What are the main causes of bone spurs. How can bone spurs be diagnosed effectively. Which treatment options are available for managing bone spurs. What preventive measures can be taken to reduce the risk of developing bone spurs.

Understanding Bone Spurs: Definition and Common Locations

Bone spurs, medically known as osteophytes, are smooth, hard protrusions of extra bone that typically form at the ends of bones. These bony outgrowths often develop in joints where two bones meet. While bone spurs can occur in various parts of the body, they are most commonly found in the:

• Hands
• Shoulders
• Neck
• Spine
• Hips
• Knees
• Feet (particularly the heels)

Do bone spurs always cause discomfort. Interestingly, most bone spurs do not cause any noticeable symptoms. However, when they rub against other bones or press on nerves, they can lead to pain and stiffness in the affected area.

Unveiling the Causes of Bone Spurs

The development of bone spurs can be attributed to various factors, with joint damage from osteoarthritis or degenerative joint disease being the most common cause. As we age, the cushioning between our joints and the bones of our spine can deteriorate, leading to the formation of these bony projections.

Other conditions that can contribute to the development of bone spurs include:

• Rheumatoid arthritis
• Lupus
• Gout

Are injuries a potential cause of bone spurs. Indeed, bone spurs often form following an injury to a joint or tendon. When the body perceives bone damage, it attempts to repair it by adding bone to the injured area.

Additional factors that may contribute to the formation of bone spurs include:

• Overuse of joints (e.g., frequent running or dancing over extended periods)
• Genetic predisposition
• Dietary factors
• Obesity
• Congenital bone abnormalities
• Spinal stenosis (narrowing of the spine)

Recognizing the Symptoms of Bone Spurs

Can bone spurs remain undetected. Surprisingly, many individuals with bone spurs are unaware of their presence until they undergo an X-ray for an unrelated condition. Symptoms typically manifest when bone spurs press on nerves, tendons, or other bodily structures.

When bone spurs do cause symptoms, they may include:

• Pain in the affected joint
• Pain or stiffness when attempting to bend or move the affected joint
• Weakness, numbness, or tingling in the arms or legs (if the bone spur presses on spinal nerves)
• Muscle spasms, cramps, or weakness
• Visible bumps under the skin, particularly in the hands and fingers
• In rare cases, difficulty controlling bladder or bowel function (if the bone spur presses on specific nerves in the spine)

Do symptoms worsen with physical activity. Many individuals experience an exacerbation of symptoms during exercise or when attempting to move the affected joint.

The “Loose Body” Phenomenon

In some instances, a bone spur may break off and become lodged in the joint lining. This detached fragment, known as a “loose body,” can cause joint locking and significantly impair movement.

Diagnosis of Bone Spurs: Medical Expertise and Imaging Techniques

When it comes to diagnosing bone spurs, a multidisciplinary approach is often necessary. The diagnostic process typically begins with an evaluation by a primary care physician, who may then refer the patient to a specialist.

Which medical specialists are best equipped to diagnose bone spurs. Rheumatologists, who specialize in joint problems, and orthopedic doctors, who focus on the musculoskeletal system, are often the most qualified professionals to diagnose and treat bone spurs.

The diagnostic process usually involves the following steps:

1. Physical examination: The doctor will palpate the affected joint to check for any abnormal bumps or protrusions.
2. X-ray imaging: This is typically the first-line imaging technique used to visualize bone spurs.
3. Advanced imaging: In some cases, additional tests may be necessary for a more detailed assessment:

• CT scan: This powerful X-ray technique produces detailed cross-sectional images of the body.
• MRI: Using strong magnets and radio waves, MRI scans create high-resolution images of organs and internal structures.
• Electroconductive tests: These measure the speed at which nerves transmit electrical signals, helping to assess any nerve damage caused by bone spurs in the spinal canal.

Effective Treatment Strategies for Bone Spurs

The management of bone spurs often begins with conservative measures aimed at relieving pain and reducing inflammation. Are over-the-counter pain relievers effective for managing bone spur discomfort. Many patients find relief with the following medications:

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen sodium (Aleve)

It’s important to note that these medications can cause side effects, especially if taken in large doses or for extended periods. Patients who have been using these medications for more than a month should consult their doctor about alternative treatment options.

