when wearing the wrong shoes.
With the help of X-rays, foot pain specialists can immediately identify painful thickening of the plantar or Achilles tendon.
How is heel spur treated?
Athletes with inflammation of the plantar (heel) tendons are advised to reduce the load in the foot and not exercise when they feel pain. Stretching the heel tendons in the foot prevents this condition and accelerates recovery. Special insoles free the place where the tendon is attached to the heel from stress. Shock wave therapy accelerates the treatment of this pathology.
- Instep supports that reduce the weight on the arch of the foot.
- Shockwave therapy
- Biological cell regeneration (YAKE®-Matrix regeneration therapy)
- Stretching exercises and physiotherapy.
- Botulinum toxin injections
Inflammation of the tendon sheath (tendovaginitis) is the cause of pain in the instep
Inflammation of the synovial sheath of tendons moving from the anterior tibial muscle along the dorsum of the foot and connected to the toes. These tendons can become inflamed and swollen due to overuse. © Grays Anatomy
Symptoms of tendovaginitis
- Stitching / pulling pain in the foot
- Redness and overheating of the skin
- Crunching of the tendons (crepitus)
- Perceptible thickening of the tendons in the foot
Sometimes, during walking, pain is felt in the back of the foot. A number of tendons run from the tibial muscle through the dorsum and supply each toe. Excessive stress can cause inflammation in the tendons.
Pain in the foot, namely on its back, is very similar to a marching (fatigue) fracture in which the patient feels a stabbing pain while lowering the leg to the heel. The tendon sheath also becomes inflamed due to improper shoes or prolonged exercise. Improper and too narrow shoes, as well as excessive sports loads, are the main causes of inflammation of the tendon sheath.
How to cure tendon inflammation in the foot?
- Cooling compress
- Painkillers (Ibuprofen)
- Fixation with an orthosis
- Operative treatment
For people involved in sports, it is recommended to pause their workouts and replace their footwear with more foot pain. …NSAIDs – Non-steroidal anti-inflammatory drugs (NSAIDs) help to overcome and stop foot pain. In addition, the experts at Gelenk Klinka in Freiburg do not recommend exercising while taking Ibuprofen.
Calcaneus exostosis (Haglund’s exostosis): stitching pain in the hindfoot
Symptoms of calcaneus exostosis
- Swelling and redness on the heels
- Severe pain in the foot
- Hyperthermia, redness
In addition to the heel spur and achillodynia, there are other causes of stabbing and pressing pain in the back of the foot.For athletes, these are, for example, sneakers with tapered heel pads. These shoes put a lot of pressure on the upper surface of the heel bone and are the beginning of a series of abnormalities in the foot. When wearing unsuitable shoes, other defects may appear in the foot, which the patient may not have known about. Thus, hollow foot often leads to heel deformation and the formation of an outgrowth on it. Therefore, in people with this deformity, cartilaginous outgrowth on the heel is formed more often than in others.
How is Haglund’s Exostosis treated?
Athletes-runners are most often affected by this disease. Patients are advised to pause training and reduce the load in the foot. Exostosis of the calcaneus is treated with the following methods:
- Calcaneal inserts
- Orthopedic insoles
- Antirheumatic drugs
- Surgery (e.g. removal of periarticular mucous membranes) 9006
Symptoms of a marching fracture
- Stitching pain in the metatarsal foot
- Swelling in the foot
Excessive or intense training can lead to painful march fractures of the metatarsal bones in the foot.Due to overload, fractures are formed not only in the foot, but also in other congested areas. Most often, fatigue fractures are observed in the foot because it carries the entire body weight. In addition, such injuries to the metatarsal (metatarsal) bone of the midfoot are observed in the area of the second metatarsal bone. In this case, the big toe, which is held by the adductor muscle, begins to move outward.
In most cases, stress fractures in the foot are mistaken for joint sprains or bruises.However, with this pathology, due to overload, the structure of the metatarsal bone is disrupted. Stitching pain in the foot under stress is characteristic of a fatigue fracture.
How to treat a marching fracture?
- Immediate load reduction
- Anti-edema treatment: (YAKE®-Matrix regeneration therapy, Lymphatic drainage)
- Anti-inflammatory drugs
- Foot immobilization, load reduction
Stop playing sports until the foot pain is gone. Anti-inflammatory drugs speed up the process of reducing swelling in the foot. Reducing the weight on the forefoot with special shoes accelerates recovery. With a marching fracture in the foot, no displacement of bones is observed. In most cases, only the cortical bone is damaged. It follows from this that complete immobilization of the foot is not necessary. The recovery process takes up to six weeks. This is how much the patient is recommended to keep the foot at rest.
Posterior calcaneal bursitis and inflammation of the bursa surrounding the Achilles tendon (Achilles bursitis)
Symptoms of Achilles bursitis
- Swelling of the heel
- Redness and overheating of the skin
- Stitching pain in the heel with each step
Painful inflammation of the joint capsule (bursitis) Can also cause pain in the foot. The periarticular synovium is a thickened cavity containing synovial fluid, which is responsible for the mobility of tendons and muscles.In addition, they protect soft tissue from pressure and bruising.
One of the signs of bursitis is pain in the back of the foot. The Achilles tendon is formed as a result of the fusion of the flat tendons of the posterior calf muscles – the gastrocnemius muscle and the soleus muscle and is attached to the tubercle of the calcaneus. In addition, the Achilles tendon sits between two bursae, which can become inflamed with excessive exertion. Quite often, Achilles bursitis cries out pain in the back of the foot.
How is posterior calcaneal bursitis treated?
- Reducing foot load, cooling compresses, immobilization
- NSAIDs are non-steroidal anti-inflammatory drugs (eg.Ibuprofen)
- Puncture of the inflamed bursa (bursa synovial)
- Operative removal of the bursa
Shoes with tapered heel inserts should be replaced with more comfortable shoes with orthopedic shock-absorbing insoles. Anti-inflammatory drugs can help treat foot pain and relieve symptoms. In order to “unload” the foot a little, patients are advised to suspend sports. In advanced cases, surgical removal of the synovial bag of the posterior part of the foot is performed.
Intermetatarsal bursitis – inflammation of the bursa synovial in the forefoot of the foot
Pain in the foot also appears as a result of intermetatarsal bursitis. Inflammation of the bursa of the forefoot can occur as a result of strength exercises and the wearing of tight shoes that squeeze the toes. Since with each movement a significant part of the load falls on the phalanges of the fingers and bones of the metatarsus, the foot can be deformed. Thus, pathologies in the foot, namely transverse flat feet or hallux valgus can lead to over-irritation of the synovial bursa of the forefoot calving.
Orthopedic specialists quite often observe bursitis of the first metatarsophalangeal joint (metatarsophalangeal bursitis) in patients. Due to the already frolicking deformation of the big toe, the shoes in this area begin to press even more. A misalignment of the first toe often leads to bursitis and painful swelling. The bursae between the other metatarsal bones become inflamed during vigorous exercise.
How is forefoot bursitis treated?
- Insoles for transverse flat feet
- Non-steroidal anti-inflammatory drugs (ex.Ibuprofen)
- Surgical removal of the bursa
Anti-inflammatory drugs reduce pain and swelling in the foot in the foot. Strength sports loads for patients need to be reduced urgently. Flatfoot insoles will help reduce stress on the forefoot in the area of the toes.
The abductor big toe muscle – bottom view in red – is responsible for abducting the big toe. In cross-country athletes, this muscle can become inflamed.© Grays Anatomy
Muscle pain in the foot: Inflammation of the abductor hallucis muscle (Musculus abductor hallucis)
Symptoms of inflammation of the muscles of the inner part of the foot
- Stitching pain in the foot
- Redness and overheating of the skin
Muscular appearance and overheating in the foot pain: The abductor hallucis muscle (Musculus abductor hallucis) occupies a medial position in the plantar part of the foot. In addition, this muscle is responsible for the flexion process of the thumb abduction.Stitching pain in the foot is one of the signs of pathology of the muscle that abducts the arch of the foot.
How to treat inflammation of the abductor big toe muscle?
- NSAIDs – non-steroidal anti-inflammatory drugs
- Stretching exercises
A stabbing pain in the extensor of the thumb can be confused with pain in the plantar (heel) tendon or with a march (fatigue) fracture. Stretching exercises can help maintain a healthy foot.
Inflammation or rupture of the tendons of the peroneal muscles
Symptoms of inflammation of the tendons of the peroneal muscles
- Pain in the lower leg
- Pain in the lateral ankle
- Pressing pain throughout the tendon of the peroneal muscle
- Outer lining
- Outer lining
- Reducing stress and resting in the foot
- Cooling of acute inflammations in the foot
- Anti-inflammatory drugs (e.g.Ibuprofen)
- Physiotherapy, exercises for stretching the calf muscles
- Orthopedic insoles
- Foot surgery
- Removal of dead (necrotic) tissue with a sharp scalpel
- Alignment of the bone structures of the peroneal foot
- Alignment of the bone structures of the peroneal foot
- Lowering the transverse arch of the forefoot
- Extension of the forefoot
- Flexion of the big toe
- Pain in the foot under load
- Calluses on the phalanges (corns)
- Orthopedic insoles for strengthening the transverse arch of the foot
- Exercises for the foot and gymnastics
- Shoes with low soles, not narrowing the toes
- Operation (Weil-Osteotomie: Korrektur des Spreizfußes) Osteotomy 900
The method of treatment of pathology will depend on the reasons for which the pain in the foot began. However, in any case, doctors recommend replacing the most comfortable shoes. Sometimes gymnastic exercises help to strengthen the forefoot. In case of deformities in the foot, due to transverse flat feet, insoles with special wedge-shaped elements are used. In such insoles, a notch is made on the heel, and a metatarsal pad is installed in the area of the transverse arch of the foot. This design allows you to straighten the transverse arch of the foot and reduce the load in the foot.
Morton’s neuroma: pain in the middle of the foot due to entrapment of nerves
Morton’s neuroma is an abnormal thickening of the common toe nerve that causes pain in the foot between the third and fourth toes. This disease, which is characterized by stabbing pain in the foot, as well as numbness and burning sensation in the fingers, can be triggered by transverse flat feet. © Dr. Thomas Schneider
Symptoms of Morton’s Neuroma
- Stinging pain in the toes and forefoot
- Numbness of the toes
- Feeling as if you are stepping on a pea
- Reduction of pain after removing shoes
Disease of Morton’s Neuroma manifests itself in the form of Morton’s Neuroma edema of the neural membrane between the metatarsal bones, and the transverse flat feet accelerates its development.A decrease in the anterior transverse arch of the foot with transverse flat feet has a negative effect on the condition of the forefoot. As a result, the first metatarsophalangeal joint is directly on the floor, and the area between the metatarsal bones is narrowed. While walking, the metatarsal bones compress the median nerve (Nervus medianus), causing the connective tissue that forms the nerve sheaths to swell.
As a result of the above-mentioned edema, the pressure on the nerve endings in the foot increases. Patients feel severe stabbing pain in the foot, and sometimes burning or numbness.Thus, almost the entire area of the blood supply to the nerves in the foot is affected.
If you have the feeling that you are stepping on a pea or pebble while walking, then you most likely have Morton’s Neuroma.
How is Morton’s Neuroma Treated?
- Low-soled shoes that do not narrow the toes
- Gymnastics for the feet
- Local anesthesia
- Operative decompression – reducing the degree of compression of the metatarsus
- Osteotomy of the metatarsal bones
- Neurectomy – surgical excision of the inflamed nerve 900 takes off his shoes, the pain in the foot caused by Morton’s Neuroma immediately disappears.Tight ski boots can also trigger foot pain.
In order for the pain in the foot caused by Morton’s neuroma to go away as soon as possible, it is recommended to abandon pointed high-heeled shoes. However, in some cases, with inflammation and flattening of the nerve, only surgical treatment of Morton’s Neuroma helps.
