Calcaneal spur - Causes, Symptoms and Treatment .MF .
Heel spur - a growth of bone on the surface of the calcaneus, having a kind of spike.Heel spur is often on the plantar surface of the calcaneus (in the medial process of the calcaneus) to the site of attachment to her muscles and fascia holding the arch of the foot - this is called the plantar calcaneal spur.Less spur located on the back surface of the heel bone (in rear tuberosity of the calcaneus region) in the place of attachment of the Achilles tendon - a back heel spurs.
Spohr composed of newly formed bone tissue with signs of chronic inflammation.The soft tissues of the bone spur is often shaped pouch mucosa.
Heel spurs are common.They are found in 26.4% of people aged 40-44 years, and the age group 70 years and older - at 88.5%.
Schematic representation of plantar calcaneal spur
causes of heel spurs
1. Chronic trauma is considered one of the most common causes of heel spurs, which is observed in athletes, runners, dancers.
2. Flatfoot in which it noted the increased tension of the plan
3. Excessive pressure on the feet associated with the profession.
4. The rapid increase in body weight in obesity.
5. Wearing uncomfortable tight shoes.
6. bruise the heel bone, marginal fractures in the calcaneal tuberosity.
7. Recurrent bursitis (inflammation of the joint capsule), the Achilles tendon (for example, in athletes with frequent trauma in the area).
symptoms of heel spurs
Patients with plantar spur complain of sharp, burning pain in the heel, while relying on it, which they compare to the feeling of "nail in the heel."Pain may spread across the heel.Sometimes they can appear suddenly and have a sharp character, and in some cases develop gradually.Dimensions Spurs do not affect the intensity of the pain caused by it, as the pain caused primarily by inflammatory changes in the soft tissues (podpyatochny bursitis, bursitis of the Achilles tendon, periostitis (inflammation of the periosteum)), sometimes with the involvement of the nearby small nerve branches.Because of the intense pain of the patients are trying to unload the heel, which go on the toes or on the outer edge of the foot ( "clubfoot" stop), and in bilateral lesions gait becomes "rolling" character, patients resort to cane or crutches.
Diagnostics heel spurs
In some cases, spur large pointed shape does not manifest itself clinically and found incidentally during x-ray.
On examination of visible inflammatory changes in the plantar heel spur, as a rule, is not defined.It is not detectable under a thick layer of soft tissue, in this case is determined only pain with pressure on the heel to the plantar side.At the back of the heel spur is sometimes marked swelling and callus skin at the site of attachment to the heel bone of the Achilles tendon.
In order to clarify the diagnosis performed X-ray and ultrasound studies.X-rays of the foot in the lateral projection is determined by the additional formation of bone density in the form of a spike or a beak in the plantar surface of the tuberosity of the calcaneus (with plantar spur) or at the point of attachment of the Achilles tendon (at the back of the spur).Ultrasound examination of soft tissues of the foot in plantar spur revealed signs of plantar (plantar) fasciitis.
Lateral radiograph of the heel bone of the patient with plantar calcaneal spur (marked by the red arrow)
Treatment of heel spurs
in the treatment of heel spurs are used mostly conservative methods aimed at elimination of inflammatory changes in the surrounding soft tissues.These methods include wearing special orthopedic insoles and orthopedic shoes with the special purpose of unloading the heel area.Individual orthopedic insoles are deepening and the pad in the heel area, and orthopedic footwear has a recess in the heel (plantar at spur) or back side (at the back).Patients themselves may be made of soft foam toe, making his heart cavity or hole.
Apply warm bath with the addition of sea salt, prescribe muscle massage the feet and legs, and gymnastics.From physical treatments used or prafinovye ozocerite baths, electrophoresis of novocaine, phonophoresis of hydrocortisone.In the case of pronounced inflammation prescribe bed rest with providing foot rest or the imposition of immobilizing plaster splint for up to 10-14 days.Perhaps the use of laser therapy, magnetic therapy and radiotherapy.Sometimes also used puncture podpyatochnoy bursa and the introduction into it of glucocorticosteroids in strictly sterile conditions.
With the ineffectiveness of conservative therapy is sometimes necessary to resort to surgery, which involves the removal of heel spurs, together with the subject portion of a bone, the operation is performed under the intraosseous anesthesia.When the plantar calcaneal spur horseshoe-shaped incision is made along the lower edge of the heel bone, the flap of skin with subcutaneous fat to be turned away in the direction of the fingers, and then cut off the muscle and plantar aponeurosis, which is attached to the calcaneal tuberosity.The spur is removed together with the underlying bone plate while excised subcutaneous calcaneal part of the bag and fat.The wound is sutured in layers.Superimposed compressive bandage is made of gypsum immobilization splint for 4 weeks.After removing the splints appointed wearing orthopedic insoles.
forecast at the spur
prognosis for calcaneal spur subject to the timely and efficient treatment is favorable.
Prevention of heel spurs
With a view to preventing the development of heel spurs advisable to avoid undue stress on the feet, especially for people suffering from flat feet or prone to develop it.
Surgeon Kletkin ME