Additional Therapeutic Approaches

Beyond over-the-counter pain relievers, several other treatment modalities can be effective in managing bone spurs:

• Rest: Allowing the affected joint to rest can help alleviate pain and promote healing.
• Steroid injections: These can help reduce inflammation and pain in the affected joint.
• Physical therapy: This can improve joint strength and increase range of motion.

When is surgical intervention necessary for bone spurs. If conservative treatments prove ineffective or if the bone spur significantly impairs movement, surgical removal of the extra bone may be recommended.

Preventive Measures: Reducing the Risk of Bone Spur Formation

While it’s not always possible to prevent bone spurs, especially those resulting from the natural wear and tear associated with arthritis, several preventive measures can be taken to reduce the risk of developing bone spurs due to other factors:

1. Proper Footwear

How can appropriate footwear help prevent bone spurs. Wearing well-fitted shoes with the following characteristics can significantly reduce the risk of developing bone spurs, particularly in the feet:

• Wide toe box
• Good arch support
• Adequate cushioning

It’s advisable to have shoes professionally fitted to ensure they don’t rub against your feet while walking. Wearing thick socks can provide an additional layer of protection.

2. Nutritional Support

A balanced diet rich in calcium and vitamin D is essential for maintaining strong, healthy bones. These nutrients play a crucial role in bone metabolism and can help prevent the abnormal bone growth associated with bone spurs.

3. Regular Exercise

Engaging in weight-bearing exercises, such as walking or stair climbing, can help maintain bone strength and density. These activities stimulate bone formation and can potentially reduce the risk of bone spur development.

4. Weight Management

Maintaining a healthy weight is crucial in preventing bone spurs. Excess body weight places additional stress on joints, potentially accelerating wear and tear and increasing the likelihood of bone spur formation.

5. Early Detection and Treatment of Joint Issues

Why is early intervention important in preventing bone spurs. Promptly addressing any signs of joint trouble, such as pain, swelling, or stiffness, can help prevent the progression of conditions like arthritis that often lead to bone spur formation. Early diagnosis and treatment of these underlying conditions may reduce the risk of developing bone spurs.

Advanced Treatment Options for Persistent Bone Spurs

While many cases of bone spurs respond well to conservative treatments, some patients may require more advanced interventions. What options are available for those with persistent or severe bone spur symptoms.

1. Extracorporeal Shock Wave Therapy (ESWT)

This non-invasive treatment uses shock waves to stimulate healing in the affected area. ESWT has shown promise in treating bone spurs, particularly those in the heel (heel spurs). The procedure works by:

• Increasing blood flow to the affected area
• Stimulating the body’s natural healing processes
• Potentially breaking down calcified deposits

2. Ultrasound-Guided Needle Tenotomy

This minimally invasive procedure involves using ultrasound guidance to direct a needle to the affected area. The needle is then used to break up the bone spur and any associated scar tissue. This technique is particularly useful for bone spurs affecting tendons.

3. Radiofrequency Ablation

For bone spurs causing nerve pain, radiofrequency ablation may be an effective treatment option. This procedure uses heat generated by radio waves to disrupt nerve function, potentially providing long-lasting pain relief.

4. Regenerative Medicine Techniques

Emerging therapies in the field of regenerative medicine show promise for treating bone spurs and associated joint damage. These include:

• Platelet-Rich Plasma (PRP) Therapy: This involves injecting a concentration of the patient’s own platelets to accelerate healing.
• Stem Cell Therapy: Using the body’s own stem cells to promote tissue repair and regeneration.

Living with Bone Spurs: Lifestyle Adjustments and Coping Strategies

For individuals diagnosed with bone spurs, making certain lifestyle modifications can significantly improve quality of life and help manage symptoms. What strategies can be employed to cope with the challenges posed by bone spurs.

