Plantar Fasciitis and Bone Spurs – OrthoInfo

Plantar fasciitis (fashee-EYE-tiss) is one of the most common causes of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year.

Plantar fasciitis occurs when the plantar fascia, a strong band of tissue that supports the arch of your foot, becomes irritated and inflamed.

The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot and supports the arch of your foot.

The plantar fascia is a ligament that lies beneath the skin on the bottom of your foot.

The plantar fascia is designed to absorb the high stresses and strains we place on our feet when walking, running, and doing other activities like playing sports. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.

Too much pressure on the plantar fascia can damage or tear the tissues, causing heel pain. 

Risk Factors

In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition:

• New or increased activity
• Repetitive high impact activity (running/dancing/sports)
• Prolonged standing on hard surfaces (especially among nurses, factory workers, and teachers)
• Anatomy (flat feet or a high arch)
• Tight calf muscles
• Obesity
• Age (plantar fasciitis is most common among people aged 40 to 60)

The most common symptoms of plantar fasciitis include:

• Pain on the bottom of the foot near the heel.
• Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain goes away after a few minutes of walking
• Greater pain after (not during) exercise or activity.

After you describe your symptoms and discuss your concerns, your doctor will examine your foot. They will look for these signs:

• A high arch or flat foot
• An area of maximum tenderness on the bottom of your foot, just in front of your heel bone
• Limited dorsiflexion, or “up” motion, in your ankle
• The absence of symptoms from other conditions, such as insertional Achilles tendinitis, calcaneal (heel) stress fracture, or plantar nerve entrapment

Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem.

X-rays

X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis.

Heel spurs can be seen on an X-ray. A heel spur can be the result of longstanding (occurring for a long time) tension on the plantar fascia insertion (the spot on the heel bone where the plantar fascia attaches). However, most people who have bone spurs on their heels do not have heel pain. Since heel bone spurs are not the cause of plantar fasciitis, plantar fasciitis pain can be treated without removing the spur.

Heel spurs do not cause plantar fasciitis pain.

Other Imaging Tests

Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered.

An MRI scan may be used if the heel pain is not relieved by initial treatment methods or if your doctor is concerned that a different problem is causing your heel pain.

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Nonsurgical Treatment

More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.

Rest. Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running, dancing, or step aerobics). Your doctor may recommend that you use a walking boot and crutches for a short period of time to allow your foot to rest.

Changing your activity. Low impact exercise, such as cycling or swimming, puts less stress on your joints and feet than walking or running.

Stretching. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.

Calf stretch

• Calf stretch
  Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.
• Plantar fascia stretch
  This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.

Ice. Rolling your foot over a cold water bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day.

Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen or naproxen reduce pain and inflammation. Using the medication for more than 1 month should be reviewed with your primary care doctor.

Physical therapy. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may involve specialized ice treatments, massage, and other therapies to decrease inflammation around the plantar fascia.

Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a large amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating (raising) and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful.

Soft heel pads can provide extra support.

Avoid shoes that do not provide support or are worn out. Make sure to replace your old athletic shoes before they wear out and no longer support your feet. 

Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to get used to, a night splint is very effective at reducing heel pain from plantar fasciitis.

Other Treatments

Your doctor may recommend the following procedures if you still have symptoms after several months of nonsurgical treatments.

Casting. Wearing a cast for a short period of time can be very helpful in the treatment of plantar fasciitis because it keeps your foot from moving, which is a better environment for healing. Since a cast is custom-molded to your foot and cannot be removed, it is often a better option than wearing a boot.

Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. 

Your doctor may limit this treatment or avoid it altogether because steroid injections can weaken the plantar fascia and lead to a rupture (tear), which can lead to flattening of the foot and chronic pain.

Platelet-rich plasma (PRP) injections. PRP is obtained from your own blood and can be injected into the plantar fascia to promote healing. PRP injections do not have the same risk of leading to plantar fascia rupture. However, this treatment can be expensive, and more research is needed on the effectiveness of PRP injections.

Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed.

ESWT is noninvasive, meaning it does not require a surgical incision. Because of the minimal (low) risk involved, ESWT is sometimes tried before surgery is considered.

Ultrasonic tissue repair. This is a minimally invasive treatment for patients with persistent (ongoing) plantar fasciitis. Ultrasound imaging is used to guide a probe toward the injured plantar fascia. The tip of the probe then vibrates to break up and remove damaged tissue.

