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Injection for bone spur: Bone Spur Causes, Treatment, Pictures, Surgery & Symptoms

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Causes, Symptoms, Diagnosis & Treatment

Overview

What is a bone spur?

A bone spur, also called an osteophyte, is a smooth, bony lump that grows off a bone. Bone spurs develop over long periods of time, usually near joints (where two or more bones meet).

Who gets bone spurs?

Bone spurs are most common in people 60 years or older, but younger people can get them, too. People with osteoarthritis (OA) are much more likely to get bone spurs. OA is a common form of “wear and tear” arthritis that happens when cartilage, which cushions your bones, wears down.

Where can bone spurs grow?

Although they can grow from any bone, osteophytes are particularly common in the:

  • Foot, especially the heel (heel spurs or calcaneal spurs), big toe and ankle.
  • Hand or finger.
  • Hip.
  • Knee.
  • Neck.
  • Shoulder.
  • Spine.

Symptoms and Causes

What causes bone spurs?

Joint damage from OA is the biggest cause of bone spurs. OA is a breakdown of cartilage — the firm, flexible tissue that cushions bones and allows joints to move more easily. OA develops as we age or after damage (like a sports injury).

As the body tries to repair cartilage, it creates new bone material. These new bony growths are osteophytes.

Ankylosing spondylitis also may cause bone spurs. This rare arthritis causes spinal inflammation. Over time, ankylosing spondylitis fuses, or connects, the small bones in the spine (vertebrae). The body responds by forming spinal osteophytes.

What are symptoms of bone spurs?

Some people have bone spurs and don’t even know it. Spurs start to create symptoms when they:

  • Put pressure on nearby nerves.
  • Restrict movement.
  • Rub against other bones or tissues.

When that happens, you may feel some:

  • Knobby or bumpy areas, especially in the fingers or toes.
  • Numbness and weakness, especially in the legs if the spine has spurs.
  • Pain near the affected joint, like heel pain.
  • Reduced range of motion (how far the joint moves).
  • Stiffness.
  • Tendinitis (swelling of a nearby tendon).
  • Tendon tears (like a rotator cuff tear in the shoulder).

Diagnosis and Tests

How are bone spurs diagnosed?

Without symptoms, you may accidentally discover a bone spur during an X-ray or other test for a different condition.

If you report pain, stiffness and loss of motion to your healthcare provider, he or she will:

  • Ask you to describe your symptoms.
  • Ask about your medical history and family’s medical history.
  • Ask you to rate your discomfort.
  • Perform a physical examination.
  • Test your joint’s range of motion and strength.
  • Order imaging tests, like X-rays to look for arthritis and spurs or CT scans or MRIs to identify damaged ligaments or tendons.

Management and Treatment

When should I talk to my healthcare provider?

If you have bone spurs without symptoms, you don’t need treatment. Tell your healthcare provider if you develop joint pain, stiffness, limited motion or numbness.

How are bone spurs treated?

Some home remedies and lifestyle changes help ease osteophyte symptoms:

  • Ice to reduce swelling.
  • Over-the-counter pain relievers, such as acetaminophen or NSAIDS like ibuprofen.
  • Rest.
  • Supportive shoes or shoe inserts.
  • Weight loss to decrease joint and bone stress.

If those methods aren’t enough, your healthcare provider can prescribe:

  • Physical therapy: Exercises and stretches can reduce pain, improve range of motion and strengthen muscles around joints.
  • Prescription pain medications: If over-the-counter pain medicines don’t provide relief, your healthcare provider may prescribe a stronger option or cortisone shot.
  • Surgery: If symptoms continue after a year of treatment, surgery can remove the bone spurs.

Prevention

How can I reduce my risk of bone spurs?

There is no certain way to prevent bone spurs. But you can reduce your chance of developing them by following a healthy lifestyle:

  • Be physically fit.
  • Eat a balanced, nutritious diet.
  • Maintain a healthy weight to reduce extra stress on bones and joints.
  • Maintain good posture and ergonomics (proper positioning at your desk).
  • Prevent joint injuries by stretching and using safe exercise techniques. Don’t overdo it.
  • Wear well-fitting, supportive shoes.

Outlook / Prognosis

How long do bone spurs last?

Bone spurs don’t go away unless you have surgery to remove them.

Do bone spurs grow back?

Although bone spurs don’t usually grow back after surgery, more may develop elsewhere in your body.

Living With

What can I do for pain and stiffness from bone spurs?

You can relieve pain and stiffness from bone spurs with rest, ice and over-the counter-medications. Properly fitting shoes and weight loss also reduce joint stress. If symptoms become severe or unmanageable, call your healthcare provider.

Should I avoid activity?

Even with bone spurs, try to stay active and healthy. Avoid activities and movements that hurt. Choose low-impact activities, like walking instead of running.

When you exercise, take steps to minimize joint damage: Make sure you have good footwear, concentrate on proper techniques, and always warm up and stretch.

A note from Cleveland Clinic

Bone spurs may cause no symptoms at all or may drastically affect your day-to-day life. Home remedies and lifestyle choices can help you delay or ease symptoms. If you can’t control your pain or other symptoms on your own, ask your healthcare provider about additional strategies.

5 Facts You Need to Know About Bone Spurs

What is a bone spur? Bone spurs — also called osteophytes — are outgrowths of bone that form where the ends of bones meet in joints. Bone spurs commonly develop with age and many people live with them for years, undetected. However, these bony overgrowths can also lead to significant pain and other symptoms for some people. Keep reading to learn 5 key facts you need to know about bone spurs.    

1. Bone spurs are actually your body’s way of trying to heal damage

Bone spurs typically develop around areas of joint, cartilage, tendon or ligament inflammation and injury in the body. When the body detects an injury or inflammation, it triggers a cellular response to repair the damage by producing excess bone in the area.

 

Common areas for bone spurs include the hands, shoulders, hips, knees, feet, ankles and spine. Inflammatory injuries like achilles tendonitis and plantar fasciitis can lead to the development of bone spurs on the heels. Degenerative arthritis (osteoarthritis) is a leading cause of bone spur development on weight-bearing joints in the spine, knees and hips.    

2. Osteoarthritis is the leading cause of bone spur development

Osteoarthritis is the most common form of arthritis. Also called wear and tear arthritis or degenerative arthritis, it occurs when the protective layer of cartilage covering joints begins to break down and wear away. The body attempts to repair cartilage loss by producing extra bone around the damaged joint.

3. The spurs themselves are not painful…..but they cause pain when they affect nearby structures

Bone spur development is common with age, as the body’s joints, tendons and ligaments undergo natural degenerative changes. In a lot of cases, bone spurs are small and non-painful. Many people live with bone spurs for years and only discover them after getting an X-ray or imaging study for another reason. However, bone spurs can cause symptoms when they compress or irritate nearby tissues or nerves.

 

The most common symptoms of bone spurs are pain, stiffness and loss of movement in the affected joint. In the shoulders, spurs may rub against the rotator cuff tendons, leading to tendonitis or a tendon tear. In the hands, spurs may form in the finger joints, causing loss of joint movement and a knobby appearance in the fingers. In the hips and knees, spurs can lead to stiffness and a loss in range of motion. In the feet and ankles, painful spurs can cause pain in the bottom of the foot or heel.

 

The cervical and lumbar spine are two of the most common areas for bone spurs to develop. Vertebral spurs can compress nearby nerve roots or the spinal cord and cause the open spaces in the spine to narrow. Nerve root or spinal cord compression in the lumbar spine leads to sciatica, pain, weakness, numbness and tingling in the low back, buttock and leg. Compression in the cervical spine leads to the above symptoms in the neck, shoulder, arm and fingers.         

4. Bone spurs only require treatment if they’re causing pain and symptoms

Typically, non-painful spurs don’t require any form of treatment. If bone spurs are causing pain and symptoms, your doctor will prescribe conservative treatment options with the goal of reducing inflammation in the injured area and strengthening your bones and joints. Over-the-counter NSAIDs can help relieve pain and inflammation. Additionally, your doctor may recommend a cortisone injection directly into the damaged joint to reduce inflammation, irritation and pain. A course of physical therapy can be beneficial to help strengthen joints and muscles and regain joint movement and range of motion.

5. In some cases, surgery is necessary 

In some cases, bone spurs that are directly pressing on nerves cause significant pain, weakness and loss of movement. If pain and symptoms can’t be treated with conservative treatment options, then surgery may be necessary. Many bone spur removal surgeries can be performed with minimally invasive techniques. 

6. Unfortunately, bone spurs aren’t preventable

There are no ways to prevent the development of bone spurs. However, you can take self-care steps at home to keep your bones and joints healthy and decrease your risk of injuries. 

 

  • Exercise regularly. Regular exercise is the best thing you can do to maintain strong, healthy joints, muscles and bones. Low-impact exercises like walking, swimming, bicycling or yoga can help you stay active while reducing stress and pressure on your joints and soft tissues.

 

  • Maintain a healthy weight. Excess body weight places more stress and pressure on weight bearing joints. Talk to your doctor about ways you can maintain a healthy, stable weight. 

 

  • Wear supportive footwear. Reduce the risk of heel spurs by wearing shoes that fit correctly and provide good heel and arch support. Additionally, supportive shoes will reduce pressure on your knees, hips and back.