1. Ergonomic Considerations

Adapting your work and living spaces to minimize stress on affected joints can help reduce pain and discomfort associated with bone spurs. This may include:

• Using ergonomic chairs and desks
• Adjusting computer monitors to eye level
• Using supportive pillows while sleeping

2. Activity Modification

While staying active is important, it may be necessary to modify certain activities to avoid exacerbating bone spur symptoms. This could involve:

• Switching to low-impact exercises like swimming or cycling
• Using assistive devices for daily activities
• Taking frequent breaks during prolonged periods of activity

3. Stress Management

Chronic pain from bone spurs can be stressful, and stress itself can exacerbate pain. Implementing stress-reduction techniques such as meditation, deep breathing exercises, or yoga can be beneficial.

4. Support Groups

Joining a support group for individuals with bone spurs or related conditions can provide emotional support and practical advice for living with the condition.

The Future of Bone Spur Treatment: Emerging Research and Innovations

As medical science continues to advance, new treatment modalities for bone spurs are on the horizon. What promising developments are researchers exploring in the field of bone spur management.

1. Targeted Drug Delivery Systems

Scientists are working on developing drug delivery systems that can target bone spurs more precisely, potentially improving treatment efficacy while minimizing side effects.

2. Gene Therapy

Research into gene therapy techniques may lead to treatments that can prevent or reverse the formation of bone spurs at a genetic level.

3. Advanced Imaging Techniques

Improvements in imaging technology may allow for earlier detection and more precise treatment of bone spurs. This could include:

• High-resolution MRI techniques
• Molecular imaging methods

4. Nanotechnology

The application of nanotechnology in medicine may lead to new treatment options for bone spurs, such as:

• Nanoparticles designed to target and break down bone spurs
• Nano-scale scaffolds for promoting healthy bone growth

As research in these areas progresses, individuals affected by bone spurs can look forward to potentially more effective and less invasive treatment options in the future.

Causes, Symptoms, Diagnosis, Treatment, & Prevention

Written by WebMD Editorial Contributors

• What Are Bone Spurs?
• Causes of Bone Spurs
• Symptoms of Bone Spurs
• Bone Spur Diagnosis
• Bone Spur Treatments and Home Care
• Bone Spur Prevention
• More

Bone spurs (also called osteophytes) are smooth, hard bumps of extra bone that form on the ends of bones. They often pop up in the joints — the places where two bones meet.

Bone spurs can form on many parts of your body, including your:

• Hands
• Shoulders
• Neck
• Spine
• Hips
• Knees
• Feet (heels)

Most bone spurs don’t cause problems. But if they rub against other bones or press on nerves, you might experience pain and stiffness.

The most common cause of bone spurs is joint damage from osteoarthritis or degenerative joint disease. The cushioning between your joints and the bones of your spine can wear down with age. Rheumatoid arthritis, lupus, and gout can also damage your joints.

Bone spurs also often form after an injury to a joint or tendon. When your body thinks your bone is damaged, it tries to fix it by adding bone to the injured area.

Other causes of bone spurs include:

• Overuse – for example, if you run or dance a lot over a long period of time
• Genes
• Diet
• Obesity
• Bone problems that you were born with
• Narrowing of the spine (spinal stenosis)

You might not realize you have a bone spur until you get an X-ray to look for another condition. They only cause problems when they press on nerves, tendons, or other structures in your body. Then, you might feel any of the following:

• Pain in the affected joint
• Pain or stiffness when you try to bend or move the affected joint
• Weakness, numbness, or tingling in your arms or legs if the bone spur presses on nerves in your spine
• Muscle spasms, cramps, or weakness
• Bumps under your skin, seen mainly in the hands and fingers
• Trouble controlling your bladder or bowels if the bone spur presses on certain nerves in your spine (a symptom that’s seen very rarely)

Your symptoms might get worse when you exercise or try to move the affected joint.

A bone spur can break off and get stuck in the lining of the joint. This is called a “loose body.” It can lock up the joint and make it hard to move.