Surgical Treatment

Because more than 90% of patients with plantar fasciitis recover with nonsurgical treatment, surgery is generally saved for people who have not seen improvement after 12 months of aggressive nonsurgical treatment.

Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite extensive efforts at calf stretching.

In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs.

Complication rates for gastrocnemius recession are low, but can include damage to the sural nerve and calf weakness.

Partial plantar fascia release. Often performed at the same time as a gastrocnemius recession, a partial plantar fascia release involves making an incision on the bottom or side of the heel. The surgeon identifies the plantar fascia insertion at the heel (the spot where the ligament attaches to the bone) and makes a partial cut to relieve tension in the tissue. If there is a large bone spur, it can also be removed.

Although the surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy has a higher risk of nerve damage than open surgery.

• Complications. The most common complications of release surgery include nerve damage and not fully relieving pain.
• Recovery. A short period of protected weightbearing is recommended after surgery to allow the incision to heal.

Most patients have good results with surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after trying all nonsurgical treatments.

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Information on this topic is also available as an OrthoInfo Basics PDF Handout.

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Calcaneus (Heel Bone) Fractures – OrthoInfo

A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. This type of fracture commonly occurs during a high-energy event — such as a car crash or a fall from a ladder — when the heel is crushed under the weight of the body. When this occurs, the heel can widen, shorten, and become deformed.

Calcaneus fractures can be quite severe. Treatment often involves surgery to reconstruct the normal anatomy of the heel and restore mobility so that patients can return to normal activity. But even with appropriate treatment, some fractures may result in long-term complications, such as pain, swelling, loss of motion, and arthritis. Many patients with labor-intensive jobs are unable to return to their job after a calcaneus fracture. 

The bones of the feet are commonly divided into three parts:

• The hindfoot
• The midfoot
• The forefoot

Seven bones — called tarsals — make up the hindfoot and midfoot. The calcaneus (heel bone) is the largest of the tarsal bones in the foot. It lies at the back of the foot (hindfoot) below the three bones that make up the ankle joint. These three bones are the:

• Tibia (shinbone)
• Fibula (smaller bone in the lower leg)
• Talus (small foot bone that works as a hinge between the tibia and the fibula)

Together, the calcaneus and the talus form the subtalar joint. The subtalar joint allows side-to-side movement of the hindfoot and is especially important for balance on uneven surfaces.

Normal foot anatomy. Together, the calcaneus (heel bone) and talus form the subtalar joint, which moves the foot side to side in walking.  

Calcaneus fractures are uncommon. Fractures of the tarsal bones account for only about 2% of all adult fractures, and only half of tarsal fractures are calcaneus fractures.

A fracture may cause the heel bone to widen and shorten. In most cases, a fracture also enters the subtalar joint in the foot. When this occurs, damage to the articular cartilage covering the joint may cause long-term complications such as chronic pain, arthritis, and loss of motion.

Severity

The severity of a calcaneus injury depends on several factors, including:

• The number of fractures.
• The amount and size of the broken bone fragments.
• The amount each piece is out of place (displaced). In some cases, the broken ends of bones line up almost correctly; in more severe fractures, there may be a large gap between the broken pieces, or the fragments may overlap each other
• The injury to the cartilage surfaces in the subtalar joint.
• The injury to surrounding soft tissues, such as muscle, tendons, and skin.

When the bone breaks and fragments stick out through the skin or if a wound penetrates down to the bone, the fracture is called an open fracture. An open fracture often causes more damage to the surrounding muscles, tendons, and ligaments and takes a longer time to heal. Open fractures have a higher risk of infection in both the wound and the bone. Immediate treatment to clean the wound is required to prevent infection.

The calcaneus is most often fractured during a fall from a height or a motor vehicle collision

The severity of a fracture can vary, although most are caused by a violent impact. For example, a simple twist of the ankle may result in a single crack in the bone. The force of a head-on car collision, however, may result in the bone being shattered (comminuted fracture).

Similar fractures can result from different mechanisms. For example:

• If you land on your feet from a fall, your body’s weight is directed downward. This drives the talus bone directly into the calcaneus.
• In a motor vehicle crash, the calcaneus is driven up against the talus if the heel is crushed against the floorboard.

In both cases, the fracture patterns are similar. As a rule, the greater the impact, the more the calcaneus is damaged.

In a high-energy fracture, other injuries, such as fractures of the spine, hip, or other heel, can occur.