Hallux valgus – “bump” or curvature of the toes
Hallux valgus symptoms
- Outward curvature of the first toe
- Deviation inward of the big toe
- Swelling, redness, overheating and pressing pain in the foot
- Pain in the middle part of the foot (metatarsalgia)
Hallux valgus occurs when the thumb is supined in the direction of the smaller toes.Inflammation of the bursa (bursa) of the first metatarsophalangeal joint and its wear and tear can cause painful arthrosis. © Dr. Thomas schneider
Hallux valgus is a common female problem. Women suffer from this disease 10 times more often than men. Hallux valgus is characterized by a painful enlargement of the bone of the first toe on the inside, as well as swelling, redness and pain in the foot during exercise. However, not all patients with hallux valgus have foot pain.
In case of inflammation of the mucous membranes in the area of the joints (bursitis), pain in the foot is felt with each step, and the endurance of the big toe is significantly reduced. Bunion is formed due to the accumulation of excess fluid in the synovial fluid, which is sometimes purulent.
In the most difficult cases, excessive stress on the small toes in the foot can lead to stress fractures, that is, to a violation of the integrity of the bones.
How is hallux valgus treated?
Severe foot pain requires qualified treatment.In most cases, only surgical treatment of hallux valgus helps to cure pain in the foot to straighten the deformity of the big toe.
Hallux rigidus – arthrosis of the first metatarsophalangeal joint
Symptoms of arthrosis of the first metatarsophalangeal joint
- Swelling of the thumb
- Restrictions on the mobility of the thumb
- Pain depending on the intensity of movements in the first metatarsophalangeal joint
- Noise of friction in the joint
Osteoarthritis may occur on the first plus joint.In this case, specialists consider Hallux rigidus disease, or in other words, a hard (rigid) finger. One of the most important causes of arthrosis of the first metatarsophalangeal joint is the deformity of the thumb (hallux valgus). Other causes of illness can be trauma, injury, or overuse.
With arthrosis, pain in the foot increases and the big toe becomes rigid, which is why Hallux rigidus is defined.Patients have limited movement and severe pain in the foot. In order to reduce pain in the foot, when the foot rolls, the person transfers the body weight to the adjacent small toes, which is the cause of the appearance of transient metatarsalgia (pain in the metatarsal bones due to the transfer of body weight).
Treatment of arthrosis of the first metatarsophalangeal joint
- NSAIDs – non-steroidal anti-inflammatory drugsli>
- Infiltration – injection of pain relievers (e.g.cortisone)
- Orthoses for joint immobilization
- Orthopedic insoles or immobilization of a diseased joint
- Heilectomy – removal of bone growths around the joint
- Osteotomy – shortening of the first metatarsal bone
- Immobility 9006 Hallux rigidus treatment should prevent or at least halt the development of arthrosis. In this case, it is advisable to use special insoles to reduce the load on the joint.Anti-inflammatory medications (NSAIDs) can help reduce joint pain and reduce the likelihood of wear and tear on the articular cartilage.
Osteoarthritis can change the entire structure of the first metatarsophalangeal joint: Due to the increased pressure around the joint, bone spurs are formed, which accelerates the wear of the articular cartilage. During hailektomy, a minimally invasive joint operation (hailektomy), the surgeon removes these bony growths and thus preserves the vitality of the joint.
If, due to arthrosis, the articular cartilage has been completely worn out, then the only treatment is immobilization (arthrodesis) of the first metatarsophalangeal joint .Orthopedic specialists of Gelenk-Clinic will carry out this intervention without any particular risks of limiting the patient’s mobility and athletic abilities. After arthrodesis, the patient can return to professional sports.
Taylor’s deformity (tailor’s foot): deviation of the V metatarsal bone and the formation of a “bump” at the base of the little finger
Symptoms of Taylor’s deformity
- Flexion position of the little finger
- Pressing pain in the foot. due to inflammation of the articular capsule
- Calluses (corns) on the sole of the foot
- Expansion of the transverse arch of the foot
Taylor’s deformity or “tailor’s foot” is a symptom similar to that of arthrosis of the first metatarsophalangeal joint, a disease of the little toe, in which the calf toe deviates and overlaps adjacent fingers.In this case, the area of the 5th metatarsophalangeal joint becomes inflamed, as a result of which the patient feels severe pain in the foot. The cause of the “tailor’s foot”, as in the case of hallux valgus, is transverse flat feet. Frequent wearing of high-heeled shoes with a tapered toe increases deformity and pain in the foot.
How is Taylor’s Deformity Treated?
- Shoes with low soles that do not narrow the toes
- Avoiding high heels
- Silicone inserts in the distal part of the foot
- Surgical intervention
Wearing loose shoes prevents the progression of deformity.With a balanced distribution of the load on the foot, the process of overloading the connective tissues and destruction of the forefoot arches stops immediately. Silicone pads under the distal foot help prevent existing inflammation and deformities in the foot.
In difficult cases, a tailor’s foot straightening operation is performed. This intervention returns the little toe to its original position, which contributes to the narrowing of the foot.
Foot pain in people of the middle and older age group
While in young people pain in the foot occurs as a result of overload and injuries, in people of the middle and older age group, pain in the foot can occur due to harmless deformities in the foot, which are not cause the young and the slightest inconvenience.In older people, such deformities appear much faster and lead to ankylosis (immobility) in the joints and arthrosis. The reason for this is changes in the metabolic process under the influence of hormonal drugs, which have a negative effect on muscle balance and tendons in the foot. Joint wear leads to arthrosis in the foot or metatarsophalangeal joint.
Plovalgus deformity in the foot: painful flattening of the longitudinal arch of the foot on x-ray.© Gelenk-doktor.de
Planovalgus deformity of the foot
Symptoms of planovalgus deformity of the foot
- Swelling of the medial ankle
- Rapid fatigue in the foot when walking
- Pain from the outer edge of the foot
- Pain in the foot, extending to the lower leg
- Flat feet
- 905 Foot pendulum
905 in the foot when rolling the foot from heel to toe
Plovalgus deformity is one of the most common and painful deformities in the foot. This definition describes two main pathologies in the foot that appear simultaneously: the valgus foot is an X-shaped curvature of the heel axis, and flat feet is a decrease in the longitudinal arch of the foot to the floor.
When the longitudinal arch of the foot is raised, the posterior muscles of the lower leg are active. Together with the gastrocnemius and soleus muscles, the tibialis posterior muscle performs plantar flexion in the foot. She also participates in supination and adduction of the foot. With weakness or instability of the tibial muscle, the longitudinal arch of the foot drops.
All circumstances that reduce muscle performance can lead to a weakening of the longitudinal arch of the foot. In addition to muscle weakness, such pathologies include diseases caused by metabolic disorders, as well as rheumatism, gout and steroid hormonal drugs. Read more about the causes of pes planovalgus.
Patients suffering from planovalgus deformity feel pain in the foot under stress. With this disease, the distance of “painless walking” is shortened, and the medial ankle is often swollen.With pathologies of the posterior tibial muscle, pain in the foot can be given directly to the lower leg. This deformity in the foot is also noticeable from the patient’s shoes: The inner edges look very worn, as the foot roll is felt not through the big toe, but through the inner edge of the foot. In this case, the toes are deflected outward.
Treatment of painful planovalgus deformity in the foot
Planovalgus deformity of the foot is almost always treated conservatively. Sports training and pain therapy can help treat foot pain.Special orthopedic insoles support the longitudinal arch of the foot and improve gait.
If, with injuries and ruptures of the tibial collateral ligament, physical therapy did not bring the desired result, but the pain remained, the specialists of our clinic perform an operation on the foot.
During surgery, the tibial collateral ligament is shortened and cleared of inflammation.
Another method of treating degenerative changes in the tibial collateral ligament is autogenous transplantation.
In addition, it is possible to perform bone grafting to normalize the position of the calcaneus. This intervention is necessary for muscle contraction and planovalgus deformity in the foot.
Osteoarthritis of the tarsus: Wear of the metatarsal joint (Osteoarthritis in the Lisfranc joint)
Metatarsal arthrosis most often occurs in the area of the thumb and affects other joints and bones of the tarsus. The wear of the metatarsal joint causes pain in the instep.© Dr. Thomas schneider
Symptoms of arthrosis of the metatarsal joint
- Pain in the back of the foot
- Swelling and pain in the instep of the foot
- Change in load in the foot
- Pain in the foot when rolling from heel to toe
- Increased pain in the foot during climbing
- Pain in the foot at the beginning of movement
Arthrosis of the metatarsal joint is characterized by pain over the longitudinal arch of the foot in the instep. The bones of the tarsus (tarsal bones) are located between the bones of the metatarsus and the talus.They form the transition between the tarsus and metatarsus long bones. In medicine, this process is called the Lisfranc joint.
Metatarsal pain and arthrosis are often caused by trauma: Preexisting fractures of the tarsal bones only increase the pain in the foot. However, in some cases, the reason is unclear. Then experts consider the problem of idiopathic wear in the metatarsal joint.
Quite often, pain and arthrosis in the metatarsal joint occurs along with swelling and overheating of the dorsum of the foot.Damaged joints in the back of the foot are identified by orthopedists during palpation.
At an early stage of the disease, arthrosis of the metatarsal joint and associated pain in the foot are treated by specialists with special orthopedic steles that support the longitudinal arch of the foot. If the pain in the foot worsens, arthrodesis of the Lisfranc joint is performed.
How is metatarsal arthrosis treated?
- Anti-inflammatory pain relievers
- Orthopedic insoles to support the longitudinal arch of the foot
- Arthrodesis of the Lisfranc joint
Occasionally, pain in the foot associated with arthrosis can be treated with anti-inflammatory drugs.In more advanced cases, foot pain is eliminated during arthrodesis of the Lisfranc joint. Surgical immobilization has no negative impact on the performance of the foot and the stability of the Lisfranc joint. The reduced mobility of the Lisfranc joint after surgery plays only a minor role.
Diabetic foot: Pain in the foot due to diabetic neuropathy and poor blood supply
Symptoms of a diabetic foot
- Lack of sensitivity in the foot
- Altered perception of pressure, cold and heat
- Pain and itching in the foot and lower leg
- Muscle deformity in the foot and lower leg
Pain can be felt in several parts of the foot, however, in rare cases, it occurs for orthopedic reasons.As a rule, foot pain is associated with metabolic disorders.
Diabetes is one of the main causes of foot pain. Peripheral neuralgia – especially foot pain – is one of the most common comorbid complications of diabetes. Diabetic neuropathy (peripheral nerve damage) is accompanied by impaired sensitivity and pain in the foot. In addition, this pathology is characterized by pain in the heel, numbness of the sole of the foot, as well as a change in the perception of heat and cold.Pain and sensory disturbances in the foot increase the risk of injury. Ulcerative formations and inflammation in the foot are dangerous, as they often remain invisible.
Treatment of diabetic polyneuropathy
- Improved blood sugar control
- Pain therapy with antidepressants
- Avoiding alcohol and nicotine
- Medicines that stimulate blood circulation
Neuropathic pain in the foot is not treated by an orthopedic specialist: family doctor or general practitioner.The main causes of neuropathic foot pain and diabetes are being overweight, smoking, drinking alcohol and unhealthy diet.
Disruption of uric acid metabolism causes gout and stitching pain in the feet
One of the signs of gout can be pain in the foot, accompanied by redness on the skin and soreness when pressed. The initial stage of gout is characterized by a sudden stitching pain in the foot at the base of the big toe. Often, patients suffering from this pathology wake up at night and feel severe pain in the thumb.At the same time, the joint swells and overheats.
Gout occurs when uric acid crystals are deposited in the joint. From this it follows that the cause of gout is a violation of the metabolism of uric acid.
For normal excretion of urine from the body, limit yourself to the use of meat products and alcoholic beverages.