Often, bone spurs are first evaluated by your regular doctor who will likely refer you to a specialist. You’ll probably need to see a rheumatologist or orthopedic doctor. Rheumatologists specialize in joint problems. Orthopedic doctors focus on the musculoskeletal system. Your doctor will feel the joint to check for a bump. They may also order an X-ray to help them to see the bone spur better.

Other tests your doctor can use to diagnose bone spurs include:

• CT scan. It’s a powerful X-ray that makes detailed pictures inside your body.
• MRI. This uses powerful magnets and radio waves to make pictures of organs and structures inside your body.
• Electroconductive tests. These tests measure how fast your nerves send electrical signals. They can show the damage bone spurs have caused to nerves in your spinal canal.

To relieve pain and bring down swelling, you can try one of these over-the-counter pain relievers:

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen sodium (Aleve)

These can cause side effects, especially if you take them in large doses or for a long time. If you’ve taken them for more than a month, ask your doctor if you can try a different treatment.

Other therapies for bone spurs include:

• Rest
• Steroid shots to bring down swelling and reduce pain in the joints
• Physical therapy to improve joint strength and increase movement

If these treatments don’t work or the bone spur affects your movement, you might need surgery to remove the extra bone.

Bone spurs usually can’t be prevented if they’re the result of the natural wear and tear of arthritis. But you can take these steps to avoid bone spurs caused by other things:

• Wear shoes with a wide toe box, good arch support, and enough cushion to pad each step. Get your shoes fitted by a professional so they don’t rub against your feet when you walk. Wear thick socks to prevent your shoes from rubbing.
• Eat a well-rounded diet with plenty of calcium and vitamin D to protect your bones.
• Do regular weight-bearing exercises like walking or stair climbing to keep your bones strong.
• Try to keep the extra pounds off.

See your doctor if you have any signs of joint trouble, like pain, swelling, or stiffness. If you catch and treat arthritis early, you may be able to prevent the damage that leads to bone spurs.

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Causes, Symptoms, Diagnosis, Treatment, & Prevention

Written by WebMD Editorial Contributors

• What Are Bone Spurs?
• Causes of Bone Spurs
• Symptoms of Bone Spurs
• Bone Spur Diagnosis
• Bone Spur Treatments and Home Care
• Bone Spur Prevention
• More

Bone spurs (also called osteophytes) are smooth, hard bumps of extra bone that form on the ends of bones. They often pop up in the joints — the places where two bones meet.

Bone spurs can form on many parts of your body, including your:

• Hands
• Shoulders
• Neck
• Spine
• Hips
• Knees
• Feet (heels)

Most bone spurs don’t cause problems. But if they rub against other bones or press on nerves, you might experience pain and stiffness.

The most common cause of bone spurs is joint damage from osteoarthritis or degenerative joint disease. The cushioning between your joints and the bones of your spine can wear down with age. Rheumatoid arthritis, lupus, and gout can also damage your joints.

Bone spurs also often form after an injury to a joint or tendon. When your body thinks your bone is damaged, it tries to fix it by adding bone to the injured area.

Other causes of bone spurs include:

• Overuse – for example, if you run or dance a lot over a long period of time
• Genes
• Diet
• Obesity
• Bone problems that you were born with
• Narrowing of the spine (spinal stenosis)

You might not realize you have a bone spur until you get an X-ray to look for another condition. They only cause problems when they press on nerves, tendons, or other structures in your body. Then, you might feel any of the following:

• Pain in the affected joint
• Pain or stiffness when you try to bend or move the affected joint
• Weakness, numbness, or tingling in your arms or legs if the bone spur presses on nerves in your spine
• Muscle spasms, cramps, or weakness
• Bumps under your skin, seen mainly in the hands and fingers
• Trouble controlling your bladder or bowels if the bone spur presses on certain nerves in your spine (a symptom that’s seen very rarely)

Your symptoms might get worse when you exercise or try to move the affected joint.

A bone spur can break off and get stuck in the lining of the joint. This is called a “loose body.” It can lock up the joint and make it hard to move.