Integrity Spine and Orthopedics Treats Spine and Joint Conditions

Integrity Spine and Orthopedics specializes in performing minimally invasive spinal procedures for a range of painful spine conditions, including herniated discs, arthritis of the spine and bone spurs. We also offer pain management and general orthopedic services to help you manage acute or chronic back and joint pain.

 

Please call us at 904-456-0017 to request an appointment to see one of our board-certified orthopedic doctors in our Jacksonville, FL, clinic location. We also offer free MRI reviews to qualified patients — contact us today for more information.

What Causes Bone Spurs?

Before we get into the specific causes of bone spurs, let’s first take a look at what bone spurs are. Bone spurs are outgrowths of bone which are most often found in and around joints.

A bone spur is essentially “extra bone” growth which has formed on top of normal bone.

Bone spurs typically occur in areas of the body such as the knees, feet, hips, spine, shoulders and hands. Although the name “spur” suggests something sharp, bone spurs are usually smooth and may or may not cause any symptoms.

Over time, a bone spur may continue to grow, leading to painful irritation of surrounding soft tissue like tendons, ligaments or nerves. Bone spurs tend to be most painful at the bottom of the heel due to the pressure of body weight.

Bone spurs can be caused by a variety of factors, but they’re usually the result of the body attempting to overcome and repair some type of injury by producing excess bone. This can be as simple as putting extra pressure or continued stress on the bone or joints over an extended period of time.

A bone spur can occur when there has been trauma to a joint, repeated excessive use of a joint, arthritis, or even tendonitis. In some cases, a bone spur can simply be the result of genetics. You can thank grandma or grandpa for that one.

How to treat bone spurs

Treatment for bone spurs generally depends on the severity of the pain being experienced. If pain is mild, doctors may recommend medication to reduce the inflammation of the tissue surrounding the bone spur (anti-inflammatory drugs). In some cases, doctors may recommend physical therapy to help increase joint motion and strengthen surrounding muscles, which may help alleviate some symptoms.

Bone spurs which are causing more severe pain may either be treated by cortisone injection or by surgery. The goal of surgery is to remove the bone spur altogether and alleviate any associated irritation. Bone spurs may reoccur sometime after surgery (2 to 3 years) if the initial cause of the spur is not found and corrected.

If you suspect you may have a bone spur, consult with your doctor.

The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies

Curr Rev Musculoskelet Med. 2009 Mar; 2(1): 3–9.

and

Yusuf Ziya Tatli

Tufts Medical Center, 800 Washington Street, Box #400, Boston, MA 02111 USA

Sameer Kapasi

Tufts Medical Center, 800 Washington Street, Box #400, Boston, MA 02111 USA

Tufts Medical Center, 800 Washington Street, Box #400, Boston, MA 02111 USA

Corresponding author.

Received 2007 Oct 10; Accepted 2008 Aug 25.

This article has been cited by other articles in PMC.

Abstract

This article presents a review of conservative therapies for plantar fasciitis pain reduction with a discussion of steroid therapy risks. The therapies reviewed include orthoses, stretching, extracorporeal shockwave, BTX-A, and corticosteroid injection/iontophoresis. These modes were included based on the availability of double blinded randomized controlled trials. We noted the following findings. Orthoses, regardless of type, can improve pain levels. Plantar stretching shows limited short-term benefit (1 month), but can reflect significant long-term improvement (10 months). Extracorporeal shockwave therapy shows equivocal benefit with some studies showing significant improvement and others showing none. Although BTX-A injections were the least studied, significant pain improvement was demonstrated in the short and long term. Steroid injection/iontophoresis showed significant improvement in the short term (1 month). Steroid therapy, when coupled with plantar stretching, can provide efficacious pain relief; however, steroid injections should be combined with ultrasound monitoring to reduce complications.

Keywords: Plantar fasciitis, Steroid injection, Extracorporeal shockwave therapy, Stretching, Orthoses, BTX-A

Plantar fasciitis is a common foot disorder responsible for approximately one million physician visits per year [1]. While there are a plethora of management techniques for plantar fasciitis, there are none that are presented as a definitive technique. In addition, the etiology of plantar fasciitis is not well understood [2]. Accordingly, this article will focus on a variety of conservative therapies with a follow-up focus on steroid injections and the risks thereof.

Anatomy

The plantar fascia is synonymous with the deep fascia of the sole of the foot. The plantar fascia is comprised of pearly white longitudinally organized fibers. It begins at the medial tuberosity of the calcaneus where it is thinner and extends into a thicker center portion. This thicker portion is flanked by thinner lateral and medial portions. The thicker central portion of the plantar fascia then extends into five bands surrounding the digital tendons (Fig. ) [2, 3].

From Buchbinder [4]. Used with permission from NEJM. Plantar and medial views of the foot demonstrating the origin and insertion of the plantar fascia and the location of nerves in proximity to the heel. The windlass mechanism, or bowstring effect, of the plantar fascia refers to its function in raising the arch of the foot during the push-off phase of walking

Plantar fasciitis classically presents histologically with “degenerative changes in the plantar fascia, with or without fibroelastic proliferation and chronic inflammatory changes” [4].

Mechanics of the plantar fascia

Hicks described a windlass mechanism of action for the plantar fascia. Dorsiflexion of the toes leads to a shortened effective length of the plantar fascia causing a raising of the arch. Toe extension leads to increased arch tension with the metatarsophalangeal joint as the pivot or tethering point. Hicks [5] demonstrated this definitively with cadaveric models.

When a plantar fasciotomy was performed, the cadaver would lose this windlass mechanism, thus diminishing the arch stability subsequently disallowing a more stable terminal stance and toe standing. In addition, Hicks [5] found that the breaking strain for this windlass ranged from 1. 4 to 3.4 times the subject’s body weight. Thus, the plantar fascia, while playing a significant role in walking stability, can readily break with a minimal increase in strain.

While the exact etiology of plantar fasciitis remains unclear, it is theorized that overloading the plantar foot muscles originating at the volar calcaneus (adductor hallucis, quadratus plantae, flexor digitorum brevis, and abductor digiti minimi quinti) can lead to inflammation and consequent pain in the plantar fascia [6]. Hence, therapy for plantar fasciitis focuses on either reducing the muscle tightness that causes the initial injury or reducing the inflammation that worsens the injury.

Diagnosis

Plantar fasciitis is a clinical diagnosis. It is based on patient history and physical exam. Patients can present with local point tenderness along the medial tuberosity of the os calcis, pain on weight bearing and/or pain on first steps. Plantar fascia pain is especially evident upon dorsiflexion of the patients pedal phalanges, which further stretches the plantar fascia or windlass mechanism. Therefore, any activity that would increase stretch of the plantar fascia, such as walking barefoot without any arch support, climbing stairs, or toe walking, can worsen the pain [4, 7].

Method

A Medline search from 1996 to the present was performed. Trials were included if they were randomized studies and evaluated orthoses, stretching, extracorporeal shockwave, BTX-A, or corticosteroid injection as therapies for plantar fasciitis. Trials were excluded if they did not meet the above criteria or if they compared the efficacy of one mode of therapy to another, that is, stretching to orthoses or BTX-A to steroid therapy in plantar fasciitis. According to SORT grading of quality of evidence assessments [8], all studies used were Level 1. Case studies, retrospective studies, descriptive articles, and quasi-randomized studies were excluded from the review; however, these studies were included in the introduction and discussion sections (Table ).

Table 1

SORT graded as per Ebell et al. [8]

Subject Authors Symptom duration prior to therapy Pain free time after therapy Significant improvement from baseline? Therapy grade Consistency
Orthoses A Consistent
Landorf et al. [9] 4 weeks 3 months Yes
Winemiller et al. [10] 30 days 4 weeks, 8 weeks Yes
Stretching B Consistent
DiGiovanni et al. [11] 10 months 8 weeks Yes
DiGiovanni et al. [12] 10 months 2 years Yes
Radford et al. [13] 4 weeks 2 weeks No
Extracorporeal shockwave therapy A Inconsistent
Haake et al. [14] 6 months 12 weeks, 1 year No
Speed et al. [15] 3 months 6 months No
Buchbinder et al. [16] 6 weeks 12 weeks No
Kudo et al. [17] 6 months 3 months Yes
Ogden et al. [18] N/A 3 months, 1 year Yes
BTX-A B Consistent
Babcock et al. [19] 6 months 3 weeks, 8 weeks Yes
Steroid injection/iontophoresis A Consistent
Crawford et al. [20] N/A 1 month Yes
Gudeman et al. [21] N/A 2 weeks Yes

Numerous treatment measures have been used for plantar fasciitis with varied clinical benefits. Nonsurgical techniques include orthoses [9, 10], stretching [11–13], splinting, taping, topical medications with or without iontophoresis, oral nonsteroidal anti-inflammatory medications [22], extracorporeal shockwave therapy [14–18], laser, and percutaneous injections with steroid [20, 21] or botulinum toxin type A. Surgical options with endoscopic or open fasciotomy can be the last resort for patients with intractable plantar fasciitis [23], but are not discussed further in the article.

Orthoses

Landorf et al. described a participant blinded randomized trial where they compared the response of 135 patients with plantar fasciitis to soft thin foam sham orthoses, prefabricated firm foam orthoses, and customized semi-rigid plastic orthoses over 3 months. While they were able to show statistically significant results for improved function with the prefabricated and customized orthoses as compared to the sham, Landorf et al. [9] were unable to show statistical significance for improvements in pain and concluded that both customized and prefabricated orthoses were efficacious for the treatment of plantar fasciitis.