Treatment of gout (hyperuricemia)
- Nutrition: Less meat and alcohol
- Weight loss
- Pain relievers for acute gout attacks
- More fluid (promotes the secretion of uric acid)
- Urostatics (medications) 9000
Metabolic disorders can be cured by changing the diet.For normal excretion of urine from the body, limit yourself to the use of meat products and alcoholic beverages.
Rheumatoid foot: Rheumatoid arthritis causes painful swelling and overheating in the foot
Symptoms of rheumatoid arthritis
Rheumatoid arthritis (rheumatism) is a painful, inflammatory disease of soft tissues and joints, characterized by pain in the foot.
The causative agent of the disease are autoimmune pathologies, in which the body’s inflammatory response is directed against its own tissues.This fact is the reason for the wear and tear of the articular cartilage. Arthritis is diagnosed with a biochemical blood test. Stitching pain in the foot, swelling and overheating are considered consequences of rheumatoid arthritis.
How to cure rheumatoid arthritis?
- Medicines: NSAIDs – non-steroidal anti-inflammatory drugs
- Rarely: Cortisone injections
- Devil’s claw (medicinal plant)
- Omethylated 5-fatty acids hallux valgus and hammer toes
Diagnostic imaging (ex.Ultrasound, X-ray, MRI) helps to distinguish rheumatoid arthritis from other diseases in the foot. The treatment of this disease is associated with a number of difficulties, since it is carried out with the help of antirheumatic anti-inflammatory drugs. It is recommended to undergo rheumatitis treatment by highly qualified rheumatologists. For complicated deformities, surgical correction of the ankle joint is performed.
Tarsal canal syndrome: Stitching pain and numbness in the foot due to a pinched tibial nerve in the ankle.© Dr. Thomas schneider
Tarsal canal syndrome: Pain on the outside of the foot due to pinched tibial nerve
Symptoms of tarsal canal syndrome ::
- Itching and numbness in the forefoot of the sole of the foot
- Burning pain in the metatarsal part of the foot
- Discomfort or sharp pain in the back of the foot
- Pain in the foot at night and at rest
- in the foot, radiating to the lower leg
Tarsal canal syndrome occurs due to pinching (compression) of nerves, just like Morton’s neuroma.In this case, the transverse ligaments of the ankle joint compress the tibial nerve. In turn, a burning and dull pain in the foot spreads to the gluteal region along the back of the leg, and then intensifies when the foot is extended. Sometimes, with compression (tunnel) neuropathy, pain occurs depending on the intensity of the load in the foot at rest. Many patients experience the problem of posterior tibial nerve neuropathy after wearing ski shoes.
The metal rods of the ski boots stretch the ankle ligaments, causing the patient to feel pain and numbness in the foot.Quite often, swelling and pain in the foot causes tarsal canal syndrome – for example, in diabetics or with tumors of the soft tissues and ankle joint. As a result, the pressure in the foot increases, and the ligaments, in turn, limit the space for the nerves that pass inside the joint.
Diagnosis of the disease is based on its clinical manifestations and a preliminary survey of the patient. Depending on the results of the examination, patients are offered two types of treatment – conservative and surgical.
How to treat tarsal canal syndrome?
- Pain relievers and anti-inflammatory drugs
- Mobilization of the lower leg and ankle joint
- Cortisone injections
- Orthopedic insoles
- Surgical expansion of the tarsal tunnel (decompression or conservative treatment 9006 tarsal canal.
Surgical dilatation of the tunnel canal – as with carpal tunnel syndrome – is performed to relieve compression (decompression) of the nerves. After a successful operation, all symptoms of tunnel neuralgia gradually disappear.
Foot pain in children and adolescents
Foot pain in children occurs for various reasons. Typically, children complain of foot pain in minor injuries, such as twisting their feet or hitting their toes.Plantar warts on the sole of the foot are also the cause of pain.
If a child complains of bone, muscle and joint pain, it is recommended that other factors be considered.
If the pain in the foot is so severe that the child cannot step on the foot, go to the emergency room. During a diagnostic examination, qualified doctors will determine the presence of structural damage or fractures in the foot.
Pain in the foot due to an acute inflammatory process that manifests itself during growth in a person (apophysitis)
- Pain in the heel, aggravated by exertion
- Lameness during exercise
- Pressing pain in the foot
- Swelling and redness of the heel
Pain in the foot in children and adolescents, as a rule, is not associated with structural changes in bones, tendons and joints.
Foot pain is often caused by an imbalance between skeletal growth and muscle growth. As a result of the growth process, irritation of the tendon bases is observed – for example, insertional tendinopathy, enthesopathy and tendinitis. In the foot, this pathology affects the place of attachment of the Achilles tendon to the heel. In children, the bone growth zone is located here, namely the bone fusion, in which the growth of the foot occurs. First of all, pain in the heels, namely at the base of the Achilles tendon of the calcaneus, is one of the signs of a child’s growth.
How to cure growing pain in children and adolescents?
- Physical rest
- Silicone heel pads
- Orthopedic insoles for the instep
- Weight loss
- Pain relievers
In adolescents who are actively involved in sports, pain in the foot and heel may be associated with eccostal disease.
After orthopedic examination and correct diagnosis, complaints of foot pain in adolescents can be cured with physical and manual therapy
Ankle pain due to osteochondritis dissecans (Koenig’s disease)
- Pain in the ankle joint during exercise
- Pinching / blockages in the joint
- Pain in the foot due to inflammation of the synovial membrane of the joint (synovitis)
Osteochondritis dissecans or disseminating osteochondrosis is a metabolic disorder in the cartilage and bone tissue just below the cartilaginous plane.Affected, as a rule, are the areas of the talus that are most prone to physical exertion. That is why osteochondritis dissecans in the foot is noted in sports-active children and adolescents.
This disease is characterized by loss of blood circulation in a separate area of the bone under the joint. At the first stage of the disease, slight pain appears in the foot of uncertain localization and a focus of osteonecrosis is established. In the second stage, pain in the foot increases and synovitis appears.
At the third stage, incomplete separation of the necrotic body occurs, which leads to pinching of the joint and the formation of the so-called articular mouse.At the last stage, the necrotic body is completely separated, and the pain in the foot increases.
Treatment of osteochondrosis dissecans in adolescents
- Immobilization, ban on sports
- Reducing the load in the foot with elbow crutches
- Normalization of calcium metabolism using Vitamin D3
- Operation: Arthroscopy of the ankle joint 5th arthroscopy
- Bone transplantation (spongioplasty)
- Re-fixation of a separated bone fragment
If an orthopedic surgeon diagnoses osteochondrosis dissecans, then, as a rule, the patient is prohibited from playing sports for a long time.In children, osteonecrosis of the bone goes away if all the doctor’s prescriptions are followed. With age, the patient’s chances of curing pain in the foot decrease conservatively, and therefore, starting from the age of 18, osteochondrosis dissecans is treated with surgical methods. When separating bone fragments, an operation of osteochondrosis dissecans is necessary. Autogenous transplantation (bone replacement) – by taking a graft from the iliac crest of the pelvic bone contributes to the complete recovery of the patient.
Pain and deformities in the foot due to bone fusion: tarsal coalitions
- Frequent twisting of the leg
- Pain and limited movement in the ankle joint
- Plovalgus deformity of the foot in children.
Planovalgus foot deformity in children is one of the stages of development. However, parents perceive it as a deformity in the foot and begin an active search for a specialist. By natural development, the longitudinal arch of the foot in children is straightened up to 4-6 years. Normal development in the foot is also facilitated by activity and walking barefoot.
If, with a planovalgus installation of the feet, children complain of pain in the foot and muscle spasm radiating to the lower leg, parents need to look for a qualified orthopedist.Often, foot pain limits the child’s mobility while walking and is a cause of premature fatigue. In the presence of these symptoms, there is a danger of bone fusion in the foot, which, as a rule, must develop separately. Pain in the foot resulting from bone fusion is noted in children from the age of 12. The reason for this is a spasmodic flat foot (planovalgus deformity), which did not straighten during the development of the child’s foot.
The human foot consists of 26 bones.In the hindfoot and tarsus, these bones are stable and connected. Improper development of bones, namely their fusion during the growth of the foot, can lead to serious complications. According to statistics, about 1% of children have such tarsal coalitions.
Due to their experience, the specialists of the Gelenk Clinic in Freiburg note the regularity of the following intergrowths:
- Fusion of the scaphoid and talus: talonavicular coalition (Coalition talonavicularis) in 70% of patients
- Fusion of the calcaneus and talus: synostosis (Coalition talocalcanearis) in 30% of patients calcaneonavicularis)
Muscle spasm is one of the most common manifestations of the tarsal coalition.To quickly fix the problem, it is necessary to follow the recommendations of the attending physician.
Diagnosis of tarsal coalitions is based on clinical examination and the use of various imaging techniques. The X-ray of the foot is designed to more accurately determine the degree of development of the pathology, and digital volumetric tomography (DVT) helps to obtain a three-dimensional image of the bones, which is the optimal method for diagnosing the tarsal coalition.
How is a coalition of bones in the foot under the ankle treated?
- Surgical separation of the bone fusion of the tarsus
- If necessary, subtalar arthrodesis to restore the longitudinal arch of the foot
Tarsal coalitions in the foot in children is a malformation of the bones of the foot, which can be cured by surgical methods.The operation before the transitional age of the child is necessary to restore the normal growth process in the foot.
During the operation, the surgeon separates the spliced bones in the foot. If the surgery is performed after the patient’s foot is growing, there is a high likelihood of arthrosis of the lower (talonavicular) ankle joint, or arthrosis of the tarsal bones, which causes additional pain in the foot.
Varus, clubfoot and equine foot: Foot deformities and pain in children
Clubfoot is a congenital deformity in the foot that occurs in 0.1% of all newborns.Due to the specific shape of the feet, this pathology is determined immediately after the birth of the child. Clubfoot treatment is carried out even in infancy with the help of fixing plaster bandages.
In the equine foot, deformity occurs, which manifests itself in the form of persistent plantar flexion and characteristic positioning of the foot. Quite often, children have a double deformity in the foot – clubfoot and equine foot. Like clubfoot, equine foot is detected immediately after the birth of a child or even before his birth with the help of ultrasound.Often, the equine foot is neurological in nature: damage to the nerves or calf muscles can cause this pathology.
How to cure equine foot syndrome in children?
Physiotherapy is the main treatment for equine foot syndrome in a child.
Cartilaginous exostosis / Osteochondroma (benign bone tumor) in children
Cartilaginous exostosis is a benign osteocartilaginous growth on the surface of a bone that forms from ossified cartilaginous tissue.As a rule, this process ends after the patient’s foot stops growing. Surgery is necessary only if osteochondroma causes pain in the foot and affects the nerve endings and joints. © Dr. Thomas Schneider
Osteochondroma in the ankle joint is a benign growth of cartilage tissue in the metaphysis of the tarsal bone, due to which the bone grows in length in childhood and adolescence. Osteochondral exostosis causes pain on the surface of the foot in children.In this case, you need to contact a specialist who will successfully carry out an operation to remove this growth in the foot.
Treatment of cartilaginous exostosis
- Patience and observation
- If pain in the foot appears: surgical resection of the growth
Surgical treatment of pathology is carried out if osteochondral growths pass through the nerves and blood vessels or form pinching of the tarsal joint pain in the foot.
Frequently Asked Questions
Pain in toes
Pain in the toes
Pain in the metatarsophalangeal joints appears due to a violation of the contact of the articular surfaces and a violation of biomechanics in the foot.This leads to trauma to the synovial membrane and osteoarthritis of the articular cartilage, as well as to subluxation of the joints.
Pain in the toes is due to hallux valgus of the first toe, causing inflammation of the periarticular sac of the inner arch of the foot. The inflamed articular bag of the first metatarsophalangeal joint swells and begins to hurt when pressed.