Often, bone spurs are first evaluated by your regular doctor who will likely refer you to a specialist. You’ll probably need to see a rheumatologist or orthopedic doctor. Rheumatologists specialize in joint problems. Orthopedic doctors focus on the musculoskeletal system. Your doctor will feel the joint to check for a bump. They may also order an X-ray to help them to see the bone spur better.

Other tests your doctor can use to diagnose bone spurs include:

• CT scan. It’s a powerful X-ray that makes detailed pictures inside your body.
• MRI. This uses powerful magnets and radio waves to make pictures of organs and structures inside your body.
• Electroconductive tests. These tests measure how fast your nerves send electrical signals. They can show the damage bone spurs have caused to nerves in your spinal canal.

To relieve pain and bring down swelling, you can try one of these over-the-counter pain relievers:

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen sodium (Aleve)

These can cause side effects, especially if you take them in large doses or for a long time. If you’ve taken them for more than a month, ask your doctor if you can try a different treatment.

Other therapies for bone spurs include:

• Rest
• Steroid shots to bring down swelling and reduce pain in the joints
• Physical therapy to improve joint strength and increase movement

If these treatments don’t work or the bone spur affects your movement, you might need surgery to remove the extra bone.

Bone spurs usually can’t be prevented if they’re the result of the natural wear and tear of arthritis. But you can take these steps to avoid bone spurs caused by other things:

• Wear shoes with a wide toe box, good arch support, and enough cushion to pad each step. Get your shoes fitted by a professional so they don’t rub against your feet when you walk. Wear thick socks to prevent your shoes from rubbing.
• Eat a well-rounded diet with plenty of calcium and vitamin D to protect your bones.
• Do regular weight-bearing exercises like walking or stair climbing to keep your bones strong.
• Try to keep the extra pounds off.

See your doctor if you have any signs of joint trouble, like pain, swelling, or stiffness. If you catch and treat arthritis early, you may be able to prevent the damage that leads to bone spurs.

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Heel spur – treatment, symptoms, causes, diagnosis

Video

• Heel spur. Question answer.
  Subject: Q&A
• Heel spur
  Subject: Encyclopedia of diseases

Title

• Causes of disease
• Symptoms
• Diagnostics
• Treatments for heel spurs

SHOCK WAVE THERAPY –
the most effective treatment for
HEAL SPUR!

Read more

Heel spur is a calcium deposit on the bottom of the heel bone. On x-ray, the heel spur may protrude 0.5-1 cm forward. Although heel spurs are often painless, they can still be quite painful. Heel spurs are often associated with plantar fasciitis. Plantar fasciitis is the most common cause of pain in the bottom of the heel. Approximately 2 million patients in the US are treated for plantar fasciitis each year. Plantar fasciitis occurs when the strong band of tissue that supports the arch of the foot (plantar fascia) becomes irritated and inflamed. Heel spurs on the back of the heel are also often associated with inflammation of the Achilles tendon (tendinitis) and can cause soreness and pain in the back of the heel that worsens with foot extension.

Heel spurs and plantar fasciitis can occur by themselves or be caused by the presence of diseases such as arthritis (including Reiter’s reactive arthritis), ankylosing spondylitis, diffuse idiopathic hyperostosis. It is important to note that a heel spur may not cause any symptoms at all, and may be discovered incidentally during an X-ray examination.

Cause

A heel spur occurs when calcium deposits form on the bottom of the heel bone and this is a process that usually occurs over many months. Heel spurs are often caused by stretching of the muscles and ligaments, stretching of the plantar fascia, and repeated ruptures of the membrane that covers the heel bone. Heel spurs are especially common in athletes whose sports activities are associated with a lot of jumping and running.

Risk factors for heel spurs include:

• Impaired gait that places excessive stress on the heel bone, ligaments, and nerves in the heel area.
• Running on hard surfaces
• Poorly fitted or worn shoes
• Overweight, obesity

In most cases, plantar fasciitis develops without a specific cause.

But there are certain risk factors that increase the chance of developing plantar fasciitis and include:

• Old age. Involutional changes in the tissues leads to a decrease in the elasticity of the plantar fascia and a decrease in adipose tissue in the heel area
• Diabetes
• Activity involving standing for long periods of time
• Episodes of intense physical activity
• The presence of flat feet or vice versa high arch of the foot.
• Gastrocnemius tightness and limited foot flexion.