Winemiller et al. compared the response of 101 patients to active bipolar magnet cushioned insoles or sham insoles over 8 weeks. They found that there was no statistically significant difference in improvement in subjective heel pain between different insole modes; however, there was a statistically significant improvement in both the magnetic and nonmagnetic groups in morning foot pain intensity. Winemiller et al. [10] claimed that magnetic insoles provide no additional benefit as compared to nonmagnetic.

Stretch

DiGiovanni et al. assessed the role of Achilles tendon stretching versus plantar fascia stretching in a randomized study of 101 patients. Both Achilles stretching groups and plantar fascia stretching groups appreciated a decrease in pain upon first steps in the morning as well as increased function; however, the plantar stretchers appreciated a statistically significant improvement in activity function and first step pain as compared to the Achilles stretchers [11].

DiGiovanni further assessed the improvement of plantar fascia versus Achilles tendon stretching by directly comparing the two in a crossover study of the same patient pool with a 2-year follow up. DiGiovanni et al. switched Achilles tendon group to plantar fascia stretching after the initial 8 weeks of the trial. After 2 years, the Achilles tendon patient pool was reassessed for maximum pain level and pain on first steps in the morning. While there was a significant difference between the two groups at 8 weeks, there was no statistical difference between the two at 2 years, with further improvement in pain in both groups [12].

Radford recruited 92 subjects for their study that compared calf muscle stretching with sham ultrasound to sham ultrasound alone. The study tested the short-term effectiveness of stretching. In the 14 days that the study lasted, there was no statistically significant difference between stretch and sham groups. Radford et al. concluded that short-term stretching shows no statistically significant benefit for plantar fasciitis [13].

Extracorporeal shockwave therapy

Haake et al. assessed the efficacy of extracorporeal shockwave therapy (ESWT) in 272 subjects. The patients employed in this study had tried more conservative methods of plantar fasciitis therapy without effect for approximately 6 months. The study pool either received ESWT or sham therapy. The patients were assessed after 12 weeks. Haake et al. found that approximately three-fourth of their study pool improved regardless of sham or ESWT. Consequently, they showed that ESWT was “ineffective in the treatment of chronic plantar fasciitis” [14].

Speed studied 88 patients who had plantar fasciitis for at least 3 months each. The patients were exposed to therapeutic sessions with sham or ESWT once every month for a total of 3 months. Three effects were assessed: day pain, night pain, and “morning startup pain.” The patients were assessed at the beginning of the study, the beginning of the treatment, and at 1 and 3 months after completion of the treatment. Over the 6-month course of the study, no statistical significance was shown between sham and ESWT groups in the above categories [15].

Buchbinder et al. recruited 166 patients for their study in which they used ultrasound guided ESWT on patients who had plantar fasciitis for at least 6 weeks. Statistically significant improvements were appreciated in both the placebo/sham groups and ESWT groups in morning step pain, general activity pain, and overall pain characterization. Buchbinder et al. [16] demonstrated that ESWT provided no greater benefit than placebo.

Kudo et al. performed a confirmatory study in which they compared ESWT to sham ESWT in 114 patients with plantar fasciitis for at least 6 months and resistant to other therapies. Patients were excluded from the study if they had used other modes of therapy within 2 weeks of their treatment. The patients were exposed to a single treatment. This study demonstrated a statistically significant improvement in first steps pain by visual analog scale at 3 months. Kudo et al. [17] reported that ESWT provides for a beneficial treatment in recalcitrant plantar fasciitis.

Ogden et al. found ESWT to be an effective treatment for plantar fasciitis in their two phase trial. In the first phase, they formulated and finalized their protocol with 20 nonblinded patients. In the phase two trial, Ogden randomized 293 patients to receive either ESWT and an ankle block or a mild anesthetic and nontransmitted shockwaves. They found significant differences in investigator assessment of heel pain at 4, 8, and 12 weeks and at 12 months using a dolorimeter-based visual analog scale. Significance was also found in subjective self-assessment of morning heel pain at the same time intervals. However, in self-assessment of activity related pain, significance could be found at 4, 8, and 12 weeks, but not at 12 months. Hence, Ogden et al. [18] were able to complete that ESWT shows beneficial response in plantar fasciitis up to and for at least 1 year.

Botulinum toxin type A (BTX-A)

Babcock et al. investigated 27 patients (43 plantar fasciae) with duration of symptoms for at least 6 months. Either BTX-A was injected into the feet of the therapy group or saline into the sham group. In the case of patients with bilateral plantar fasciitis, saline was injected into one foot and BTX-A in the other. The authors showed that the BTX-A groups had statistically significant improvements at 3 and 8 weeks in all variables tested (Maryland foot score, pain visual analog scale, pressure algometry response, and pain relief visual analog scale). Babcock et al. [19] finalized that BTX-A injections into the plantar fascia improves the patients pain level.

Steroid

Crawford et al. described 106 patients, which they divided into four groups: prednisolone with lignocaine, prednisolone with lignocaine after a tibial block, lignocaine alone, or lignocaine after a tibial block. There was no statistically significant difference in pain levels when prednisolone was given with tibial block or when anesthetic was given. There was a statistically significant decrease in pain levels according to visual analog scales in both groups of patients receiving steroid after 1 month; however, after 3 months there was no statistical significant difference. Hence, Crawford et al. [20] concluded that steroid injections can provide short-term relief.

Gudeman assessed the efficacy of steroid iontophoresis in 40 feet (37 subjects). Feet were divided equally into a group that received phosphate buffered solution iontophoresis and one that received dexamethasone iontophoresis. The treatments lasted for 2 weeks during which each foot received six iontophereses. The Maryland foot score was used to analyze the groups. The active group showed significantly greater improvement immediately after treatment. However, both groups showed positive results at 1 month follow up. Ultimately, Gudeman et al. [21] found that dexamethasone iontophoresis is effective in improving pain immediately after treatment, but not more than placebo in the longer term.

Discussion

As evidenced above, multiple modes of therapy can lead to pain reduction in plantar fasciitis. Initial conservative management provides satisfactory results in approximately 80–90% of cases in clinical practice [24–27]. When more conservative management is unsuccessful, steroid injection is a preferred option [28–30]. Although steroid injection is the mainstay for the management of many hyper inflammatory disorders, there is little known about steroid affect at the cellular level and, consequently, little about the etiology of the risks of connective tissue rupture after the same [31].

Fascial rupture, which can be likened to tendon rupture, was investigated by Kennedy and Willis, who found that failing strengths decreased by 35% after administration of steroid in vitro to Achilles tendons. Cystic spaces and collagen necrosis were appreciated in their steroid group. This result continued through to 7 days. However, at 2 and 4 weeks following injection, these cystic spaces were replaced by an eosinophillic staining material and fibroblast proliferation was noted. Disordered collagen deposition was appreciated under scanning electron microscope. In addition, the failing strength returned to that of the control subjects. By 6 weeks, full biomechanical integrity was reestablished as evidenced by reorganization of collagen into parallel fibers. Hence, Kennedy and Willis concluded that physiologic dosed steroid injection weakens normal tendons for up to 14 days through collagen necrosis. They also recommend limited physical activity for the 2 weeks following injection and against repeated injection [24].

Furthermore, Wong et al. [32] showed that glucocorticoids suppress cellular metabolism and collagen synthesis in cultured human tenocytes and proteoglycan production [31]. Proteoglycan synthesis has a role in extracellular matrix and collagen matrix fibrillinogenesis. Wong et al. [31, 33] concluded that spontaneous rupture following steroid injection may occur through suppression of proteoglycan synthesis.

While steroid injection and iontophoresis can significantly improve foot pain in plantar fasciitis, the two methods warrant further investigation. As evidenced by Crawford and Gudeman, steroid therapy in plantar fasciitis plays a significant role in short-term therapy [20, 21]. However, a number of complications were noted including plantar fascial rupture, plantar fat pad atrophy, lateral plantar nerve injury secondary to injection, and calcaneal osteomyelitis and in iontophoresis, burning of the underlying skin [21, 34–39].

Fascial rupture and fat pad atrophy are especially serious complications as they can lead to intractable complications. Fascial rupture interrupts the intrinsic windlass mechanism of the foot and can promote further inflammation in the surrounding tissue, thus promoting pain. In addition, plantar fat pad atrophy diminishes subcalcaneal cushioning, availing the plantar fascia to further insult and, hence, more pain. Acevedo et al. appreciated symptomatic rupture in approximately 10% of subjects. Their retrospective chart review showed that approximately two-thirds of the patients (29/44) developed sudden onset rupture with a subsequent inability to weight bear, whereas one-third did not have acute onset. All of the ruptured patients presented with new additional symptoms including long arch pain, lateral mid foot pain, and an exam showing decreased windlass tension [35].

Treatment of plantar fasciitis rupture remains unclear. Treatment options for the rupture are open surgical repair, endoscopic repair, and nonoperative measures. Sellman and Acevedo et al. demonstrated that 50% of symptomatic ruptured plantar fasciitis patients have long-term complications [36]. Acevedo and Beskin [35] used a special treatment protocol including a “boot brace” which was beneficial for expedited symptom improvement with a switch to a stiff soled athletic shoe with an arch support orthosis. Daly et al. [40] performed plantar fasciotomy for those patients with intractable plantar fasciitis with resolution of symptomology in 57% of the patients.