Pain in the outer arch of the foot is caused by pronation of the small toes. In medicine, there is such a thing as a varus deviation of the little finger (Taylor’s deformation) or “tailor’s foot” (Digitus quintus varus).Varus deformity of the fifth metatarsal bone can be painless, and sometimes patients do not even notice it.
Autoimmune diseases such as rheumatitis or metabolic disorders such as gout cause severe pain in the foot.
After strenuous physical activity, jogging or hiking, marching (fatigue) fractures of the metatarsal bones (metatarsal bones) can form, which cause severe stabbing pain in the foot and toes.
How does pain appear on the outside of the foot?
Pinching of the tibial nerve in the ankle can cause pressing pain in the foot and sensory disturbances on the outside of the foot (see Tarsal Canal Syndrome).Also, tibial neuropathy causes stabbing pain and numbness in the foot.
Deformity of the fifth metatarsophalangeal joint of the tailor’s foot may cause pain in the outer arch of the foot.
In some cases, pain on the outside of the foot can be caused by a pathology such as planovalgus deformity.
Pain on the back of the foot
Pain on the back of the foot
In athletes, foot pain occurs due to inflammation of the tendon sheath (Tendovaginitis).
The next reason for pain at the base of the foot is arthrosis of the Lisfranc joint. Stitching pain in the foot with each step can lead to swelling in the back of the foot.
A pinched ankle nerve can cause anterior tarsal canal syndrome and stitching pain in the foot.
With a strong load with its own weight or prolonged standing in the “standing” position, pain on the outside of the foot may appear without an underlying disease.
Pain on the inside of the foot
Pain inside the foot
Pain on the inside of the foot is due to deformity of the big toe (Hallux valgus). In this case, the bone of the first toe of the foot begins to deviate from its usual position and swells due to inflammation of the periarticular sac (bursitis).
After long walking or hiking, pain in the foot also occurs, namely from its inner side. In case of insufficient regeneration, inflammation (long extensor of the big toe) along the inner part of the foot can become inflamed.
Deformities such as the planovalgus foot also cause pain on the inside of the foot. As the sole rolls along the inner edge of the foot, the ankle becomes inflamed and patients begin to feel pain in the foot.
Heel pain: causes of
Heel pain has several causes.
For example, heel and foot pain. after an injury, accident or fall from a height may be associated with a fracture of the heel bone.
Tendon disorders cause stabbing pain in the calcaneus (heel spur) under the sole, resulting in perceptible discomfort in the foot.In the case of the lower calcaneal spur, the base of the plantar tendon of the calcaneus is affected, and in the case of the superior calcaneal spur, the base of the Achilles tendon. …
A stabbing pain in the heel and foot from above may indicate various pathologies of the Achilles tendon.
In case of bony growths in the area of the calcaneal tuberosity, leading to inflammation of the soft tissues in the heel and pain in the foot, a diagnosis of Haglund’s disease is made. This problem is aggravated by inflammation of the bursa (bursitis) in front of or behind the Achilles tendon.
Foot pain after rest or in the morning after sleep
Pain in the foot in the morning after sleep
Pain in the foot at the beginning of movement, which appears in the morning after sleep or after a long stay of the foot at rest, has precise causes.
Pain in the foot at the beginning of movement, which appears in the morning after sleep or after a long stay of the foot at rest, has precise causes. Pain in the foot and in other joints at the beginning of movement is one of the signs of arthrosis that affects the ankle and talo-tarsal joints.After warming up the joint, the pain in the foot goes away, but after some time of painless walking, the pain in the foot reappears. The most common arthrosis of the upper ankle joint.
Osteoarthritis of the lower ankle joint (calcaneal-talus joint) causes pain in the foot when moving on an uneven surface.
Ankle pain at the beginning of movement can provoke (arthrosis of the Lisfranc joint).
Pain in the forefoot at the beginning of movement causes arthrosis of the first metatarsophalangeal joint.(Hallux rigidus).
In addition, pain in the foot at the beginning of movement can be associated with various inflammatory processes. With inflammation in the area of attachment of ligaments and tendons to the bones (enthesopathy) and inflammation of the tendon sheath (tendovaginitis), at the beginning of training and after a state of rest, stitching pain in the foot appears, which immediately disappears after warm-up. Doctors do not recommend enduring such pain in the foot. If a person feels the above-described pain in the foot, then he needs to be examined and treated.
Pain in the foot in the morning after a breakdown occurs in a disease such as achillodynia.
This also applies to pain in the lower heel spur (Plantar fasciitis), which disappears after a few steps.
Pain during foot roll
Very often with pain in the foot, a person twists the leg inward, as a result of which the load on the tendons of the calcaneus (Achilles and heel tendons) increases and a heel spur is formed. The result is pain in the foot with every step.
Osteoarthritis of the lower ankle causes stabbing pain in the area between the ankle and heel when the foot rolls from toe to heel. The joint between the talus and calcaneus is responsible for the movement of the foot over uneven surfaces.
If the patient feels pain in the toes when rolling the foot, then the first metatarsophalangeal joint is affected, which accounts for the bulk of the load. After prolonged training, the periarticular bags between the metatarsal bones and the flanks of the toes can also become inflamed.In this case, specialists in the treatment of the foot consider such a pathology as intermetatarsal bursitis. When the foot rolls from heel to toe and vice versa, pressing pain is felt in the inflamed areas of the foot.
This is a ruptured heel tendon. The painful focus is located at the anterior edge of the plantar fascia.
Diseases such as gout, diabetes and rheumatism cause pain and discomfort in the foot.
Pinching of the lateral and medial plantar nerve causes pain in the toes (Morton’s neuroma).Patients with this condition feel as if they are stepping on a pea or pebble when walking. Most often, patients talk about the presence of a foreign body in the foot, but forget about the pain.
Pain in the foot at night is accompanied by itching, burning and loss of sensation, as well as pinching of other nerves, such as the tibial. In this case, experts consider such a disease as STK or neuralgic pain of the posterior tibial nerve in the foot.
Diseases of the foot.Most popular foot diseases
VALGUS STOP DEFORMATION
DIABETIC FOOT SYNDROME
Curvature of the toes
BONES ON THE LEGS
Natobirds in the front of the foot
VALGUS STOP STOP
A problem such as hallux valgus is not only an external defect, but also a serious pathology that causes many inconveniences and painful sensations.With this disease, an X-shaped curvature of the ankle joints and feet occurs with a change in the support of the heel to its inner edge. The presence of deformity is indicated by a significant distance between the heels in a pose with the legs brought together.
Hallux valgus is a curvature of the axis of the foot with the lowering of the midfoot, turning the heel outward and lowering its edges. Pathology is a consequence of congenital or acquired impairment of function, shape or size of individual bones, ligaments or muscles, which affects all other parts of the foot.This violates the ratio of the anatomical structures, which leads to a redistribution of the load. The situation is aggravated by the development of flat feet, due to which the bones of the foot are displaced in relation to each other, which forms hallux valgus.
The disease usually occurs in childhood due to congenital connective tissue dysplasia. Also, the cause may be osteoporosis, rickets, poliomyelitis, trauma, spasticity, paresis, paralysis, intrauterine limb development disorders, posture disorders, endocrine diseases or an overweight child.In adults, the development of pathology can be the result of injuries, paralysis or flat feet, especially after a sharp weight gain.
With hallux valgus, pain in the legs appears after walking and static loads, especially when wearing uncomfortable shoes. These symptoms may be accompanied by tension or pain in the muscles of the legs and a disturbed gait. The fight against the disease in the initial stages includes wearing orthopedic shoes, special gymnastics, massages, physiotherapy, the use of therapeutic mud, ozokerite and paraffin.With severe deformity, surgical correction is performed.
If you suspect hallux valgus, you should seek the help of a specialist as soon as possible in order to avoid complications of the disease and surgery.
Roughness of the skin of the feet is a pathology that is considered a cosmetic defect, despite its rather unpleasant consequences.Rough skin is the result of hyperkeratosis, a disease in which the cells of the epidermis divide too quickly and their desquamation is disturbed, which leads to thickening of the stratum corneum.
Hyperkeratosis can lead to deep bleeding fissures, punctate hemorrhages, ulcers, interdigital and hard root calluses, which will cause many painful sensations when walking. For healthy people, such complications do not pose a danger, but for patients with diabetes, they threaten the development of gangrene.
The causes of hyperkeratosis are divided into two groups: external and internal. Internal causes include impaired blood circulation in the vessels of the legs, varicose veins, athetosclerosis, diabetes mellitus, psoriasis, ichthyosis, hypo- or vitamin deficiency. But most often the reason is external factors: uncomfortable, tight or large shoes, prolonged or excessive loads on the legs, excess weight, foot deformities and violations of personal hygiene rules. Increased loads on the foot and rubbing the skin with shoes provoke increased division of horny cells, which also do not have time to actively exfoliate, forming a thickening of the skin.
For the successful treatment of hyperkeratosis, it is necessary first of all to establish the cause of the appearance of the pathology and eliminate it. To eliminate the external manifestations of the disease, softening of the hardened skin of the feet, removal of the hard layer of the epidermis, skin resurfacing and medical pedicure are required. To soften and moisturize, foot baths, the use of aloe juice are effective, for the treatment of cracks – applications with syntomycin ointment. It is very important to choose the right orthopedic shoes that will help correct the deformity of the foot, evenly distribute the load when walking and prevent chafing.
In order to avoid long and unpleasant treatment, it is important to detect the initial manifestations of the disease as soon as possible, while they are a minor cosmetic defect, and immediately take the necessary measures.
DIABETIC FOOT SYNDROME
Everyone who suffers from diabetes mellitus runs the risk of a complication of the disease that threatens the amputation of the lower limb.To avoid such an outcome, you need to closely monitor changes in well-being, paying special attention to the condition of the skin of the feet.
The risk of amputation of the lower limb arises due to the development of diabetic foot syndrome, in which the trauma of the skin of the feet increases. High blood sugar disrupts blood circulation in the vessels of the legs, which leads to a deterioration in the nutrition of the skin and exposes it to frequent damage. Also, high sugar reduces the sensitivity of nerve endings, which is why skin trauma can go unnoticed.Any damage can easily lead to the formation of ulcers and abscesses, turning into gangrene.
Diabetic foot syndrome can be recognized by symptoms such as dry feet, swelling, redness of the feet, fever, ingrown nails, pointed fingers, bursitis, pain or numbness in the legs, fungus, blisters, calluses, warts or sores on the feet. To successfully prevent the disease, it is important to detect the presence of any of these signs as early as possible and immediately consult a specialist.It is also very important to control blood sugar levels, observe diet and personal hygiene, and wear orthopedic shoes or insoles.
Orthopedic footwear has a minimum number of seams and a “breathable” structure, has antibacterial, antifungal and antiallergic properties. The benefit of orthopedic insoles is that they create unloading at the site of the ulcer and prevent damage. The insoles have an antibacterial coating on the lower ball and allow the feet to “breathe”.
Simple preventive measures, taken on time, in most cases help prevent the occurrence of diabetic ulcers, thereby eliminating the risk of limb amputation.
Curvature of the toes
Curvature of the toes is an abnormality in which the toes take on an unnatural shape.This is not only an aesthetic problem, but also the cause of pain, cramps, ulcers and chronic diseases of the joints of the feet.
The main reasons for the development of curvature of the fingers are disorders of muscle balance and abnormalities in the structure of the bones of the feet. The movement of the toes is carried out using the work of the muscles of two groups: flexors and extensors, the tendons of which are attached to the phalanges of the fingers. Normally, the tendons of these muscles work with equal strength. But with flat feet, the feet are lengthened, as a result of which the flexors begin to prevail over the extensors.This leads to excessive tension on the tendons, resulting in a gradual curvature of the fingers. With an increase in the tone of the short flexors, which are attached by tendons to the middle phalanx, a claw-like curvature of the fingers is formed. With an increase in the tone of the long flexors, a hammer-like curvature occurs.