The function of the plantar fascia is to absorb the loads that fall on the foot. But at a certain point, the fascia cannot withstand the loads, and tears and inflammation of the fascia occur.

Symptoms

Although many patients with plantar fasciitis have a heel spur, the spur does not always cause pain. Almost 10% of adults have spurs, but only 5% have foot pain. And therefore, the treatment of heel pain, most often, does not require the removal of the spur.

The most common symptoms of plantar fasciitis are:

• Pain in the lower part of the foot near the heel
• Pain on first steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. Pain lessens after a few minutes of walking
• Increased pain after (not during) exercise or physical activity.

Heel spurs often cause no symptoms. But heel spurs can lead to occasional pain or chronic pain – especially when walking or jogging if inflammation develops at the site of the spur. In general, the cause of the pain is not the heel spur itself, but trauma to the soft tissues of this spur.

Many patients describe pain with heel spur and plantar fasciitis, like a pin sticking out of the bottom of the foot when they get up in the morning and this pain later becomes a dull ache. Also characteristic is the complaint that acute pain also appears immediately when standing up, after sitting for a long period of time

Diagnostics

After studying the medical history, complaints of the patient, the doctor examines the leg: the presence of a high arch, the area of ​​pain in the heel area, the presence of mobility restrictions in the foot. To verify the diagnosis, instrumental methods of research may be required. Radiography provides a clear image of bone tissue. This research method makes it possible to exclude other causes of heel pain, such as a fracture or arthrosis. The heel spur is well visualized on x-ray.

MRI is a very informative research method that allows you to visualize well not only the bone tissues of the foot, but also soft tissues (ligaments, cartilage), which is important in diagnosing damage to the plantar fascia, Achilles tendon or cartilage tissue damage in arthritis.

Ultrasound examination is also widely used for diagnosing heel spurs and plantar fasciitis and, although it is inferior to MRI in image quality, but given the complete safety, it can be used quite often, for example, to monitor the effectiveness of treatment.

Treatment

Heel spur treatment can be conservative or surgical. In 90% of patients with plantar fasciitis (heel spur), conservative treatment is effective within 10 months.

Conservative methods of treatment include:

Drug treatment includes the use of drugs of the NSAID group (ibuprofen, voltaren, naproxen), which can be used both orally in the form of tablets and topically, in the form of ointments, gels containing NSAIDs. In some cases, it is possible to use injections of corticosteroids, which allows you to quickly remove the inflammatory process. A corticosteroid may be injected into the plantar fascia to reduce inflammation and pain. But repeated steroid injections can lead to rupture of the fascia, and therefore the use of steroids must be clearly indicated.

Extracorporeal shock wave therapy (ESWT). During this treatment, powerful sound wave pulses break up the calcium deposits in the heel spur and stimulate the regeneration process in the plantar fascia.

The SWT procedure in some cases helps to avoid surgical treatment.

Physiotherapy (laser therapy, electrophoresis, cryotherapy) can significantly reduce inflammation in the plantar fascia and reduce pain.

Orthopedic products . There are various products that can reduce the load on the foot, especially effective heel pads made of silicone, which significantly reduce the load on the calcaneus and plantar fascia.

LFK . Exercises aimed at strengthening the muscles of the foot are quite effective in the treatment of heel spurs and plantar fasciitis in combination with other methods of treatment.

Surgical treatments are used only if there is no effect of conservative treatment within 12 months.

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;
• pain is aggravated by 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.
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Uric acid (in the blood) (Uric acid)

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

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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;
• ultrasound therapy: tissue heating and reduction of inflammatory reactions using ultrasonic waves;
• magnetotherapy;
• mud and mineral baths;
• laser therapy: heating the deep layers of tissues with a laser helps to locally improve blood flow.

Shock wave therapy is a non-invasive method of treatment that allows you to quickly reduce or completely remove the pain syndrome. 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 radio frequency 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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