Because of the recent availability and facility of ultrasound (US) to improve needle placement accuracy and confirmatory magnetic resonance imaging (MRI) in clinical practice, enhanced therapeutic response rates have been reflected in some of the studies [29, 30, 35, 41]. Tsai et al. described the objectivity of US-guided steroid injection to plantar fascia by demonstrating a decrease in fascial thickness and loss of hypoechogenicity. In addition, following single US-guided steroid injection, fat pad atrophy, which was theorized to cause worsening pedal dynamics, was not observed [30]. Heel fat pad inflammation and degeneration may cause pain and can be misdiagnosed as plantar fasciitis [42]. Further, MRI or US can be used to make appropriate diagnoses, which is particularly important for patients with chronic polyarthritis.

Nevertheless, these complications are uncommon and preventable; rupture may occur without steroid injections [35]. Paying special attention to history and physical examination change can lend some clues to associated complications. Monitoring sudden pain loss, change of patient pain location, developing numbness, changes in plantar fascial and fat pad thickness, edema, palpable masses, asymmetric flexible hammertoe deformities of the 2nd, 3rd, and 4th toes without nerve injury, and utilizing US for follow ups and injection placement can help to alleviate negative outcomes. Further, limiting the number and frequency of steroid injections and educating patients on reduction of aggressive physical activity during a 2-week post-injection period should be suggested [35].

Conclusion

Steroid therapy is a valuable adjunct to other therapy measures, including plantar fascial stretching. However, one should be cognizant that overuse of steroid injection can lead to complications. US guidance should be utilized to improve injection target and monitor soft tissue changes, thus preventing complication.

References

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Augusta Back – Augusta Georgia

Overview | Causes | Symptoms | Diagnosis | Treatment | FAQ

Click on image to enlarge

Overview

A
bone spur, or osteophyte, is a projection of bone that develops and
grows along the edge of joints. Bone spurs are fairly common in people
over the age of 60. It is not the bone spur itself that is the real
problem; pain and inflammation begin to occur when the bone spur
rubs against nerves and bones.
[top]

Causes

As
we age, the discs in our spine naturally degenerate and lose some
of their natural shock-absorbing ability. Factors that contribute
to and accelerate this process include stress, injury, poor posture,
poor nutrition, and family history.

It
is not uncommon for people with osteoarthritis to get bone spurs.
Osteoarthritis is a degenerative condition in which joint cartilage
begins to wear down, causing bone to rub against bone. As a result,
the body may begin to produce new bone to protect against this,
which is how a bone spur forms.
[top]

Symptoms

  • Back
    and neck pain
  • Pain
    radiating through an arm and/or leg
  • Prominent
    lumps on the hands, feet or spine
  • Numbness
  • Burning
  • Muscle
    cramps

[top]

Diagnosis

Outlined
below are some of the diagnostic tools that your physician may use
to gain insight into your condition and determine the best treatment
plan for your condition.

  • Medical
    history: Conducting a detailed medical history helps the doctor
    better understand the possible causes of your back and neck
    pain which can help outline the most appropriate treatment.
  • Physical
    exam: During the physical exam, your physician will try to
    pinpoint the source of pain. Simple tests for flexibility and
    muscle strength may also be conducted.
  • X-rays
    are usually the first step in diagnostic testing methods. X-rays
    show bones and the space between bones. They are of limited
    value, however, since they do not show muscles and ligaments.
  • MRI
    (magnetic resonance imaging) uses a magnetic field and radio
    waves to generate highly detailed pictures of the inside of
    your body. Since X-rays only show bones, MRIs are needed to
    visualize soft tissues like discs in the spine. This type of
    imaging is very safe and usually pain-free.
  • CT
    scan/myelogram: A CT scan is similar to an MRI in that it provides
    diagnostic information about the internal structures of the
    spine. A myelogram is used to diagnose a bulging disc, tumor,
    or changes in the bones surrounding the spinal cord or nerves.
    A local anesthetic is injected into the low back to numb the
    area. A lumbar puncture (spinal tap) is then performed. A dye
    is injected into the spinal canal to reveal where problems
    lie.
  • Electrodiagnostics:
    Electrical testing of the nerves and spinal cord may be performed
    as part of a diagnostic workup. These tests, called electromyography
    (EMG) or somato sensory evoked potentials (SSEP), assist your
    doctor in understanding how your nerves or spinal cord are
    affected by your condition.
  • Bone
    scan: Bone imaging is used to detect infection, malignancy,
    fractures and arthritis in any part of the skeleton. Bone scans
    are also used for finding lesions for biopsy or excision.
  • Discography
    is used to determine the internal structure of a disc. It is
    performed by using a local anesthetic and injecting a dye into
    the disc under X-ray guidance. An X-ray and CT scan are performed
    to view the disc composition to determine if its structure
    is normal or abnormal. In addition to the disc appearance,
    your doctor will note any pain associated with this injection.
    The benefit of a discogram is that it enables the physician
    to confirm the disc level that is causing your pain. This ensures
    that surgery will be more successful and reduces the risk of
    operating on the wrong disc.
  • Injections:
    Pain-relieving injections can relieve back pain and give the
    physician important information about your problem, as well
    as provide a bridge therapy.

[top]

Treatment

The
goal when treating bone spurs is to minimize pain and prevent any
additional joint damage. Treatment methods may include weight loss,
stretching and physical therapy, rest and ice. Injections can reduce
inflammation long enough to relieve symptoms. Medications such as
ibuprofen or injections may be administered for pain. Bone spurs
can be surgically removed in the case of serious damage and deformity.
[top]

FAQs

How
can osteoporosis impact the spine and cause a bone spur?

Osteoporosis
can have extremely serious consequences on the spine. It is a degenerative
condition in which joint cartilage can begin to wear down, causing
bone to rub against bone. As a result, the body may begin to produce
new bone to protect against this, which is how a bone spur forms.

How
can I tell if I have a bone spur?

Bone
spurs can generally be detected through X-ray, which can provide
a visual of any bony deposits.

Do
I need surgery to treat a bone spur?

Because
bone spurs are usually evidence of an underlying problem, this main
problem should be addressed first. This can include treatment methods
for degenerative disc disease, arthritis and osteoporosis. These
conditions can often be successfully treated with nonsurgical methods.
[top]

What Is a Bone Spur?

Though hard, bone tissue is constantly renewing—a bit like fingernails and hair. Sometimes new bone cells form small protrusions on a bone, called bone spurs. Bone spurs are usually painless, but occasionally they irritate surrounding tissues and cause symptoms.

2 Types of Bone Spurs

Bone spurs are sometimes called by their medical names, osteophytes and enthesophytes. Experts suggest both types of bone spurs are a reaction to skeletal stress.1

  • Osteophytes are typically found at the edge of a bone at a joint. They are considered to be the result of friction and stress on the bone, and are often associated with osteoarthritis.
  • Enthesophytes are bone spurs that develop where ligament or tendon insert into a bone. (The site of attachment of soft tissue into bone is called an enthesis.) Enthesophytes may develop because of tight ligaments and tendons rubbing against bone, a soft tissue injury, or an inflammatory disease.

People do not always make the distinction between osteophytes and enthesophytes; Enthesophytes may sometimes be called osteophytes.

Below are a few differentiating points about the two types of bone spurs.

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Osteophytes

Osteophytes can develop for a number of reasons, including chronic stress, friction, or pressure. Mini-traumas prompt the body to build more bone in an effort to repair itself.

  • Osteophytes can be found throughout the body, including the spine, neck, shoulder, knee, heel, fingers, back, or hip. Osteophytes are usually asymptomatic, so person can have a bone spur(s) for years and not know it.
  • Symptoms depend on the location of the spur. A bone spur on the knee may elicit pain when the knee is bent; whereas a spur on the spinal cord may affect nerves, producing numbness in extremities.
  • If the osteophyte causes pain, nonsurgical treatment is typically recommended first. Treatment can include:
    • Anti-inflammatory medications
    • Physical therapy
    • Corticosteroid injection
  • Developing an osteophyte is a typical sign of osteoarthritis. In fact, osteoarthritis is the leading cause of osteophytes.2

The incidence of developing an osteophyte increases with age, and becomes common among people over 60 years old.2

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Enthesophytes

These bone spurs form where soft tissues—tendons, fascia, ligaments, or articular capsules—inserts into bones.

  • Enthesophytes can occur throughout the body, from the spine to the upper and lower extremities. In otherwise healthy patients, they are common in the heel.
  • Symptoms can include pain and swelling in the joint, or redness.
  • The development of enthesophytes is often associated with:
    • Local trauma
    • High levels of physical activity

Occasionally, enthesophytes are a symptom of a systemic condition, such as seronegative spondyloarthritides; an endocrine disorder, such as diabetes mellitus; and calcium pyrophosphate deposition disease.

References

  • 1. Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S. Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat. 2006;208(4):471-90.
  • 2.Bone Spur. ReedGroup MD Guidelines website. http://www.mdguidelines.com/bone-spur Accessed July 6, 2016.

Everything You Need to Know About Viscosupplementation

Osteoarthritis is the highest occurring joint disorder in the United States, affecting nearly 27 million people. Osteoarthritis in the knee alone affects 10 percent of men and 13 percent of women over 60. It often develops slowly, and the pain can worsen over time.