The development of toe deformity is facilitated by wearing uncomfortable shoes (with thin toes or high heels), injuries, joint diseases, neuromuscular diseases, overweight and diabetes mellitus.Based on this, the main conservative ways to deal with the problem are wearing orthopedic shoes, fitness exercises, massages and physiotherapy.
If you do not contact a specialist in time, the deformity of the fingers can become fixed and the only way to get rid of it will be surgery.
BONES ON LEGS
The formation of a “bone” or “bump” on the legs in the area of the big toe worries not only as an external defect, but also as a cause of constant painful sensations when walking.In order for the fight against this problem not to be in vain, you first need to establish what kind of disease it is a consequence of.
Most often, a “bump” appears due to the development of hallux valgus of the first toe. With this disease, the ligamentous-muscular apparatus of the feet weakens, due to which the joints and bones change. A transverse flatfoot develops with the first toe deviating outward, as a result of which a “bump” is formed.
Another reason for the appearance of a “bump” on the leg is bursitis – an inflammation of the joint capsule, as a result of which a lot of fluid is formed in it.The accumulation of fluid leads to an increase in the joint capsule, which looks like a “bump”. The disease is characterized by characteristic symptoms: pain and burning in the joint area, red skin, swelling and increased joint mobility.
Also, a “bump” can appear with gout – the deposition of uric acid salts in the joint of the thumb. The formation of salt crystals provokes inflammation, which is accompanied by severe pain. The development of the disease is characterized by an attack of acute pain, which is often accompanied by headache, fever, fatigue, local redness and swelling.
The main causes of all these pathologies are most often heredity, osteoporosis, wearing uncomfortable and tight shoes, excessive stress on the legs or excess weight.
Therefore, in order to prevent it, it is necessary to observe the mode of work and rest, wear orthopedic shoes or insoles, if you suspect a disease, be sure to contact a specialist.
Natobirds in the front of the foot
Quite often people have to deal with the formation of corns in the forefoot, which can cause burning or pain when walking.Corns are coarsening and thickening of the stratum corneum of the skin of the feet due to prolonged stress on it.
Calluses are most common at the base of the toes and on the pads of the feet. Their formation is essentially a protective reaction of the body to pressure or rubbing that damages the skin. At the site of damage, blood circulation is disturbed, as a result of which skin cells begin to produce large amounts of keratin, which leads to keratinization of the skin. The main reasons that provoke keratinization of the skin are excessive or prolonged stress on the legs and wearing uncomfortable, tight or large shoes.Also, flat feet, bursitis, excess weight, diabetes mellitus, or a fungal infection may be the cause.
The fight against corns is reduced to establishing and eliminating the cause of their appearance. If the cause is deformity of the feet, stress on the legs, pressure or rubbing with shoes, the best solution is to wear orthopedic shoes or insoles. They will help correct deformity of the feet, correctly distribute the load on the legs, relieve the skin from pressure or chafing, and ease the pain when walking.
After eliminating the cause of the appearance of corns, it remains only to get rid of its local manifestations. If the problem is not started, it will be enough to soften the skin and remove its stratum corneum with a pumice stone. A foot bath and a compress with salicylic acid cream will help soften the skin for 6-8 hours. To reduce the burning sensation in the affected area, you can use creams that contain menthol.
In advanced cases (the presence of deep or root calluses), the fight against the problem at home is ineffective, and in diabetes mellitus it is also dangerous.Therefore, in order not to create additional problems for yourself, you need to seek help from a specialist.
The misalignment of the heel cannot be considered just an external defect, since it does not develop by itself, but is the result of serious dysfunctions of the feet.To successfully combat this problem, it is important to contact a specialist in a timely manner, who will determine the cause of its occurrence and select the necessary measures to combat it.
A full-fledged walking process for a person is ensured by the well-coordinated work of all joints, ligaments and muscles of the musculoskeletal system. In this case, the support, spring and balancing functions are assigned to the feet. The successful implementation of these functions is facilitated by the correct structure and position of the bones of the feet, which are regulated by the ligaments and muscles.With the help of the work of the ligaments and muscles, the foot acquires its shape and the ability to move.
The step cycle is carried out by combining two opposite natural movements of the feet: supination and pronation. In the process of walking, they allow the foot to elastically spread out under the influence of body weight, followed by a return to its original shape. When supination occurs, the rear of the foot turns outward, the longitudinal arch is lifted, the foot is shortened and its joints are “closed”. Pronation is accompanied by the rotation of the foot inside and its lengthening, which carries out a spring and balancing function.
Due to pathological changes in the structure of the feet, hypersupination or hyperpronation may develop, which is especially fraught with consequences. Hypersupination is accompanied by excessive bending of the feet outward, as a result of which the fulcrum of the heels is shifted in the same direction and the arches of the feet are raised. In the case of overpronation, the dorsal surfaces of the feet turn inward and the soles outward, which causes the center of the heel support to move to their outer part. Such changes entail the formation of persistent deformation of the bones of the feet and have a negative effect on the functioning of the entire musculoskeletal system.
In the presence of such disorders, gait worsens, pain appears in the feet, heels, ankles, and even in the knees and lower back. The best way to combat pathology is to wear orthopedic shoes or insoles in order to correct the defect and prevent its progression. Also, using them will help reduce pain and correct gait. A special exercise plays a significant role, which helps to strengthen the muscles involved in the walking process.
In order to prevent the development of pathology, it is necessary to train the muscles of the legs and eliminate traumatic factors: excessive loads on the legs and wearing the wrong shoes.
Approximately one in ten people experiences constant severe pain in the heel area that does not go away even after a long rest.Pain that aggravates in the morning when trying to take the first steps, when walking on stairs or after intense physical activity is most often caused by the formation of plantar fasciitis – a disease in which inflammatory-degenerative changes in the plantar fascia occur.
The plantar fascia is the ligament that connects the calcaneus to the metatarsal bones, supporting the longitudinal arch of the foot. They perform a shock-absorbing function, protect the bone structure and ensure its stability.In the standing position, the weakened plantar fascia is particularly stressed where it attaches to the calcaneus. In the case of an overload of the fascia, a micro tear occurs in this place and, as a result, local inflammation of its fibers, which is the cause of the pain.
Plantar fasciitis is a common cause of flat feet due to repeated minor injuries to the fascia, excess weight, rheumatic diseases, circulatory problems in the legs, or improper metabolism.All treatment measures are aimed at eliminating the inflammatory process. Physiotherapy, foot massages, leg exercises and passive orthopedic relief will be effective means. Among the effective means are springy heel cushions or combined orthopedic insoles. The latter distribute the load on the foot, reduce the shock wave when walking and reduce pain. In order to prevent the disease, you need to do exercises, do not overload the muscles of the feet with prolonged loads and choose comfortable shoes.
Never forget that it is much easier and less costly to prevent a disease than to fight it.
Often people are faced with such a problem as the appearance of acute pain in the heel when leaning on it.Such pain is the main symptom of the heel spur, a disease in which a bone growth occurs in the lower part of the calcaneus due to the deposition of calcium salts. However, the pain is not caused by the presence of a spur, but by inflammation of the tissues surrounding the calcaneus.
Bone build-up is formed as a compensatory response to damage to the ligaments or muscles at the site of their attachment to the heel bone. The main reason for the appearance of a heel spur is plantar fasciitis (inflammation of the plantar fascia), but others are not excluded: flat feet, diseases of the spine and joints, heel injuries, running on a hard surface, excessive loads, excess weight, gait disturbance and wearing uncomfortable shoes.
All measures to combat the disease are aimed at eliminating its cause – the removal of inflammation. It is also necessary to practice therapeutic gymnastics, massages, physiotherapy, adherence to a gentle regimen for the feet, wearing special orthopedic heel cushions and insoles. The latter work to relieve pain due to their soft texture in the projection area of the heel bone and their ability to absorb the shock wave when walking. They also help to correctly distribute the load on the foot, which greatly reduces the risk of additional trauma to the plantar fascia.
In order to prevent heel spurs, it is necessary to prevent the development of previous diseases, not to overload the ligaments and muscles of the feet with prolonged loads, choose comfortable shoes and preferably wear orthopedic insoles or heel cushions.
As you can see, the process of treating this disease takes a lot of work and time, so try not to forget about the elementary measures to prevent it.
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Stitching pain in the heel is the main symptom of the heel spur, a foot condition that can occur when the legs are overused.This pathology makes it difficult for a person to live fully, since every day you have to fight the feeling that a stone or a nail has got under the heel. Why does the heel hurt and how to get rid of the pain?
Causes of heel spur
During the day, we subject our feet to continuous stress: while walking, running, and even in those cases when we just stand in one place. The human foot is a very complex biomechanical structure. It includes 26 bones, which form three sections: the tarsus, metatarsus and phalanges of the fingers.The sections of the foot are interconnected by bones, ligaments and muscles, which forms the so-called longitudinal and transverse arches of the foot.
Thanks to them, when walking, the body weight is distributed not over the entire plantar surface, but over three points of support: on the heel and two points in front – the first and fifth metatarsal bones. This arched shape of the foot provides its spring function.
The internal structures of the foot are protected by the plantar fascia, a large ligament that connects the heel bone to the toes.It is essential for proper cushioning of the foot.
Heavy stress on the feet can damage or even tear the connective tissue, which triggers the inflammation process. This will lead to severe pain. Against the background of progressive inflammation, bone density structures begin to be deposited at the place of fixation of the plantar fascia to the heel bone. Because of this, a bone spike, or “heel spur”, is formed. It presses on soft tissues, causing pain and discomfort.
How heel hurts with a heel spur
If the problem is ignored, the pain in the heel will worsen over time.It is important to hear the complaints of your body at an early stage of the “spur”. The disease makes itself felt in the morning immediately after waking up. Heel pain can increase with each step. Painful sensations are even more disturbing if a person walks a lot or stands for a long time. At an advanced stage, the heel hurts already without load.
The discomfort caused by the heel spur forces you to give up physical activity and the usual way of life, because it becomes difficult to walk. If you endure pain for a long time, hoping that it will disappear on its own, the process of inflammation will spread to other nearby tissues, which will cause complications.Their treatment will take several months, and even after it, repeated inflammations are possible in such cases.
Who is at risk of heel spur
- Constant and excessive stress on the feet significantly increases the risk of developing heel spurs. People who, because of their professional activities, are forced to be “on their feet” for a long time: sellers, doctors, teachers, hairdressers, etc. are under the blow of the disease.
- Too intense physical activity can also provoke the development of pathology, for example, the need to walk a lot (work as a courier), too intense sports, hard physical work.In general, any activity on hard surfaces can lead to wear on the heel: walking, running or jumping.
- Often, the process of the development of the disease is triggered by heel injuries – bruises and microfractures of the ligament. Excessive load on the feet is also created by excess weight. In addition, in the presence of longitudinal flat feet, the risks of a heel spur increase significantly, since the load on the foot is not distributed correctly.
- Another common cause of this pathology is the use of unhealthy footwear: high-heeled shoes, with flat soles or a narrow front section.Due to the incorrectly distributed load, the arches of the feet begin to decrease over time, and the feet themselves become flatter. If not taken care of, they can deform over time.
What to do to prevent heel pain?
First of all, we refuse to wear shoes that are harmful to the feet. For example, when walking in high heels, the center of gravity shifts, which increases the load on the feet by 5-6 times. The pressure on the toes increases, the risk of flat feet increases, which can also provoke a heel spur.Using these shoes puts a lot of stress on your spine, so if you don’t wear heels, you will generally feel much better and more confident by the end of the day.