(Left) In some injuries, the talus is forced downward and acts like a wedge to fracture the calcaneus. (Right) This computerized reconstruction of a calcaneus fracture shows the amount of damage that can occur.

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Patients with calcaneus fractures usually experience:

• Pain
• Bruising
• Swelling
• Heel deformity
• Inability to put weight on the heel or walk

With some minor calcaneus fractures, the pain may not be enough to prevent you from walking — but you may limp. This is because your Achilles tendon acts through the calcaneus to support your body weight. If, however, your calcaneus is deformed by the injury, your muscle and tendon cannot generate enough power to support your weight. Your foot and ankle will feel unstable, and you will walk differently.

It is important that you tell your doctor the circumstances of your injury. For example, if you fell from a ladder, how far did you fall, and what type of surface did you land on?

It is also important that you tell your doctor if you have any other injuries or medical problems, such as diabetes, or if you take medications or smoke.

Physical Examination

After discussing your symptoms and medical history, your doctor will perform a careful examination. They will:

• Examine your foot and ankle to see if your skin was damaged or punctured from the injury.
• Check your pulse at key points of the foot to be sure that there is a good blood supply to the foot and toes.
• Check to see if you can move your toes, and can feel things on the bottom of your foot.
• Determine whether you have injured any other areas of your body by examining the rest of your injured leg, as well as your other leg, pelvis, and spine.

Tests

Imaging studies will help confirm the diagnosis of a calcaneus fracture:

X-rays. X-rays, the most common and widely available diagnostic imaging technique, create images of dense structures, such as bone. An X-ray can show whether your calcaneus is broken and whether the bones are displaced.

Computed tomography (CT) scans. Because of the complex anatomy of the calcaneus, a CT scan is routinely ordered after a fracture has been diagnosed on X-ray. A CT scan will produce a more detailed image of your foot than an X-ray and can provide your doctor with valuable information about the severity of your fracture. This information will help your doctor recommend the best plan for treatment.

Your doctor may share both your X-rays and CT scans with you to help you better understand the nature and severity of your injury.

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Your doctor will consider several factors in planning your treatment, including:

• The cause of your injury
• Your overall health
• The severity of your injury
• The extent of soft tissue damage

Because most calcaneus fractures cause the bone to widen and shorten, the goal of treatment is to restore the normal anatomy of the heel. In general, patients whose normal heel anatomy is restored have better outcomes, and in most cases, recreating the normal heel anatomy involves surgery. Your doctor will discuss the different treatment options with you.

Nonsurgical Treatment

Your doctor may recommend nonsurgical treatment if the pieces of broken bone have not been displaced by the force of the injury.

Immobilization. A cast, splint, or brace will hold the bones in your foot in proper position while they heal. You may have to wear a cast for 6 to 8 weeks — or possibly longer. During this time, you will not be able to put any weight on your foot until the bone is completely healed.

Surgical Treatment

If the bones have shifted out of place (displaced), your doctor may recommend surgery.

Surgery to repair a calcaneus fracture can restore the normal shape of the bone but is sometimes associated with complications, such as wound healing problems, infection, and nerve damage.

Nonsurgical treatment of some fractures, however, can also lead to long-term complications, such as pain, arthritis, and a limp. Your doctor will review the details of your injury and talk with you about the risks and benefits of surgical versus nonsurgical treatment.

Timing of surgery. If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery. Elevating your leg and keeping it immobilized for several days will decrease swelling. It will also give injured skin a chance to recover. Waiting before the operation may improve your overall recovery from surgery and decrease your risk of infection.

Open fractures, however, expose the fracture site to the environment — increasing the risk of infection — and must be treated immediately. They require surgery to clean the wound and remove damaged tissue.

Early surgery may also be recommended for other fractures. Although uncommon, a piece of the calcaneus can be pulled off when the Achilles tendon splits away from the bone (avulsion). For this type of fracture, emergent surgery can decrease the risk of injury to the skin around the Achilles tendon.

Surgical procedure. The following procedures are used for various types of calcaneus fractures:

• Percutaneous screw fixation. If the bone pieces are large, they can sometimes be moved back into place without making a large incision. Special screws are then inserted through small incisions to hold the fracture together.

(Left) A displaced fracture of the calcaneus. (Right) The fracture has been reduced and the bones held in place with screws.

• Open reduction and internal fixation. During this operation, an open incision is made to reposition (reduce) the bones into their normal alignment. They are held together with wires or metal plates and screws.