With so many people suffering from osteoarthritis, it is important to understand the wide range of treatments available. While osteoarthritis is not curable, there are effective treatment options available that can noticeably improve and manage pain. One of those options is viscosupplementation. Below we answer some of the most common questions associated with osteoarthritis and viscosupplementation.

What is osteoarthritis?

Osteoarthritis is one of the most common causes of chronic pain and most commonly occurs in the knees. As opposed to acute or temporary pain that can be caused by the inflammation of a joint – typically as a result of an immune response from the body – osteoarthritis is a degenerative joint disease. It is a byproduct of aging and use over time. With aging, the profile of the cartilage in the body shifts. The water content of the cartilage increases while the proteins that make up the cartilage slowly degenerate. As a result, the cartilage begins to deteriorate and wear away.

Cartilage serves as a connecting point and soft buffer between the surface of your bones. When the cartilage begins to wear away, that buffer starts to get frayed or thinned out, providing less protection and stability to the affected joint. As the cartilage fades or degenerates, friction between the bones increases. This results in pain and a loss in the total range of motion of that joint. With that, the damage to the cartilage may cause the growth of bone spurs around the joints, resulting in more pain and further limiting the range of motion of the joint.

What is viscosupplementation?

Viscosupplementation can significantly reduce pain while improving the mobility and function of the joint to make activities of daily living and even athletic or strenuous exercise less painful.

Viscosupplementation is a procedure that involves injecting hyaluronic acid, a gel-like fluid, directly into the joint. Hyaluronic acid is found naturally in the synovial fluid surrounding the joints to reduce friction during movement. The injection goes into effect by lubricating the joint and assisting the synovial fluid to create more cushion. This works to reduce pain and improve the range of motion or the mobility of the joint.

When is it a treatment option?

There are several tests that your orthopaedic doctor will administer to confirm the condition and the level to which the osteoarthritis has progressed. Depending on the case and the patient, treatment options may include:

  • Acetaminophen
  • Non-steroidal anti-inflammatory drugs
  • Physical therapy
  • Occupational therapy
  • Cortisone injections

Depending on your orthopaedist’s findings and their plan for treatment, they may recommend viscosupplementation as a viable option for treating the pain and symptoms of your osteoarthritis. Viscosupplementation will usually be considered as a treatment option once other treatment options have been exhausted.

What happens during a treatment?

During a viscosupplementation treatment, your doctor will administer between three and five injections to the affected area. These will typically be injected one week apart from each other.

While not all patients experience relief with viscosupplementation, many patients report feeling a decrease in pain over the course of a three- to five-week period after the injections are administered. Patients report that the most significant level of pain relief comes two to three months after the first injection.

Depending on the patient, the length of pain relief will vary. Patients often report improvement of symptoms for six months or more after the treatment.

As with other types of injections, patients who receive viscosupplementation generally report feeling slight pain at the site of the injection. Swelling, heat, itchiness and bruising around the joint can also occur.

Who does viscosupplementation injections in the Raleigh area?

At Cary Orthopaedics, our physicians seek to treat patients without surgery whenever possible. Viscosupplementation injections serve as a minimally invasive treatment option for many patients who experience pain related to osteoarthritis. Viscosupplementation is just one of the many options we offer for the effective treatment of osteoarthritis pain.

To learn more about viscosupplementation and to find out if you are a candidate for treatment, contact us today.

 

90,000 Heel spurs: causes of occurrence, prescription of treatment

Calcaneal spurs are bone growths in the form of thorn-shaped or coracoid projections on the calcaneus, resulting from a chronic inflammatory-degenerative process in the soft tissues of the area of ​​attachment of the plantar fascia to the tubercle of the calcaneus.

The growths appear on the plantar surface or in the area of ​​the calcaneal tubercle. The base of the outgrowth passes into the bone, and the sharp end is directed towards the sole or is slightly bent upward.

The causes of this disease can be different, but most often they are associated with a load on the musculoskeletal system of the foot that goes beyond its physiological capabilities, which leads to local microtraumatization with subsequent inflammatory and degenerative changes in this area.

The main causes of the disease:

  • acute trauma
  • overweight
  • occupation associated with long-term local overvoltage in the heel area
  • longitudinal flat feet
  • chronic joint diseases
  • metabolic disorder
  • wearing the wrong shoes

Symptoms and course

The main and main symptom of a heel spur is heel pain that gets worse while walking. The patient feels as if he is stepping on a nail or needle.

At the onset of the disease, pain occurs only when walking. Sufferers try not to step on the heel. Over time, the pain becomes persistent, and its intensity does not particularly decrease at rest and when taking analgesics. Then constant lameness is added. The pain can be worse in damp and cold weather.

To avoid the development of the disease with further complications, timely treatment of the heel spur is necessary.

Diagnostics

The main method for diagnosing heel spurs is an X-ray examination. The X-ray shows the presence of a bony protrusion in the area of ​​the plantar surface of the calcaneus. Be sure to see your doctor if you have any of the above symptoms.

Treatment of heel spurs is most often conservative. It is aimed at eliminating inflammatory changes in the tissues surrounding the bone thorn, at counteracting dystrophic phenomena and at tissue regeneration.

When treating an advanced form, surgery may be required.

The St. Petersburg Medical Services Center has the necessary X-ray equipment for diagnosing a heel spur and prescribing its further treatment. Make an appointment by calling (812) 318-05-67.

Heel spur
– This is an overgrowth in the area of ​​the plantar surface of the calcaneus tubercle.This is
the disease is widespread – its share among the total mass of pathological
conditions of the musculoskeletal system is 10%. The development of this disease
possible at any age, in any person with predisposing
factors, although spurs are most often diagnosed in women over 40 years old.

Vo
while walking, the entire weight of a person falls on the plantar fascia, which
Supports the transverse and longitudinal arch of the foot. Normally, it allows
cushion the gait and distribute the load correctly.But with excessive (a
especially repetitive) stress at the attachment points to the heel bone
local aseptic inflammation begins to develop, and then
degenerative-dystrophic processes – replacement of healthy elastic
connective tissue pathological coarse fibrous and the appearance of bone
growths (enthesophytes, or actually “spurs”).

Reasons for the development of the disease:


Overweight


Excessive physical activity during sports.


Foot injuries: bone fractures, soft tissue bruises, ligament injury
apparatus, etc.


Diseases accompanied by circulatory disorders, changes
metabolic processes, for example, diabetes mellitus, gout.


Wearing uncomfortable shoes, lack of shock-absorbing insoles in them, thin and
rigid sole. Wearing high-heeled shoes.


Longitudinal flat feet – distribution of the load on the foot occurs
unevenly, the fascia suffers from excessive tension.Heel spur
formed in 90% of people with this pathology.


Connective tissue diseases (ankylosing spondylitis, rheumatoid arthritis)
are able to provoke the development of a heel spur.

Clinical picture

Pain
of a sharp, burning character, of varying intensity, arising (or
increasing) while walking, running, jumping or even with the slightest support on
heel. The intensity of pain does not depend on the size of the “thorn”.So, patients with
small flat spurs may have more severe pain than humans
with large growths. Characterized by increased pain after a night’s rest – for
during sleep, micro-tears of the fascia fused with shortening, with movements again
a micro-rupture occurs, and this is due to the intensification of the pain syndrome. On the
throughout the day, the fascia stretches, the painful sensations decrease slightly,
but in the evening they intensify again due to loads and the formation of new
microscopic damage.

Duplicate
day after day, trauma to the plantar fascia leads to cicatricial changes,
as well as deposits of calcium salts at the site of attachment to the bone, which leads to
the formation of bone growths.

Trying
unload the hindfoot, a person’s gait changes. External
there are no pathological changes in the heel area. Rarely to be found
mild edema of the heel area and calcification.

Diagnostics



clinical examination of the patient (pressure pain, limitation
foot mobility, pain when walking)


X-ray of the foot – allows you to “see” a painful formation (osteophyte
or enthesophyte) – a wedge-shaped hook extended towards the fingers, evaluate it
the size and condition of the surrounding soft tissues. It is also recommended to do
X-ray while standing, under load – this allows you to assess the degree of flat feet
and identify possible deformities of the bones of the foot)


Computed tomography, magnetic resonance imaging, although they have more
high resolution rendering, but are not of any decisive importance in
diagnosis and, consequently, treatment of this disease.


Ultrasound examination with a heel spur has the lowest diagnostic
value, since it visualizes the bone component of a given
diseases.

Treatment

Since the main causative factor is
overstrain of the plantar fascia, then the load on the feet should be limited
(suspend sports, normalize increased body weight, reduce
walking and standing time). Unloading the diseased limb and eliminating excessive
heel pressure should precede any treatment.

Wearing insoles with instep supports also
help to evenly distribute the load on the arches of the foot and, accordingly
create favorable conditions for recovery.

Massage
stop and walk barefoot on the warm sand also contributes to the complex
treating this disease.

Drug treatment includes
the use of non-steroidal anti-inflammatory drugs, as well as local
injections with glucocorticoids (hormonal drugs). Application of the latter
although it reduces pain, but with frequent (more than 3 injections) use
causes degenerative changes that aggravate the course of the disease.Also, injections with glucocorticoids are dangerous if the rules of asepsis are violated.
the development of severe infectious diseases – purulent abscesses, phlegmon and even
osteomyelitis.

Physiotherapy treatment has
most important in the treatment of torture spurs. It is possible to use almost everything
types of physical impact on the pathological process.