However, flat shoes or ballerinas don’t work either. Optimal shoe options include a 2-4 cm heel, wide front section and adjustable lacing or Velcro. It is desirable, of course, to wear orthopedic shoes that allow you to properly distribute the load on the feet.
If your work involves constant standing, it is recommended to rest periodically, allowing your legs to relax. During breaks, you can do simple foot exercises. We all know them from school: alternate walking on toes and heels, on the inner and outer sides of the foot, self-massage of the feet. It was not for nothing that in physical education lessons the teacher forced us to warm up, these exercises really help to strengthen our musculoskeletal system, including our feet.
Heel spur treatment: insoles or shock wave therapy?
One of the most effective conservative (without surgery) methods is the use of individual orthopedic insoles. A traumatologist-orthopedist uses special computer equipment (plantograph) to scan the feet, and according to its results, insoles for the left and right feet are produced. They restore the correct position of the arch of the foot by reducing the tension on the plantar fascia.
Also, for the treatment of heel spurs, doctors use shock wave therapy – the effect of a sound wave on individual structures of the musculoskeletal system.
When treating a heel spur, it is also possible to administer drugs locally to the site of inflammation to relieve severe pain.
Surgery is a last resort when conservative treatments have failed. In this case, the doctor removes not the heel spur itself, but the neurons in the disturbing area in order to relieve the patient of pain.
In recent years, people have begun to devote more time to their lifestyle, to undergo routine examinations. At the same time, unfortunately, few people care about the condition of their legs, in particular the feet, until they feel pain and discomfort. Most people have either never diagnosed them at all, or were examined only in adolescence. However, for the health of the whole body, it is important to consult an orthopedic traumatologist if symptoms such as increased fatigue, tired legs, or swelling occur in the evening.
In the basket
90,000 On the treatment of heel pain
5A PRACTICAL MEDICINE
Volume 16, No. 7 (part 1).2018
and.i. Shaikhutdinov12, m.v. Maleev1, F.F. Akhmerova2
Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, 420064, Kazan, Orenburg tract, 138 2OOO Academy of Health and Beauty Zvezda, 420015, Kazan, st. Karl Marx, 46, pom. 8
On the treatment of heel pain
Shaikhutdinov Ilgiz Insafovich – candidate of medical sciences, chief specialist, traumatologist-orthopedist, tel.(843) 231-20-61, e-mail: [email protected]
Maleev Mikhail Vladimirovich – candidate of physical and mathematical sciences, head of department, tel. (843) 237-35-23, e-mail: [email protected]
Akhmerova Firdausa Firdausovna – neurologist, tel. + 7-917-291-53-78, e-mail: [email protected]
Heel pain is a polyetiological condition requiring differential diagnosis between orthopedic, rheumatological and neurological causes.The main cause of heel pain is plantar fasciitis or heel spur. The issues of diagnosis and differential diagnosis of heel pain are described. Heel pain requires complex treatment: limiting physical activity; rational footwear, better physiological, the use of instep supports; shock wave therapy; massage and exercise therapy for the foot and lower leg. Key words: heel pain, plantar fasciitis, heel spur, shock wave therapy.
DOI: 10.32000 / 2072-1757-2018-16-7-54-57
(For citation: Shaikhutdinov I.I., Maleev M.V., Akhmerova F.F. On the treatment of heel pain. Practical medicine. 2018. Volume 16, No. 7 (part 1), pp. 54-57)
I.I. SHAYKHUTDINOV12, M.V. MALEV1, F.F. AHMEROVA2
1 Republican Clinical Hospital of the Ministry of Healthcare of the Republic of Tatarstan, 138 Orenburgskiy Trakt, Kazan, Russian Federation, 420064
2LLC Academy of Health and Beauty Zvezda, 46 Karl Marx Str., room 8, Kazan, Russian Federation, 420015
Treatment of heel pain
Shaykhutdinov I.I. – PhD (Medicine), Chief Specialist, Traumatologist-orthopedist, tel. (843) 231-20-61, e-mail: [email protected] maleev M.V. – PhD (physicomathematics), Head of the Department, tel. (843) 237-35-23, e-mail: [email protected] Akhmerova F.F. – Neurologist, tel. + 7-917-291-53-78, e-mail: fahmerova @ bk.ru
Heel pain is a polyietological condition requiring differential diagnosis because of orthopedic, rheumatological and neurological causes. The main cause of heel pain is plantar fasciitis or heel spur. The problems of diagnosis and differential diagnosis of heel pain are described. Heel pain requires complex treatment: limited physical activity; rational footwear, better physiological, use of insteps; shock wave therapy; massage and exercise therapy for the foot and lower leg.Key words: heel pain, plantar fasciosis, heel spur, shockwave therapy.
(For citation: Shaykhutdinov I.I., Maleev M.V., Akhmerova F.F. Treatment of heel pain. Practical Medicine. 2018. Vol. 16, no. 7 (part 1), P. 54-57)
The most common cause of heel pain is plantar fasciitis (FF) or heel spur (PF) . According to ICD X, this disease has the code M77.3 and belongs to class XIII “Diseases of the musculoskeletal system and connective tissue”, and
precisely – to “other enthesopathies”.The term “enthesopathy” denotes a pathological process in entheses, that is, in the places of attachment to the bone (insertions) of tendons, ligaments, joint capsules . In our case, we are talking about degenerative
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process at the site of attachment of the plantar fascia (aponeurosis) to the calcaneus. The plantar fascia is a dense connective tissue formation, with one end attached to the calcaneal tuberosity, the other to the heads of the metatarsal bones of the foot.This fascia plays an important role in the formation and maintenance of the arch of the foot . The pathogenesis of plantar fasciitis is not fully understood.
According to medical statistics, about 10% of patients seeking help with diseases of the musculoskeletal system are patients with heel pain. This disease occurs at any age, but women over 40 are most susceptible to it .
Heel pain in 90% of cases develops against the background of flat feet.In addition to flat feet, such patients have a history of acute and chronic injuries of the calcaneus, diseases associated with metabolic disorders (gout), as well as significant circulatory disorders of the legs in people with poor vascular patency (atherosclerosis of the vessels of the lower extremities, obliterating endarteritis, etc. .). In addition, inflammation of the heel area is a consequence of a number of chronic inflammatory diseases of the joints: ankylosing spondylitis and other seronegative spondyloarthritis.
Diagnosis of a heel spur is carried out on the basis of anamnesis and examination. The clinical picture with a heel spur is typical. Most often, patients complain of the so-called starting pain. Those suffering from this ailment are most difficult for the first steps after sleep, prolonged sitting. Pain with a heel spur can be burning, sharp when resting on the heel, patients describe them as a feeling of a nail in the heel. Pain can spread over the entire heel area or be localized along the inner surface of the heel.Pain can appear suddenly and be acute or develop gradually, becoming chronic. Patients involuntarily try to relieve the heel . When examining the heel area, as a rule, pathological changes are not detected. When pressing on the central and medial surface of the calcaneus from the side of the sole, a sharp soreness appears. If pain does not occur with such palpation, an alternative diagnosis to the heel spur should be sought.
X-ray examination is not required to diagnose PF and PS.It may require-
for differential diagnostics. The intensity of the pain does not depend on the size of the spur, determined on the radiograph. Quite often, spurs, sharp in shape and large in size, are an accidental X-ray finding. At the same time, severe pain in the heel area is possible with a normal X-ray picture . Ultrasound examination in PF usually reveals a thickening of the plantar aponeurosis over 4 mm, the presence of calcification (PS) in the area of its attachment to the calcaneal tuberosity .
In case of an atypical history, localization of pain and the absence of a positive effect from standard therapy, an alternative diagnosis should be excluded  (Table 1).
In addition to these diseases, it should be noted the importance of taking into account myofascial reflected pain from the muscles of the leg and foot  (Fig. 1-4). It should be noted that the myofascial trigger of the abductor toe I (Fig.1), not only provokes pain on the inner side of the heel, but in some cases, squeezing, causes tunnel syndrome of the medial and lateral plantar nerves. A trigger in the square muscle of the foot (Fig. 3) under load (stepping on a hard surface) causes acute pain in the heel, “as if a nail were being driven into the leg.” This pain is identical to that of PF! Quite often, against this background, PS is found, which does not cause pain. Heel spurs and a trigger in the square muscle of the foot can coexist, so local PS therapy will not have the desired effect.
A real effect in the treatment of heel pain can be obtained only in the case of an integrated approach. Physical activity should be reduced. Without this, as a rule, the effect will be minimal.
Rational footwear. In our opinion, it is optimal to wear the so-called physiological Joya or MBT shoes, which provide a natural roll on the outer side of the foot, have the maximum shock-absorbing effect and provide continuous walking comfort, protecting the foot, joints and spine .In the absence of the opportunity to wear physiological shoes, it must be borne in mind that the shoes must have up to 90,026
Differential diagnosis of plantar fasciitis Table 1.
Differential diagnosis of plantar fasciosis
Diseases of the support and movement organs Apophysitis of the calcaneus Fractures Metastatic disease Contusions Diseases of the Achilles tendon
Neurological diseases Tarsal tunnel syndrome Neuropathy of the medial branch of the posterior tibial nerve Neuropathy of the lateral plantar nerve
Systemic diseases Spondyloarthritis Systemic lupus erythematosus Rheumatoid arthritis
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56 PRACTICAL MEDICINE
Volume 16, No. 7 (part 1).2018
Trigger points in the abductor thumb and zone of reflected pain  Figure 1.
Trigger points in the muscle that abducts the big toe, and the zone where reflected pain is spread 
Trigger point in the square muscle of the sole and the zone of propagation of reflected pain 
Trigger point in the plantar quadrate muscle and the zone where reflected pain is spread 
Trigger points in the abductor little finger and reflected pain spread  Figure 2.
Trigger points in the muscle that abducts the little toe, and the zone where reflected pain is spread 
Trigger point in the soleus muscle and the zone of propagation of reflected pain  Figure 4.
Trigger point in the salens muscle and the zone where reflected pain is spread 
Static arch support and a low heel of 2-3 cm, a rigid sole with a thickness of at least 5 mm . It is important to use instep supports, especially individually made .
Blockade with steroids. This type of treatment is most widespread in our country. It is, as a rule, about infiltration with an anesthetic and diprospan solution of the area of attachment of the plantar fascia to the heel bone. Our many years of experience in the treatment of hundreds of patients with heel pain suggests that the use of a double diprospan blockade with an interval of
1 month effectively and for a long time (at least a year) relieves pain caused by PF and PS (this is about 70% of patients with heel pain).At the same time, injection of corticosteroids is not as safe as it might seem at first glance. The most frequent and formidable complication is the rupture of the plantar fascia, as well as the atrophy of adipose tissue, which plays an important role in mitigating the “heel stroke” when walking . In addition, suppuration, vascular accidents, and a sharp rise in blood pressure are possible. It should be noted that in all cases of using blockades with diprospan solution, we did not observe
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90,023 any complications, however, in patients of the older age group (50 years and above) for the prevention of vascular complications in the form of thrombosis, stroke and heart attack, we used clexane at a dose of 0.2-0.4 subcutaneously at night 3-4 days after injection diprospana.In view of the above, in recent years we have done blockades with diprospan in the treatment of this pathology very rarely.
Extracorporeal shock wave therapy. The method of shock wave therapy (SWT) has gained immense popularity in recent decades [10-12]. The authors point to a positive result of PF treatment in 76.7-86.6%. Analysis of the results of our use of the UHT device Duolith SD1 of the Swiss company STORZ MEDICAL AG for one year made it possible to conclude that in the treatment of heel pains it is possible to completely abandon the blockade with the hormone.The UHT technique can simultaneously perform two functions – therapeutic and diagnostic. In healthy tissues, there is no painful reaction to the procedure. Therefore, we start therapy in the area of attachment (insertion) of the plantar fascia to the heel bone. We work on the insertions of the short muscles of the foot: the flexors of the toes, the square sole, the abductors of the I and V toes. Next, we move on to the indicated muscles themselves and to the muscles of the lower leg, from where the pain reflected from the triggers can go to the heel. On one foot we apply, as a rule, 1800 strokes with the applicator of focused shock waves with a frequency of 3-5 Hz, energy of 0.10-0.50 mJ / mm2.It depends on the severity of pain and the patient’s pain threshold. In case of pathology in both feet, we inflict 3000 strokes in one session. The course of treatment usually requires 3-5 sessions of shock wave therapy with an interval of 1-2 times a week.