In this X-ray, the bone fragments have been realigned and held in place with metal plates and screws.

Bones have a remarkable capacity to heal. The more severe your injury, however, the longer your recovery may be. Patients with more severe fractures are also more likely to suffer some degree of permanent loss of function, regardless of treatment.

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become critical public health issues in the U.S. It is important to use opioids only as directed by your doctor and to stop taking them as soon as your pain begins to improve. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Rehabilitation

Whether your treatment is surgical or nonsurgical, your rehabilitation will be very similar. The time it takes to return to daily activities will vary depending on the type and severity of the fracture and whether you have other injuries.

Some patients can begin weight-bearing activities a few weeks after injury or surgery; most will need to wait 3 months before putting weight on the heel. Some patients are able to begin partial weightbearing 6 to 10 weeks after injury or surgery.

• Early motion. Many doctors encourage motion of the foot and ankle early in the recovery period. For example, you may be instructed to begin moving the affected area as soon as your pain allows. If you have had surgery, you may be instructed to begin moving the affected area as soon as the wound heals to your doctor’s satisfaction.
• Physical therapy. Specific exercises can help improve the range of motion in your foot and ankle, and strengthen supporting muscles. Although they are often painful at the beginning and progress may be difficult, exercises are required in order for you to resume normal activities.
• Weight bearing. When you begin walking, you may need to use crutches, a cane, or a walker and/or wear a special boot. It is very important to follow your doctor’s instructions for walking on your foot. If you put weight on your foot too soon, the bone pieces may move out of place and you might require surgery. If you have had surgery, the screws might loosen or break and the bone may collapse. This may not occur the first time you walk on it, but if the bone is not healed and you continue to bear weight, the metal will eventually break.

Six months after surgery, this patient’s hardware has failed. Several screws have broken and the calcaneus has collapsed. This patient required major reconstruction, and today walks with a limp and has little motion in the foot.

Complications

Complications often occur with calcaneus fractures. Minor complications include:

• Small or temporary areas of delayed wound healing
• Nerve irritation around the incision
• Tendon irritation
• Joint stiffness
• Chronic pain
• Chronic swelling

Major complications include:

• Failure of the wound to heal
• Infection
• Posttraumatic arthritis (with or without surgery)

It is important to tell your doctor if you are a smoker. Smoking affects both bone and wound healing. With or without surgery, your bone may take longer to heal if you smoke.

Learn more: Smoking and Musculoskeletal Health

Learn more: Surgery and Smoking

Additional surgery is usually required in cases of infection or wound healing complications. If all attempts to resolve an infection or a wound healing complication fail, an amputation may be necessary.

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If your injury is minor, such as a crack in the bone with little muscle damage, you may be able to resume normal activities 3 to 4 months after surgery. If your fracture is severe, however, it may take 1 to 2 years before recovery is complete.

Despite the best efforts of the doctor and patient, patients rarely regain normal foot and ankle motion after a severe fracture and do not typically resume their pre-injury level of function. A patient who is not very active might tolerate a foot that is not normal. On the other hand, a patient whose job or recreational activities require a lot of walking or climbing may require major lifestyle and career changes.

Common Problems

Common problems that may persist after recovery include:

• Skin irritation. Footwear can irritate the skin or tendons in the affected area.
• Altered gait. In some cases, the arch of the foot has not been restored, or the Achilles tendon has not healed at its normal distance from the ankle. Full motion between the talus and the calcaneus is rarely regained in these cases, and this can change the way you walk. You may have problems walking on uneven ground, such as grassy surfaces or hills.
• Pain. After a fracture, you may experience continued subtalar pain and limited motion. Even if the heel anatomy is perfectly restored, you may still have discomfort. This can happen because of injured soft tissues, persistent fracture displacement, arthritis, or limited ankle and subtalar range of motion. Although relatively uncommon, pain can also be caused by irritation from the plates or screws.

Further Treatment

If you have chronic pain or experience other complications, you may need further treatment. This may include:

There is no universal agreement among experts as to the best treatment method for calcaneus fractures. No single method works the same for everyone. Patients whose X-rays show good healing and normal heel anatomy often have ongoing symptoms after treatment. On the other hand, the calcaneus can look quite deformed on an X-ray, but the patient may have few, if any, symptoms.