Most
considered effective:

1.
laser therapy – improves blood circulation, accelerates metabolic
processes, enhances the repair (restoration) of damaged structures;

2. shock wave therapy – allows you to “crush” bone growth, accelerates
metabolic processes;

3.
ultrasound treatment, phonophoresis with anti-inflammatory drugs –
application of ultrasonic waves to carry the drug to the site
inflammation;

Also
in the complex of treatment, although with less efficiency, it is possible to use
other methods of physiotherapy – electrotherapy (amplipulse, darsonval),
magnetotherapy, vacuum therapy, etc.d.

There are also such treatment methods
like taping and the use of night orthoses.

Taping – Overlay technique
on the plantar surface of the foot with a special tape-plaster, allowing
fix the plantar fascia in an elongated state.

Night orthoses are
special orthopedic aids that fix the leg at a right angle for
relaxing the plantar fascia and creating favorable conditions for fusion
micro-fractures of the latter.

If conservative methods do not help
get rid of the problem, then it is necessary to resort to surgical treatment. IN
During the operation, an incision of the skin and subcutaneous tissue is made in the spur area.
Further along the fibers, the plantar fascia is intersected and removal is performed
osteophyte. It should be noted that surgical intervention is extremely rare.

Heel spur – ProMedicine Ufa

A heel spur, or plantar fasciitis, is a chronic microtrauma of the plantar ligament that connects the heel bone to the forefoot.In fact, the heel spur looks like a small, but, nevertheless, a very unpleasant pointed growth on the sole of the foot and is an osteophyte (bony growth) on the surface of the heel bone. This growth acts in the form of a thorn and, under load, squeezes the soft tissues of the foot. This causes the characteristic excruciating pain.

It is often difficult to detect such a spur, especially in the early stages of the disease. Sometimes this only happens during an X-ray examination.On an X-ray image, this area resembles bone tissue in terms of density and brightness. Therefore, it seems that it continues the heel bone and looks like its pointed protrusion or thorn. The heel spur comes in a variety of sizes. Most often, its length is from 3 to 12 mm. The sharp end of the overgrowth usually points towards the toes and is slightly bent upward.

Causes

Patients who are overweight, suffering from arthritis, diseases of large joints, gout, flat feet are predisposed to this disease.Also, the risk group for the development of this disease includes athletes who constantly exercise stress on the foot area. In most cases, this applies to athletes. With flat feet, the ability to correctly distribute the weight of the whole body over the surface of the foot is disturbed. In the process of developing thinning of the layer of subcutaneous fat, pain in the heel increases, since this layer is a natural shock absorber in humans when walking.

Symptoms

The very first symptom that is characteristic of this disease is the appearance of pain in the heel, especially in the morning, when resting on the heel. This symptom is also called “starting pain”. During the day, severe pain gradually fades away, but reappears in the evening.

This disease is characterized by burning, sharp pains, which many patients compare with the “feeling of a nail in the heel.” Trying not to overload the sore leg, and fearing pain, the person’s gait changes. If both legs are affected by this disease, then walking becomes very difficult. The center of gravity is transferred from the heel area to the front areas and the outer edges of the foot.This often leads to the development of transverse flat feet.

When pressing on the calcaneal tubercle or when squeezing the heel from both sides, severe pain appears. No visual changes were observed.

Diagnosis

Heel spur usually does not cause difficulties in diagnosis.
An experienced doctor is able to do this by carefully probing the foot and listening to the patient’s complaints about the pain that is especially characteristic in this case. When examining the heel area, as a rule, pathological changes are not detected.Soreness is noted on palpation along the plantar surface of the heel. Sometimes these are diffuse pains throughout the heel, more often local pains in the center or along the inner surface of the heel region.
An x-ray is taken to confirm the diagnosis. On the X-ray of the foot, a bony outgrowth in the form of a thorn is visualized along the plantar surface of the calcaneus in the zone of fixation of the plantar aponeurosis. In the early stages of the disease, this “bone spike” is not detected on the roentgenogram.Then the pains are associated not with the presence of a “bone spur”, but with inflammatory changes.

Treatment

Today there are a number of treatments for heel spurs. One of the most effective methods is shock wave therapy. The principle of operation lies in the action of ultrasonic waves on the spur, which are pulsed. The method has contraindications: pregnancy, blood clotting disorders, cancer.

X-ray therapy allows you to influence the inflammation focus using X-ray radiation.For the same purpose, high-frequency currents (UHF), laser therapy, magnetotherapy are used.

In the treatment, anti-inflammatory and analgesic drugs are also used, which are delivered to the site of inflammation using electrophoresis. Also, drugs are injected directly into the site of inflammation. The procedure should be performed by a surgeon, as there is a high risk of needle trauma to the ligaments of the foot or calf tendon, or infection. The method allows you to achieve stable remission for several years.

Helps relieve symptoms using anti-inflammatory ointments, compresses, baths, etc.

What are the side effects of spinal injections?

The back, being the central and most important part of the human body, is very sensitive. Thus, back pain is the kind of pain that can lead a person to bed rest if it gets severe and if ignored. There are injections for back pain, in addition to surgery and non-surgical procedures.These injections are used as a treatment option with epidural spinal steroid injections, which are for back and neck pain, sacroiliac injections, and facet joint injections.

What are spinal injections?

Spinal injections can be used in two appropriate ways. First, they can be used to diagnose the source of pain in areas such as the back, leg, and neck. Secondly, these spinal injections are used as a treatment to relieve back pain and stress.Spinal injections are commonly used as a comprehensive treatment program, and these procedures usually include exercise programs to improve and maintain the mobility and stability of the spine.

Spinal injections are always done under the direction of a radiologist called fluoroscopy. This process is done to confirm where the medication is taken and that it is safe. Thus, liquid contrast is injected prior to drug administration. If the contrast does not reach the exact spot, the surgeon moves the needle and then injects additional dye until the flow is correct.

There are various spine injections, each with its respective role and benefit for the patient and for improving the quality of life of the individual. When spinal injections are combined with a physical rehabilitation regimen, a long-term solution to back and neck problems can be expected.

Types of spinal injections

The types of injections described below are used to treat and diagnose certain conditions of injury and trauma, and to help physicians and patients cope better with their health.Injections into the spine and their site are different, and each is used to treat a specific type of pain, but the purpose is the same. The types are as follows.

Lumbar Epidural Steroid Injection

A lumbar epidural steroid injection is given in the lower back, where it is called the lumbar region, and injected into the epidural space to reach the nerve canal. The injection process is guided by an X-ray machine known as fluoroscopy and is used to treat pain in the lower back and leg.

Lumbar Transforaminal Epidural Steroid Injection

This injection is used to treat low back pain as well as general back pain. This injection can be used to treat sciatica pain as well. The treatment uses a needle and it takes several days for the steroids to start working. The result of this injection is much less risky compared to other invasive options.

Caudal Epidural Steroid Injection

Caudal injection is given directly in the lower back near the coccyx.The target of this injection is the spinal nerves, where a needle is used to guide an area known as the sacral space, which is located above the tailbone. The steroid is injected directly into the lower part of the spinal canal.

Thoracic Epidural Steroid Injection

Injection of a chest epidural steroid is used not only to treat back pain, but also to treat pain in the side and abdomen. As stated elsewhere, this process will show improvements in a few days.This injection not only targets the lower back and neck, but also treats mid-back pain. Causes of pain in these areas include disc herniation and trauma caused by spinal stenosis.

Epidural Steroid Injection Spine

Epidural Spinal Steroid Injection is an effective procedure for back pain. Esi is a common treatment for inflammation associated with pain in the lower back, leg, and neck pain in the arm. In both of these cases, inflammation of the spinal nerves occurs due to narrowing of the passages.The narrowing of such passages is due to several reasons, such as a bone spur, herniated disc, thickening of the ligaments, and spondylolisthesis.

Some epidural spinal steroid injections are used as a tool for pain relief and some are used simply as a diagnostic tool for treating patients. There are three ways to deliver the steroid to the epidural space, namely the interlayer approach, the caudal approach, and the transformational approach.

In the interlayer approach, the needle is placed in the posterior part of the epidural space and delivers the steroid in a wider coverage. The caudal approach uses a small bony foramen near the coccyx, also called the sacral foramen. Finally, in a transformational approach, also known as a nerve block, a needle is placed along it and then the medicine is placed in the nerve sleeve.

All three processes are performed on an outpatient basis. Some patients are unable to receive the injection and ask for a gentle procedure, while others receive a local anesthetic and undergo the procedure.

Epidural Spinal Steroid Injections Side Effects

It should be noted that this procedure has its own risks and side effects arising from the steroid drug itself. These side effects are rare compared to oral steroids. Some of the reported side effects are:

Increased pain, Headache that resolves within 24 hours, anxiety, insomnia, fever, severe hip arthritis, high blood sugar and stomach ulcers.

Selective Nerve Root Block

Selective nerve root block injection, used to diagnose and treat inflamed spinal nerve. A medical anesthetic with a steroid is injected directly near the spinal nerve into the intervertebral foramen. The medicine helps to numb the pain caused by the nerve.