Massage and physiotherapy exercises of the foot and lower leg. Heel pain is caused not only by the PF, but also, often, by myofascial triggers in the muscles of the foot and lower leg, distal tunnel syndromes, etc. Therefore, massage, ischemic compression of triggers on a tennis ball, exercise therapy, have a positive therapeutic effect.
Comprehensive treatment of heel pain with the use of shock wave therapy at the Zvezda Academy of Health and Beauty, Kazan received 32 patients. A positive clinical effect was achieved in all patients within a year. Pain syndrome assessed visually –
analogue scale (VAS) decreased in these patients by the end of treatment from 9.2 ± 0.3 cm to 0.2 ± 0.1.
1.Heel pain is a polyetiological condition requiring differential diagnosis between orthopedic, rheumatological and neurological causes.
2. The main cause of heel pain is plantar fasciitis or heel spur.
3. Treatment of heel pain requires an integrated approach: limiting physical activity; rational footwear, better physiological Joya or MBT, use of instep supports; shock wave therapy; massage and exercise therapy for the foot and lower leg.Diprospan blockade for strict indications.
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12. Scot Malay. D, Pressman M. M., Assili Amir et al. Extracorporeal Shokwafe Therapy Versus Placebo for the Treatment of Chronic Proximal Plantar Fasciitis: Results of a Randomized, Placebo-Controlled, Double-Blinded, Multicenter Intervention Trial // Foot and Ankle Surgery. – 2006. – Vol. 45. – P. 196-210.
INNOVATIVE TECHNOLOGIES IN MEDICINE I PART 1
Heel spur – Directory of diseases
Calcaneal spur refers to the bony outgrowth where the tendon attaches to the heel bone.The disease is characterized by painful sensations in the sole area, especially when walking.
Calcaneal spur (ostiophyte) is a bony growth ( osteophyte ) on the plantar surface of the calcaneus. Such growth acts in the form of a thorn and squeezes the soft tissues of the foot – hence the characteristic excruciating pain .
The sizes of heel spur can be different – from 3-4 to 12 millimeters.The sharp end of spur is usually directed towards the fingers and slightly curved upward.
It is believed that heel spur appears as a result of a high load on the heel area (with flat feet), with age-related changes, as a result of trauma, rheumatism, vascular or neurodystrophic disorders. Often added to this is inflammation of the mucous membranes (calcaneal bursitis, achilobursitis) and inflammation of the fascia – the muscle tissue of the sole (fasciitis).
The fascia is subjected to tremendous stress every day, because it is affected by every step.With damage to the fascia, an inflammatory process can occur. And the result of its development is heel spur .
Even at the beginning of the 20th century, the disease was much less common and in most cases was associated with injuries, and not with flat feet or overweight. In the modern world, heel spur is a very common disease. In 80% of cases, women suffer from it, and three quarters of them are urban dwellers.
Why and who gets heel spurs?
Heel spurs may appear on one or both heels.The likelihood of its occurrence is at any age; in older people, the heel spur is often caused by age-related changes. And at a young age, the disease provokes significant loads on the feet and playing sports with too intense training.
The first symptom of heel spur is pain in the heel when resting on it. Particularly painful are the first steps in the morning after getting out of bed, after a long break in movement – the so-called “starting pain”. During the day, the pain when walking subsides a little, and in the evening it intensifies again.
Pain can be only on the inside of the heel, or it can spread to the entire surface of the heel. The pain can be burning, sharp, and is often defined as a “feeling of a nail in the heel.” Therefore, a person involuntarily tries to relieve the heel, and this affects the gait. And in the event that heel spurs are on both feet, it becomes especially difficult to walk.
In 93% of cases with a heel spur, a violation of the gait pattern is noticeable. The shift of the center of gravity from the heel to the forefoot and the outer edge of the foot causes an irregular distribution of weight and can lead to the development of transverse flat feet.On visual examination, as a rule, pathological changes in the heel area are invisible. Pressing the calcaneus tubercle from the sole and squeezing the heel from the sides causes characteristic pain.
Overweight people have a predisposition to the development of heel spurs – a large body weight causes excessive stress on the feet. Diseases of the spine and large joints of the lower extremities, flat feet shift the normal distribution of body weight over the surface of the foot and also increase the risk of developing heel spurs.Athletes involved in athletics, running for a long time also experience significant stress on the feet and are prone to illness.
An additional factor that aggravates pain with heel spur is the thinning of the subcutaneous fat layer in the heel. This layer acts as a natural shock absorber when walking.
How do I know if I have a heel spur?
Pain in the heel usually develops and is aggravated by walking. Sometimes pains become so sudden and sharp, as if a nail has been driven into the heel.The pain is especially bad in the morning on getting out of bed.
At the same time, if your feet hurt in the heel area, this does not mean that you have heel spur . To clarify the diagnosis, it is better to consult a surgeon or orthopedist. First of all, you need to exclude other diseases that are also manifested by pain in the heel area – rheumatoid arthritis, Reiter’s syndrome and ankylosing spondylitis. These diseases are detected using a biochemical blood test – rheumatoid factors are found in it.
The presence and size of bone growth (actually spurs ) is determined on an X-ray image. But the intensity of pain depends not only on the size of the spur, but also on the sensitivity of the tissues.
Often, large spurs do not cause significant discomfort, and imperceptible on radiographs give excruciating pain . Therefore, to clarify the data, it is recommended to supplement the X-ray images with ultrasound.
What can a heel spur lead to?
In 25% of cases, a heel spur leads to a partial loss of mobility.With severe pain, can be assigned to bed rest or gentle working conditions. But it becomes difficult to live a normal life with heel spur . Especially dramatic changes await those who went in for sports and led an active lifestyle. In conditions where every step is given by pain, it is difficult to maintain the same rhythm.
How to protect yourself from the appearance of a heel spur?
It is quite possible to prevent the occurrence of a heel spur from . To do this, you need to do everything possible to prevent wear of the calcaneus, flat feet and inflammation in the soft tissues of the feet.
For those who are overweight, it is better to take care of its reduction – this will reduce the load on the feet. It is useful to do foot massage and gymnastics for the legs, walk barefoot on the grass and sand more often – this improves the blood supply to the feet and prevents the development of foot diseases.
If you have flat feet, it is better to treat it in a timely manner, before it comes to the appearance of heel spur . Orthopedic insoles should not be neglected. And if you are worried about pain in your feet, do not delay the visit to an orthopedic surgeon.
Footwear that is comfortable and non-traumatic for the feet also plays an important role in disease prevention. It is best to wear shoes with low (3-4 cm) heels that do not compress or injure the feet. High heels, when worn continuously, increase the risk of developing heel spurs. But the complete absence of a heel negatively affects the condition of the feet.
It is not recommended to wear sandals without a back – in them the arch of the foot is constantly tense. Such shoes are suitable for short-term wear, and for the everyday version it is better to choose one that holds firmly on the foot.It is also not recommended to wear narrow-toed shoes.
Treatment of a heel spur
Currently treatment of a heel spur consists in providing unloading using various types of insoles and heel pads, physiotherapy complex treatment: mud applications, ultrasound therapy, mineral baths, local administration of corticosteroids, X-ray therapy, and in the absence of an effect, surgical treatment – removal of bone outgrowth by surgery and excision of altered tissues.
They try to resort to surgery extremely rarely, in severe and neglected cases. It is important to understand that the operation does not eliminate the causes of the disease, but only makes it possible to get rid of its manifestations. Subsequently, reappearance of the heel spur is very likely. 90 026 90 000 Heel pain – causes and treatment
Heel pain can be associated with a variety of pathologies that often occur during daily activities such as walking, running and even sleeping. Heel pain is a common problem.The heel bone is the largest bone in the foot and absorbs most of the load while walking or running. Therefore, it is not surprising that sometimes she can get sick.
Most often, pain is felt on the back-bottom of the heel. These symptoms are rarely signs of a serious illness, but can significantly affect the quality of daily life. In most cases, heel pain builds up gradually, but sometimes it happens quickly, such as as a result of an injury. Heel pain can provoke other problems – avoiding pain, we begin to move in a different way.
Next, we will look at the most common diseases, as well as their causes, typical symptoms and possible treatment options.
The plantar fascia is a dense, wide tendinous plate (aponeurosis) located on the plantar part of the foot. Damage to this structure occurs most often – in about one in ten people suffering from heel pain.
What is plantar fasciitis? This is a degenerative lesion of the plantar fascia.
Causes: Excessive use (for example, regularly standing on the legs for a long period of time), muscle weakness and stiffness, changes in the biomechanics of the foot, obesity.
Symptoms: Pain under the heel that may get worse after resting, standing on tiptoes or climbing stairs. Pain can occur when touched.
Complications: Formation of a heel spur.
Treatment: Rest, exercise, use of orthoses, in severe cases, surgery.
Achilles tendonitis is the most common cause of pain in the back of the heel. The disease is characterized by inflammation and / or degeneration of the Achilles tendon.
What is Achilles tendonitis? Inflammation or degeneration of the Achilles tendon that originates at the confluence of the lateral and medial heads of the gastrocnemius and soleus muscles and joins the calcaneus.
Causes: Repetitive stress on the tendon, usually due to muscle weakness and / or stiffness; altered biomechanics of the foot.
Symptoms: Pain in the back of the heel that may get worse after rest or in the morning; Stiffness in the ankle or calf muscles swelling and tenderness on palpation of the Achilles tendon on the back of the heel or just above the ankle.
Complications: Calcaneal bursitis is an inflammation of the bursa that lies between the Achilles tendon and the calcaneus.
Treatment: Rest, exercise, orthopedic insoles.
Bone spurs can occur on both the lower and the back of the heel. They are a common cause of heel pain.
What is a bone spur? This is a bony outgrowth that forms as a result of excess calcium deposition in the bone. They can occur both on the back of the heel (Haglund deformity) and under the heel.
Causes: Repetitive excessive exercise such as running or jumping; muscle weakness and stiffness; abnormal position of the calcaneus.
Symptoms: Pain in the heel that occurs when resting on the foot after rest – a feeling as if you are stepping on something sharp. Aching pain is more common, but some people have no pain at all.
Complications: Bone spurs are often associated with plantar fasciitis and Achilles tendonitis.
Treatment: Stretching and muscle strengthening exercises, orthopedic insoles and surgery.
Fracture of the calcaneus
Bone fracture can cause pain.
What is a calcaneus fracture? These are single or multiple tears / fissures in the calcaneus.
Causes: Repetitive stress on the calcaneus, such as running, jumping, causing stress fractures; landing on heels when falling from a height.
Symptoms: Pain that worsens with pressure on the heel; edema; change in gait.
Treatment: Stress fracture of the calcaneus is treated with medication and rest (protection, rest, cold, compression and elevation), but more serious cases require surgery.
What is calcaneal bursitis? This is an inflammation of the bursa, which is located between the Achilles tendon and the heel bone.
Causes: Friction of the bursa occurs due to muscle stiffness and weakness, and can also occur due to a sharp increase in physical activity.
Symptoms: Pain in the back of the heel, especially when walking, running or standing on tiptoes; swelling, redness, and warmth at the back of the heel.
Complications: Combined with Achilles tendonitis.
Treatment: Rest, ice, medication, calf exercises, steroid injections.