Studies have compared results in patients whose fractures were treated with and without surgery. Some studies show a significant benefit of surgery, while other studies show less benefit for certain patients. Researchers continue to look for ways to improve the outcomes of treatment for different types of calcaneus fractures, as well as for patients who smoke or have other health considerations. Your doctor will talk with you about the best treatment options in your case.

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Heel spur – causes, symptoms, diagnosis and treatment

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Heel spur: causes, symptoms, diagnosis and treatment.

Definition

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

Causes of heel spurs

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

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

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

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

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

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

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

Classification of the disease

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

Heel spur symptoms

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

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

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

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

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

Heel spur diagnosis

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

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

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

X-ray of the bones of the foot

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

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MRI of soft tissues of one limb segment

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

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

Ultrasound of soft tissues

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

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Additional examination methods include:

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

C-reactive protein (CRP, CRP)

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

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Uric acid (in the blood)

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

Synonyms: Blood test for urinary…

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

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

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Which doctors to contact

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

Heel spur treatment

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

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

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

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

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

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

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

Physiotherapy:

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

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

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

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

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

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

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

Complications

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

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

Heel spur prevention

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

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

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

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

Sources:

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

IMPORTANT!

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

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Heel spur – description, causes, symptoms, diagnosis and treatment

Heel spur is an ossification of the tendon, which is the result of an inflammatory process that affects the soft tissue of the heel tubercle. Such inflammation is associated with a large number of pathologies that provoke the growth of bone tissue and affect fiber. The size of the growth that occurs in the heel is different, and its external appearance is similar to spikes or a beak.

Currently, heel spurs are detected quite often. Most often it is observed in women who have crossed the line of 50 years. But this does not mean that the spur cannot occur in persons of the opposite sex at a younger age.

If the disease is at an early stage, then there are no problems with treatment. The opposite situation develops with a running spur – the treatment is long and complicated. It is noteworthy that in elderly patients, the spur appears in 25% of cases.

Causes of appearance

A spur is formed in the heel for several reasons. This includes both congenital and life-long acquired factors, for example:

• overweight, which causes a heavy load on the legs;
• flat feet and other problems associated with improper walking;
• infections occurring in the human body;
• malcirculation;
• atherosclerosis;
• diabetes mellitus of all types;
• heel fat shrinkage in the elderly;
• rheumatism;
• diseases affecting nerve endings;
• fractures or bruises of the heels;
• inflammatory processes in the muscles or their stretching;
• natural changes associated with aging;
• pathology of the spine;
• Excessive stress on the heels caused by sports.

In order to save a person from an unpleasant pathology, it is necessary to conduct a complete examination of the body and understand the cause that provoked the appearance of a spur. If the problem is left unattended, then the tendons will begin to tear. This will lead to an inflammatory process that will spread to the muscles and heel tubercle. A liquid will appear in the indicated place, interfering with blood circulation and slowing down healing. In the heel, salt deposits form and a growth is formed – a spur.

Manifestation of a spur in the heel

The symptomatology of the problem under consideration does not depend on the cause that caused it. It is formed by the location and size of the spur. In addition, the stage of development of pathology also has an impact.

Initially, the spur makes itself felt with slight discomfort in the morning. It seems to a person that a nail has been driven into the heel, and it interferes with walking. After a while, when a person walks around, the discomfort goes away.

With the progression of the disease, increasing pain is observed after the load on the lower extremities. The strength of the discomfort depends on where the spur is located: the closer it is to the nerves, the more intense the pain. Sharp soreness can occur when getting out of bed or when climbing stairs. Very rarely, the process may not provoke discomfort, but an inflammatory process is detected during a random examination.

When the disease in question is combined with acute inflammation of the fascia, people complain of heat and tingling in the problem area, reddening of the skin and its roughness, severe pain when walking.

After a certain time, the pain becomes permanent, which affects the patient’s gait. The person twists the limb in such a way as not to put pressure on the heel, leaning on the toe and side of the foot. Often, such actions cause flat feet of the transverse type, which aggravates the patient’s condition. In advanced stages, a person is completely immobilized from unbearable pain.

Diagnosing a heel spur

Diagnosing a heel spur is easy. A qualified specialist will be able to determine the cause of the pain, based solely on the patient’s complaints. The doctor will conduct a visual examination, press on certain points and understand what the problem is.