When steroids are used to treat an individual, they are missed with anesthetics or used alone. To prevent infections, the skin over the treatment is cleaned properly and then a small amount of dye is injected to check the exact position of the needle and prevent injection into the blood vessel.In the case of the cervical spine, one injection was successful in 75% of patients, and the outcome was recorded after six months. In the case of the lumbar spine, one injection resulted in only 46% of patients seeing improvement, and the result was recorded after one year. It is recommended to start therapy on the advice of a physician as soon as the pain subsides.

Selective Nerve Root Block Side Effects

Some of the common side effects of selective injections of nerve root blockers are:

  • Rash and itching
  • Weight gain of an individual
  • Additional energy
  • Soreness in the area of ​​injection
  • Bleeding
  • And, on rare occasions, death.

Facet Joint Injection

Facet joint injections are used for diagnostic and therapeutic purposes and are placed around the facet joints. These are small joints located between the vertebrae on the back of the spinal cord. This type of injection is used to treat pain caused by degenerative conditions or trauma.

Pain in the neck, mid-back and lower back is treated with a facet joint injection. There are two methods of injection: one is to inject the anesthetic directly into the joints, and the other is to numb the nerves that carry the pain.In the event that pain is relieved with an injection of anesthetic into the joint, a therapeutic injection is then used to provide long-term relief from neck and lower back pain. For patients who are still struggling to understand what is causing their back pain, facet joint injection is a good option.

The facet joint injection procedure is performed without any sedation and while the patient is lying on his stomach, the area of ​​the back to be tested is cleaned to avoid infection. The injection process takes only a few minutes, while the entire process takes twenty to thirty minutes. The physician usually advises the patient to avoid any heavy action the day before the injection, and in the case of sedation, the patient is advised not to drive for 24 hours after the procedure.

Side Effects of Facet Joint Injection

The following are the side effects of facet joint injection:

Allergic reaction: There are no life-threatening allergies and they are usually steroid and radiopaque contrast related.Very rare cases of allergy to anesthetics recorded:

Infection: less than 1% to 3% of cases have minor infection. Severe infections are rare in 0.1% of facet injection cases.

Minimal pain is a common side effect. In some cases, the patient’s body has shown reactions to drugs such as cortisone. Other side effects that have been reported are dizziness and muscle soreness.

Sacroiliac joint injection

As the name suggests, this injection is an injection of an anesthetic and a steroid injected into the patient’s sacroiliac joint. This particular injection serves many purposes. The sacroiliac injection is done to localize the pain and generate it by relieving pain in the patient’s lower back. There are risks associated with this particular injection, such as infection, increased pain, high blood sugar, sciatic nerve damage, and an allergic reaction.

In sciatica, people who are allergic to anesthesia, patients with bleeding disorders, heart failure or diabetes, and patients with swelling should avoid injection into the sacroiliac joint.The injection reduces pain and improves the flexibility of the back. A sacroiliac injection can be given by a team of interprofessional physicians, including a radiologist, orthopedic surgeon, sports physician, and rheumatologist. The sacroiliac injection should be given by a healthcare professional who knows how to manage complications during and after injection procedures.

Side Effects of Sacroiliac Joint Injection

It is usually asked if the sacroiliac injection has any side effects. It is safe? Is it worth it?

Some common and potential side effects reported so far are bruising at the sight of an injection into the sacroiliac joint, an allergic reaction that can be caused by either anesthesia or a steroid, an infection if the skin has not been cleaned before and after the injection, increased pain, decreased flexibility and elasticity of the surrounding ligaments and soft tissues, and cartilage degeneration. Some of the negative effects can be side effects such as weight gain, blood pressure, and blood sugar.

Back Pain Injection

Injection in the back is recommended by the doctor when all procedures have failed to relieve pain and the patient has lost flexibility. Back injections can help address two main problems: inflammation or damage to the nerve and spinal stenosis.

Inflammation usually occurs in the neck and back of a person, and doctors call it radiculopathy. In this case, the pain shoots sharply from the lower back to the legs or from the neck to the arms. Another cause of radiculopathy may be a herniated disc.

Spinal stenosis means that the spine has narrowed and this is due to a herniated disc pressing against the spinal cord. This pain, which occurs due to stenosis, can get worse during exercise and soothe during rest.

There are several injections to relieve pain, such as epidural as above, nerve block and discography. Back injections can have side effects such as nausea, vomiting, headache, soreness, and pain at the injection site.The injections can cause bleeding and infection, although this is rare, talking to your doctor will be very helpful.

Risks of spinal injection

The risks associated with spinal surgery are as follows:

  • Bleeding
  • Infection
  • Nerve damage
  • Arachnoiditis
  • Paralysis
  • Avascular necrosis
  • Headache
  • Muscle weakness

All injections have been presented in this article along with their side effects.Back pain has many alternatives. Apart from the non-surgical process and operations, back pain can be relieved with appropriate injections with the help of a suitable healthcare professional. We hope this content was helpful to you.

Resources: spine, pinnaclepainaz

HEEL SPUR – School of Health – GBUZ City Polyclinic 25 Krasnodar MH KK

June 09, 2017

The plantar aponeurosis on the lower surface of the foot experiences a great load at the point of attachment to the medial process of the calcaneal tuberosity.The normal physiological response to excessive stress is the formation of additional connective tissue, and if the load continues, calcification (ossification) of this fibrous-cartilaginous connective tissue occurs, that is, the formation of a spur.

Symptoms of the heel spur

Typically, the appearance of pain in patients on the plantar surface of the heel when they get out of bed in the morning. The pain is so severe that they limp when they go to the bathroom; the pain gradually subsides, but may recur during the day, mostly after sitting or lying.Such post-static dyskinesia is quite often expressed in the syndrome of the lower heel spur.

In taking a history of patients with heel pain, it is always determined whether they also have back pain. The combination of symptoms of lower back pain or stiffness, recurrent bilateral heel pain, and joint swelling prompts additional tests to rule out spondyloarthropathy, since many types of arthritis can be associated with heel spurs.

In case of suspected calcaneal spur syndrome and plantar aponeurositis, the next step in the diagnosis of bone exostosis is radiography.The accidental discovery of a heel spur on x-rays is an interesting find, but nothing more. Exostoses occur as a result of a chronic inflammatory process, which leads to periostitis, and the presence of a spur is a confirmation of the continuation of this process.

There is no correlation between the size of the spur and the severity of symptoms. Many large spurs are asymptomatic, small spurs can cause unbearable pain, and many patients have severe complaints without radiographic evidence of spurs.

Almost always, pain in calcaneal spur syndrome is localized in the region of the medial process of the calcaneal tuberosity. Pressing your finger firmly on this area will cause severe pain. Palpation of the medial plantar arch of the foot can also cause pain. The plantar aponeurosis is easy to feel when the fingers are passively bent to the back; then it bulges sharply on the surface of the foot. The site of attachment of the aponeurosis to the heel is the site of soreness.

As mentioned earlier, lower heel spur syndrome most often causes heel pain, but other causes of pain are always taken into account in the history and physical examination.In elderly patients, atrophy of fatty tissue on the plantar surface of the heel is often observed. Heel pain can be associated with seronegative spondyloarthropathy and other systemic arthritis. Metabolic causes of heel pain are sickle cell anemia, Paget’s disease, and osteomalacia. In patients with diabetes mellitus, alcoholics, or suffering from osteochondrosis of the lumbosacral spine, heel pain can be caused by neuropathy.

Heel pain can occur with malignant tumors.Nerve compression syndromes such as tunnel syndrome and compression of the first branch of the lateral plantar nerve can cause chronic heel pain. If the patient complains of increased pain on the plantar surface of the heel after receiving several injections of steroid drugs or after the last physical activity, then the cause of the pain may be a ruptured plantar aponeurosis.

Such patients usually complain of swelling and soreness and may hear or feel the characteristic crackle of tearing.Rest and immobilization are indicated to reduce the stress on the plantar surface of the foot; it may be necessary to apply a plaster cast below the knee bend.

Treatment of heel spur

Treatment of lower heel spur syndrome and plantar aponeurositis begins with a supportive bandage, the effectiveness of which is very high. In addition, non-steroidal anti-inflammatory drugs and a custom-made orthosis – a horseshoe-shaped insert that absorbs pressure on the heel and supports the foot – is shown.Local anesthetic and soluble steroid injections are also given to relieve pain and inflammation.

To prevent possible tears and tissue atrophy, avoid repeated injections near ligaments and tendons. Once the plantar aponeurosis is supported, the pain mostly subsides. After the pain subsides, the patient is instructed on how to do the stretching exercises correctly. These plantar aponeurosis and Achilles tendon exercises are beneficial in reducing the likelihood of symptoms recurring.

These exercises consist of stretching the calf when the knee is bent and extended, and stretching the plantar aponeurosis when the toes of the affected foot are folded with a towel and moved in contact with the front surface of the opposite leg up and down. If conservative treatment is ineffective, some patients are advised to splinter at night or the usual physiotherapy.

Night splint is a rigid device that the patient puts on during sleep, helps to maintain the plantar aponeurosis in a stretched state when it is not carrying a load, thus preventing the aponeurosis from shortening and, accordingly, the occurrence of pain when the patient gets out of bed in the morning.

For a small part of patients, conservative treatment is ineffective, at least from their point of view. For them, the method of choice is an operation in which the aponeurosis is cut off from the place of its attachment to the heel by classical surgery or endoscopically.

Some orthopedic traumatologists cut off the heel spur, this intervention is mostly effective, but it is not the method of choice. The spur remains for life, and if it is not removed surgically, the pain is almost always eliminated by cutting off the plantar aponeurosis.