Triangular bone syndrome
This is one of the rarest causes of heel pain. As a rule, ballet dancers and athletes are affected.
What is Triangle Bone Syndrome? This is a soft tissue irritation at the back of the heel.
Causes: Accessory bone, a pain known as triangular bone, gets stuck in the ankle and irritates the surrounding soft tissue.
Symptoms: Deep dull pain in the back of the heel; increases with plantar flexion of the foot, passes at rest.
Treatment: Rest, ice, steroid injections, sometimes surgical treatment.
Tarsal canal syndrome
What is tarsal canal syndrome? This is compression of the tibial nerve in the tarsal canal.
Causes: Swelling, cyst, arthritis, ganglion, benign tumor or flat feet.
Symptoms: Pain in the foot and heel, which can extend to the ankle and even the lower leg; numbness and tingling on the inside of the foot and heel; worse at night; usually one leg is affected.
Treatment: Rest, anti-inflammatory drugs, orthopedic insoles, steroid injections, surgery.
Sever’s disease (inflammation of the epiphysis of the calcaneus)
Sever’s disease is the most common cause of heel pain in children.
What is calcaneal epiphysitis? This is an inflammation of the posterior epiphysis of the calcaneus.
Causes: Rapid growth of the heel bone relative to the surrounding soft tissue on one side, and excessive mechanical stress during prolonged standing, running or jumping on the other.
Symptoms: Pain in the back or bottom of the heel when walking; ankle stiffness; symptoms worsen with physical activity and go away at rest; both legs are affected simultaneously.
Treatment: Stretching and strengthening exercises, rest, orthoses, medication. Symptoms disappear within 2 months.
Atrophy of the calcaneal fatty body
Causes: High body mass index, sports with jumping and landing on hard surfaces. Running with a hard heel landing.
Symptoms: Aching dull pain in the center of the heel, aggravated by palpation, as well as walking barefoot on a hard surface, wearing shoes.
Treatment: Rest, analgesics, orthoses (heel cups), exercise, taping, massage.
To reduce pain, we often have to move in different ways, which can lead to other problems, such as pain in the knee, hip or back. An accurate diagnosis is important, so be sure to see your doctor.
In most cases, the cause of heel pain will not be serious, and symptoms will gradually disappear with changes in the level of load and adequate exercise selection.
Heel spur: symptoms, treatment, diagnosis
A calcaneal spur is a bony growth in the form of a beak or a thorn. The pathological process is most often localized in the projection of fixation of the plantar fascia to the heel bone – an area that plays a leading role in the formation of the arch of the foot and experiences most of the load when walking. The main manifestation of a heel spur is pain of varying degrees of severity in the back of the foot. At the advanced stage of the disease, the entire musculoskeletal system suffers.Chronic pain and difficulty in movement adversely affects the general state of health and all types of human activities.
The Center for Rehabilitation Medicine offers treatment of diseases of the musculoskeletal system with the most effective methods today. An orthopedic surgeon conducts a comprehensive diagnosis of the state of the body and gives individual recommendations on how to cure a heel spur in a way suitable for a particular patient.
Causes of the heel spur
The first stage of bone growth is pathological rearrangement of the plantar fascia (enthesopathy) in response to the systematic effect of a traumatic factor in the lower surface of the foot.As a result, plantar fasciitis develops – a local aseptic inflammation (without a microbial agent). The next stage is the calcification of the affected area and the formation of a heel spur.
Various pathological conditions can serve as a triggering factor for the onset of the disease:
Flat feet, high arch or hallux valgus. Due to the incorrect distribution of the load on the sole, the tendon fibers are damaged and inflamed.
Age-related deterioration of the shock-absorbing function of the foot tissues (degeneration of the fat pad in the heel area), as well as a general decrease in metabolic and recovery processes in the body.
Acute trauma to the heel or chronic trauma to the sole due to excessive jumping and shock load during professional dancing, sports (athletics, weightlifting, figure skating).
Injuries and diseases of the spine, changing the axial load on the musculoskeletal system.
Wearing footwear that violates the physiology of movement – high heels (more than 5 cm) or flat soles.
Diseases of blood vessels, metabolism – atherosclerosis, gout, obliterating endarteritis, diabetes. The development of a heel spur in these diseases is facilitated by a significant violation of blood flow in the lower extremities and a decrease in tissue regeneration processes.
Excess weight – excessive stress on the plantar fascia.
Work associated with lifting weights, prolonged stay in an upright position.
Chronic inflammatory processes in the joints, bones – rheumatoid, psoriatic arthritis.
A heel spur occurs in any age group with a fairly high frequency – every 10th patient seeks an orthopedic surgeon with pain in the plantar part of the foot. However, women after 45 years of age are more susceptible to the disease.
Symptoms of pathology
The clinical picture of the disease consists of pain and difficulty in motor activity.Most often, the symptoms of a heel spur are typical: pain in the plantar region occurs at the beginning of walking, when getting out of bed, from a chair supported on the heel. The greatest difficulties are caused by the first steps after a long rest. When walking for 10-15 minutes, the pain dulls a little, but then returns.
The disease manifests itself as a sudden onset of acute pain, and a gradual increase in the intensity of the pain syndrome, passing over time into a chronic form. Painful sensations can be sharp, burning, perceived as a foreign object in the heel (awl, nail) when walking.Pain may focus on the inner heel or spread over the entire heel area. At an advanced stage of the pathological process, uncomfortable sensations disturb the patient not only when moving, but also at rest.
The severity of the manifestation of the disease does not depend on the size of the bone growth, but on the severity of the inflammatory process in the adjacent tissues (in the fascia, periosteum, synovial bursa) and on where the heel spur is located – the closer the growth is to the nerve endings, the stronger the pain.Often, large and sharp bone spines do not cause discomfort in the patient and are detected by chance during an X-ray examination. At the same time, small osteophytes can cause severe physical suffering.
In case of untimely diagnosis and treatment, serious disorders of the musculoskeletal system join the characteristic symptoms of the heel spur. Due to the pronounced discomfort when walking, the load from the sore spot is redistributed in an unnatural way to the healthy surfaces of the foot.The gait becomes waddling, the muscles of the back, limbs are overstrained and constantly hurt.
An orthopedic doctor is responsible for the prescription and treatment of the heel spur. Diagnosis of bone formation is carried out on the basis of an analysis of the patient’s complaints, anamnesis, examination, palpation. On visual examination, the doctor does not detect any changes. When pressing on the inner and central area of the calcaneus from the plantar side, acute pain occurs. X-rays are taken to confirm the diagnosis, but it does not always reveal pathological changes.
There are a number of diseases that are similar in their manifestations to the heel spur. For differential diagnosis and clarification of the cause of the pathology, the doctor may prescribe additional studies:
blood biochemical parameters;
general clinical analysis of urine, blood;
Ultrasound of soft tissues;
MRI of anatomical structures of the foot;
dopplerography of vessels.
Consultation of related specialists is appointed if necessary. Only a specialist can identify the cause of bone growth and determine how to treat a heel spur.
Is the alternative treatment of heel spur effective?
Traditional medicine offers many recipes for getting rid of a heel spur, including how to quickly cure a pathological formation at home. The use of folk methods requires a rational attitude.Under the mask of heel pain, more serious diseases can be hidden. Self-treatment at home without a full-fledged medical diagnosis and therapy can lead to the progression of the disease and delay the healing process.
Official medicine uses several folk recipes in the complex treatment of heel pain: warm foot baths with a strong solution of sea salt, mustard or soda. But they need to be used only as directed by a doctor.
How to cure a heel spur?
The effect of heel spur therapy is achieved only with an integrated and phased approach.First of all, the cause of the inflammatory process in the plantar region is identified and, if possible, measures are taken to eliminate it. Initially, treatment is aimed at relieving inflammation and acute pain. For this purpose, various measures are used:
Maximum unloading of the foot – special orthopedic insoles or shoes, temporary restriction of movement.
Foot massage, remedial gymnastics.
Warm salt baths before massage.
Local use of absorbable, non-steroidal anti-inflammatory drugs in the form of patches, ointments.
In case of ineffectiveness of local treatment, a drug blockade of the heel spur with diprospan is used.
If there are concomitant vascular diseases, vasoactive drugs are used.
Physiotherapy allows you to get rid of pain, reduce inflammation, and restore motor functions of the feet.
After the relief of acute inflammation, physiotherapy is prescribed to accelerate tissue repair, improve blood flow, and reduce inflammatory reactions.
If conservative treatment is ineffective within 6 months and pain persists, the heel spur is surgically removed.
The peroneal tendons connect the calf muscles (peroneus brevis / peroneus longus) to the tarsal bones: the wedge-shaped inside of the foot and the metatarsal outside.Both bones surround the foot from the medial and lateral sides. The peroneal muscles help extend the foot and toes (plantar flexion).
Ankle and peroneal tendons: The long peroneal tendons are controlled by the gastrocnemius muscles, located in pairs – on the inside and outside of the ankle joint – and anchored in the tarsus region. With excessive exertion and the absence of regeneration, inflammation of the tendon sheath and ruptures of the peroneal tendons are possible.© Bilderzwerg @ fotolia
Peroneal tendons and muscles often become inflamed due to overuse, increased exercise, lack of warm-up, or foot deformities (peroneal tendon tendonitis). The critical point in this situation is a sudden change in the total load: People who start with an increased volume of training can develop muscle breaks, as well as inflammation of the peroneal muscles. Pain in the foot, caused by inflammation of the peroneal muscles and tendons, begins in the calf muscles and radiates to the foot through the tendons. First of all, the outer ankle begins to hurt. When the foot is tucked outward, the pain in the peroneal muscles increases as the tendon continues to stretch.
Likewise, in the area of the tendons that run transversely under the ankle joint, inflammation (tendinitis) can occur. Peroneal tendon tenditis results in painful inflammation as well as swelling, pain in the foot and ankle.
Tight athletic shoes that limit the smooth rolling of the foot also cause painful inflammation of the peroneal tendons.With deformities in the foot, there is no required amount of load on the leg muscles, which causes pain and overload in some parts of the foot.
Inflammatory process can lead to rupture of the peroneal tendon. In addition, a swollen peroneal tendon can compress the nerves of the tarsal (metatarsal) canal, causing the patient to experience itching, numbness, and sensory disturbances in the foot.
Treatment of inflammation of the peroneal tendons
There are no such pathologies in the foot that concern only women. However, pain in the forefoot occurs 10 times more often in women than in men.The reason for this is the fact that the connective tissues in women are weaker. Hormonal changes, such as pregnancy or menopause, can also change the structure of connective tissue. In addition, women like to wear nice high-heeled shoes, which leads to muscle curvature in the foot. Very often, instead of smoothly rolling the foot from heel to toe, the main weight falls on the forefoot, which leads to muscle deformation.
Pain in the big toe: Metatarsalgia (pain in the metatarsal bones) with transverse flat feet
Symptoms of metatarsalgia
In metatarsalgia (metatarsal pain), patients experience pain in the metatarsophalangeal joint at the level of the ball of the foot of both feet, which is located just below the toes.This area in the foot is under the most pressure than others. Due to transverse flat feet , the transverse arch of the foot decreases and the load on the plantar fascia increases. During the roll of the foot from heel to toe, the transfer of body weight to the floor occurs with the help of the ball of the foot. Weak connective tissue or poorly trained legs are two of the most significant reasons why patients begin to feel pain in the foot. If a person wears uncomfortable narrow-toed shoes every day, the risk of illness increases significantly.
And if the shoes are also high-heeled, the load on the ball of the foot and connective tissue increases. Patients are advised to take these facts into account and pay attention to the fact that the human foot, by its nature, is not capable of withstanding such loads. After several years of wearing such shoes, many experience severe pain in the foot, as well as flattening of the arch of the foot and transverse flat feet, in which the forefoot is flattened, and the first toe is retracted outward.