In some cases, confirmation of the diagnosis using additional methods is required:

• blood tests to detect inflammation;
• uric acid testing to rule out gout;
• urinalysis;
• ultrasound examination of the foot – examination of the condition of the muscles and surrounding tissues in order to prevent the development of an abscess;
• performing a duplex examination of the vessels to understand if the blood circulation is disturbed;
• MRI of the heel, which makes it possible to study the condition of the nerve fibers.

If additional diseases are identified during the examination, the doctor may prescribe a consultation with other narrow specialists.

Methods for treating spurs

The problem in question can be confused with a disease such as thorn. It is worth considering that these are different diseases, because the focus is located in different parts of the heel, so the treatment is radically different.

After an x-ray, the specialist will determine at what stage the growth of the process is: the first stage is characterized by a round spur; in the second stage, the spur is large; in the third stage, the process becomes like a bird’s beak.

In order to relieve the patient from pain, put the tendon in order and eliminate the inflammatory process, it is customary to carry out drug treatment and physiotherapy. Doctors prescribe the use of tablets, ointments and special compresses to relieve discomfort.

There are several procedures that make the treatment of spurs faster and more effective:

• x-ray;
• laser treatment;
• use of ultrasound;
• immobilization;
• application of heel prostheses;
• electrophoresis;
• phonphoresis;
• operation.

In addition, modern medicine is armed with the following methods of treating heel spurs:

1. Prescribing ointments. In the pharmacy, you can buy various ointments that relieve inflammation, renew cartilage tissue and eliminate pain. If they are used strictly according to the doctor’s prescription, then the patient has a decrease in swelling and restoration of the balance of minerals in problem areas of the body. Warming ointment promotes proper blood circulation and restoration of heat transfer. Such ointments include Voltaren, Indomethacin and Dexamethasone.

2. Medical therapy. Tablets are prescribed in the case when it is necessary to remove the inflammatory process. They accelerate tissue regeneration, promote their elasticity and restore blood circulation. These drugs include Ibuprofen, Nise, Artadol and Diclofenac.

3. Intramuscular injections. The injection should only be administered by a medical professional in order to select the correct dosage and depth of injection. To relieve pain, injections are given several times a day.

4. Blockade. Surgeons inject these injections exclusively into the heel. They relieve inflammation and fight pain. Correctly set blockade helps to cope with the problem for a long time – up to 5 years. These drugs include Betamethasone or Diprospan, which are administered in combination with lidocaine.

5. Wave Therapy. This treatment option is considered one of the most effective. It has no side effects and does not cause pain. The procedure itself lasts no more than half an hour.

6. Laser therapy. Laser treatment is absolutely painless and even pleasant. During the procedure, the laser hits the spur and provokes an acceleration of metabolism. Such therapy is carried out for about 15 minutes for 10 days. It is worth considering that this is an expensive pleasure.

It is up to the specialist to decide which method of treatment to choose after a complete examination of the patient and the final diagnosis.

Features of surgical intervention

At an advanced stage of heel spur development, doctors may prescribe a surgical intervention for the patient. This rarely happens, but the effectiveness of this method of treatment is quite high – up to 75%. In other cases, there is a return of discomfort and pain.

Indications for removal of a heel spur

There are several indications for which surgery cannot be avoided. They are:

1. Patient does not improve within 6 months of treatment.
2. Medical therapy is not possible or the patient cannot expect to be effective.
3. Loss of working capacity and mobility.

All these factors indicate that the pathological process is in the late stages. In this case, it is forbidden to postpone treatment.

How is the operation?

Surgery is performed in several stages:

1. Anesthesia for the patient.
2. Making an incision in the heel area.
3. Penetration inside the heel and removal of the problem area of ​​the fascia.
4. Nerve release from pressure by muscle incision.
5. Spur excision.
6. Heel alignment for faster tissue repair.
7. Return to the right place of nerves and muscles.
8. Suture and its processing.
9. The patient’s exit from anesthesia.

This completes the work of the surgeon. Then comes the recovery period, during which the person must completely limit movement so as not to load the heel.

Prevention of heel spurs

In order to prevent the development of inflammation in the heel fascia, you need to adjust your lifestyle and follow some rules:

1. Buy comfortable shoes and give up high heels.
2. Give preference to orthopedic insoles with an arch support.
3. Monitor your own weight, do not allow it to increase.
4. Lead a healthy lifestyle: eat right and drink plenty of purified water.
5. Visit sports clubs, gyms.
6. Try to reduce the load on the legs: stand less in one place and do not walk for a long time.