Traditional medicine claims that the heel spur is successfully cured by applying to the heel of boiled “in uniform” potatoes, walnuts, a mixture of flour and honey, lard and other food products, as well as applying compresses with nettles, onions and urine, systematic rubbing into the skin turpentine, taking foot baths from a daily infusion of iron nails in vinegar, etc. This is not to say that these methods of “treatment” are very harmful to health.

However, the effectiveness of such miraculous measures seems to be very doubtful.And yet, the possibility of herbal medicine cannot be completely ruled out. Plants possessing anti-inflammatory, analgesic and other beneficial properties are known to science. This means that they may well be used in addition to traditional treatment.

You just need to keep in mind that the correct diagnosis and the choice of therapy methods are within the competence of a specialist. Hoping for a miracle and delaying the visit to the doctor, you prolong your own torment.

When the rooster has pecked.Why should a heel spur be treated at an early stage of the disease

Age, heels, sports

A heel spur is the final stage of the disease, which can already be seen on an X-ray. The characteristic thin and slightly curved outgrowth on the calcaneus resembles a cock’s spur in appearance. And the disease begins with inflammation of the plantar ligament – the fascia – in the place where it attaches to the heel bone.

“This part is the most vulnerable because it carries the most stress when walking.With age, the fascia loses its elasticity. And as a result of prolonged stress, increased weight, wearing uncomfortable shoes and some diseases, it is injured at the point of attachment to the heel tuber. Micro-tears are formed and, as a result, inflammation, ”states Alexander Ilminsky .

Most often middle-aged and older people suffer from heel spurs. The overwhelming majority are women. In this case, the disease occurs due to excess weight and rheumatological diseases.But it happens that a spur is formed in relatively young people.

“Heredity, unfortunate high heel or sport. And it happens all together, ”explains Alexander Vasilyevich.

In girls who walk in high heels , the fascia is unnecessarily stretched, and in this position it has a large static load. Sooner or later, this will surely come around with a problem with legs. Flat-soled shoes, by the way, are also harmful. Optimally – a heel 3-4 cm high, which distributes the load between the back and front of the foot.

With physical activity , everything is also quite understandable: all sports with an increased shock load on the foot, such as running, jumping, football, rugby, hockey, can theoretically provoke the development of this unpleasant disease.

From discomfort to pain

If left untreated inflammation of the fascia , a vicious circle of the disease starts, which ultimately allows it to flow into the chronic stage. As a rule, people faced with this problem do not pay attention to the first bells and do not go to the doctor.

At first, evening pains occur: feet at the end of the day burn and ache. And in the morning there is no trace of this discomfort. “I’m tired, I probably walked a lot yesterday,” the person thinks and calms down. But the next day, history repeats itself. And then morning pain is added to the evening pain. The first steps are truly painful: it hurts to step on the heel – a person either stumbles, limping noticeably on a sore leg, or sneaks on tiptoe.

These so-called starting morning pains cause people to pay attention to the problem.But, unfortunately, even at this stage, very few people reach the doctor – they self-medicate or seek advice from friends.

And meanwhile morning pains in the feet indicate that the process has already started. The pain dulls during the day, and in the evening it arises again – it acquires a wavy character.

“At an early stage, when an acute inflammatory process occurs, simple remedies can help – ointments, compresses. But when the disease is started, the patient will have to put in a lot of time and effort to heal.That is why it is necessary to come to the doctor on time, ”the orthopedist advises.

Photo shutterstock.com

Will the X-ray show?

First of all, the doctor will examine and feel the feet, talk to the patient to take an anamnesis, and send them for an x-ray. True, sometimes the spur is not visible in the picture: it might not have time to form.

“But this does not mean that there is no disease. It just hasn’t reached the final stage yet, ”explains Ilminsky.

The organism tries to patch up the micro-tears of the fascia: first, connective tissue is formed at the site of inflammation, and then the loss of calcium salts is possible.This is how a thin bone strip is formed first, and then the spur itself.

What is interesting: when the process has reached the final stage and completed, the spur may no longer bother – the body itself has built a defense.

Aleksandr Vasilyevich says that somehow he had an elderly patient from the area who showed impressive spurs on the X-ray. When questioned, she confirmed that “once it got sick and passed”. But such an almost asymptomatic course of the disease is a rarity, depending on the individual characteristics of the organism.Most often, the situation with a spur is much sadder, so it is not worth bringing the disease to a chronic stage.

Comprehensively and under control

It is imperative to go to an orthopedist-traumatologist because he will not just make a diagnosis and prescribe treatment. Doctor will find the reason due to which the disease developed. After all, treatment without eliminating the cause will be ineffective. For example, it is useless to simply treat inflammation of the fascia that has arisen against the background of flat feet. To begin with, you need to adjust the position of the foot using special insoles, and to soften the load on the heel, there are special silicone heel pads with a removable core.

“There is no universal remedy for the treatment of heel spurs. You need to go from simple methods to complex ones. But all this should be integrated and under the supervision of a doctor, ”emphasizes Alexander Ilminsky.

As a rule, patients are prescribed anti-inflammatory therapy: local (ointments and compresses) and general (pills and injections), physiotherapy is prescribed: magnetic laser therapy, ultrasound with hydrocortisone, diadynamic currents, shock wave therapy. Helps, according to Alexander Vasilyevich, and special physiotherapy exercises – gymnastics for tension and relaxation of the plantar fascia.

Those who suspect they have a heel spur should not go to a surgeon or rheumatologist, but directly to an orthopedic traumatologist. These specialists are available in any emergency room. They are accepted in the regional hospital’s polyclinic, as well as in private clinics.

Strasbourg sock for the treatment of heel spurs

Principle of operation and effect of application.

No medication, no surgery: how a Strasbourg sock gets rid of a heel spur

A heel spur, or plantar fasciitis, is an inflammation of the fascia that connects the heel and metatarsal bones.In the course of the disease, bone growth is formed on the surface of the heel bone, reaching a length of more than 10 mm, which protrudes in the form of a thorn and squeezes soft tissues. The ailment disturbs the patient with acute pain, does not make it possible to step on the heel, as a result of which the patient transfers the load from the sore area to the toes or healthy leg. As a result, serious deformities develop, and the spur itself becomes the cause of the spread of the infection.

Where did the term heel spur come from?
This is essentially an X-ray term.Radiographers see bone growth in the fascia region that looks like a spur or thorn in the images. Interestingly, not all people who have a “heel spur” on x-rays experience discomfort and pain. There are frequent cases when, despite the pronounced picture in the picture – a sharp spike more than a centimeter long – a person has no complaints. But there is also the opposite – severe pain, despite the fact that there are no signs of a spur on the X-ray. It is impossible to diagnose such a disease on your own; only a specialist can do this.

Consider how a comfortable night brace such as a Strasbourg sock relieves heel pain and the development of inflammation of the fascia.

Strasbourg sock: the advantages of the orthosis

Those who have already encountered a heel spur know that fasciitis delivers especially acute pain in the morning when getting out of bed. This is due to the fact that the cells of the fascia begin to ossify under the influence of calcium, and they do this precisely at rest. When you try to get out of bed and put stress on the foot, salt deposits load and damage the tissues.

The Strasbourg sock is a high stocking with locking mechanisms that is worn at night. The brace raises the fingers and provides tension on the fascia, which prevents the formation of collagen fiber breaks. This is a great way to get rid of ailments and relieve pain from the first application. The foot quickly adapts to the load, so the sock is equipped with an adjustable strap that allows you to change the tension. To ensure good cushioning of the foot and even distribution of the load, the sock also has a heel shock absorber and a rigid instep support.In combination with drug therapy, the sock accelerates healing and also acts as an excellent prevention of fasciitis.

How a sock helps with a heel spur

The main task of the brace is to keep the foot in relation to the lower leg at an angle of 90 degrees. Being in an immobilized state, the plantar tissues have the opportunity to recover and relieve the patient from morning starting pains.

Of course, using a night restraint device can be inconvenient, since you are not used to sleeping in this position.However, these are temporary measures, given that the product quickly relieves pain and inflammation of the fascia. If you are used to sleeping on your back, then, as a rule, there is no discomfort at all.

Thus, with regular use at night, the Strasbourg sock has the following positive effects:

  • gently fixes the foot in a stretched position;
  • does not affect blood circulation in the limbs;
  • reduces stress on damaged fascia;
  • has an analgesic effect;
  • helps to restore joint mobility;
  • strengthens the fascia of the heel;
  • normalizes gait;
  • orthoses are made of soft breathable materials that do not rub and completely eliminate allergic reactions.

Strasbourg sock allows people with a heel spur to lead an active lifestyle, eliminate pain and get rid of the disease. It is worth remembering: in order for the pain not to return in the daytime, it is necessary to provide a full unloading of the heel when walking.

Readings:
  • Treatment and prevention of heel spurs;
  • tenditis.

Contraindications:
Where to Treat Acute Foot Pain

The key point in the treatment of the disease is high-quality and timely diagnostics of the heel spur, which the staff of the Novy Step sports and rehabilitation center will cope with.Do not postpone your visit to the doctor until later in order to be able to recover as soon as possible.

You can sign up for a consultation by calling +7 (495) 477-55-40 or via online feedback form .

Sports and Rehabilitation Center “New Step”:
our main goal is to return you the joy of an active life!

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