Heel spur

Which doctors should I contact?

Foot pathology is dealt with by orthopedic traumatologists and surgeons. The necessary list of physiotherapeutic procedures, massage and therapeutic exercises is prescribed by a physiotherapist. If there are concomitant diseases, appropriate laboratory and instrumental studies and consultations with specialists may be required.

Heel spur treatment

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

Foot relief method

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The most effective method 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 area. It is considered rational to wear orthopedic shoes, which prevent overstretching of the plantar ligament and have a maximum shock-absorbing effect, creating comfort while walking. One of the most affordable options is the production of individual arch supports that make physiological foot placement possible. 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 injection forms. It is worth noting that this is a symptomatic treatment method that does not provide a lasting analgesic effect and does not affect the course of the disease, and also has many unwanted side effects.

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

Tension of the calf muscles aggravates 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 make it possible to reduce the dose of painkillers.

Physiotherapy:

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

Shock wave therapy
is a non-invasive treatment method that can quickly reduce or completely eliminate pain. The technique is based on the influence 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 cellular ion exchange is restored, thereby providing anti-inflammatory and decongestant effects.

Therapeutic exercise and massage

. In the subacute period, when the intensity of the pain has decreased, physical exercises are added to the treatment aimed at stretching the calf muscles of the 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 and relieves pain associated with reflex muscle spasms.

Therapeutic exercise and massage are aimed at correcting the biomechanics of the body, which can significantly alleviate the course of the disease and prevent its relapse.
Surgery
. 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 gentle technique is radiofrequency microtenotomy. The essence of the operation is to eliminate damaged tissue using radio frequency waves.

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

In complex cases characterized by a long-term 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. Patients often have disturbed sleep, increased anxiety and irritability. They are forced to avoid resting on the sore heel and transfer weight to the healthy limb. This negatively affects gait and posture and increases the risk of joint damage to the weight-bearing limb. With severe pain, 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 physical activity.

Other complications, such as tearing of the fascia from the attachment site and suppuration, are rare.

Prevention of heel spurs

In most cases, the development of heel spurs can be prevented. It is recommended to provide regular rest to the feet in combination with proper exercises, and to take breaks to warm up during work if it involves constant stress on the feet.

Shoes should be comfortable, and if you have flat feet, orthopedic.

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

To reduce the severity of pain in the heel area and reduce the load on the plantar aponeurosis, you should take shorter steps, avoid walking barefoot, and avoid running, dancing, and wearing inappropriate shoes.

Sources:

Reznik L.B., Erofeev S.A., Silantiev V.N., Turushev M.A., Kuznetsov N.K. Current state of the problem of surgical treatment of plantar fasciosis (literature review). Genius of Orthopedics, magazine. T. 24. No. 4, 2021. P. 515-520.
Bone spurs. Great Medical Encyclopedia (BME), edited by Petrovsky B.V., 3rd edition, volume 27.

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment. In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor.

Drug treatment of heel spurs

Non-steroidal anti-inflammatory drugs and glucocorticosteroids provide a targeted effect against severe pain and inflammation. Non-narcotic analgesics, warming and locally irritating ointments have a general analgesic effect. In order to strengthen the immune system, they take dietary supplements and vitamin complexes. Potassium preparations and sodium chloride help restore water-electrolyte balance, acid-base balance, which is important for a favorable outcome of heel spurs and preventing an increase in the size of the bone growth.

Nonsteroidal anti-inflammatory drugs

A heel spur is accompanied by acute pain and requires the use of painkillers. For this purpose, non-steroidal anti-inflammatory drugs (hereinafter NSAIDs) are most often prescribed. They have anti-inflammatory, analgesic, antipyretic effects. The substances included in the composition belong to different chemical classes, therefore NSAIDs differ in the severity of analgesic and anti-inflammatory activity, the speed of onset of the therapeutic effect, routes of administration into the body, the presence and nature of risk factors for adverse events.

Nonsteroidal anti-inflammatory drugs are unsafe, and their use in some cases can lead to complications from the digestive and cardiovascular systems. The most common pathologies due to uncontrolled use of excessive doses of NSAIDs are erosive and ulcerative lesions of the stomach, gastrointestinal bleeding, unstable angina, myocardial infarction.

NSAIDs in tablets are recommended to be taken in a minimum short course of 2-4 days, in minimal but effective dosages. In case of residual pain syndrome, they switch to non-steroidal anti-inflammatory drugs in the form of ointments, creams and gels. Compared to tablet forms, they are safer, well tolerated by patients, and are less likely to cause unwanted allergic and toxic reactions. Used as an adjunct to systemically prescribed NSAIDs.

Contraindications

The main contraindications for NSAIDs in the form of ointments, gels, and creams are associated with individual intolerance to the components of the composition, damage to the integrity of the skin, and rashes in the heel bone area.

NSAIDs in tablets and injections are not prescribed for diseases and pathological conditions such as:

stomach and duodenal ulcers;
gastric and cerebrovascular bleeding;
inflammatory bowel diseases;
hemophilia;
blood clotting disorders;
bronchial asthma;
cardiovascular pathologies;
persistent increase in blood pressure;
renal, liver, heart failure;
period after coronary artery bypass surgery.

Non-steroidal anti-inflammatory drugs should be taken with caution in the elderly, children under 12 years of age, during pregnancy and breastfeeding.

Glucocorticosteroids

Another group of medications intended to relieve pain and inflammation from heel spurs are steroid hormones. They have a diverse effect on the pathological process:

inhibit the activity of inflammation;
prevent the development or alleviate the course of an allergic reaction;
relieve pain;
reduce absorption and increase excretion of calcium;
prevent the destruction of bone and cartilage tissue.

The use of steroid hormones is possible orally, in the form of ointments, creams, gels, and injections. Tablet forms demonstrate high efficiency. Intramuscular administration can be used in cases of intense pain in the absence of effect from tablets and ointments. Drug blockades with local anesthetics and glucocorticosteroids relieve pain and relieve inflammation.

Steroid drugs prescribed by a doctor must not only be effective, but also safe for the patient. The list of contraindications, as well as side effects, for glucocorticosteroids is extensive, which is why they are used extremely rarely, only as directed and under the supervision of a specialist. The use of steroid hormones justifies the ineffectiveness of NSAIDs, the serious condition of the patient, and the need to achieve a quick clinical result.

Glucocorticosteroids in tablets can cause serious complications, such as:

hallucinations;
disorientation;
deterioration of vision and hearing;
headache;
nausea, vomiting;
stomach ulcer;
pancreatitis;
violation of metabolic processes;
joint and muscle pain;
increased blood and cranial pressure.

Withdrawal syndrome with complaints of weakness, general malaise, lethargy, and nausea is also possible. Undesirable reactions to the use of ointments, gels, creams: peeling, redness and itching of the skin, irritation, symptoms of dermatitis.

When performing a blockade, it is important to choose the right location and determine the depth of injection of the drug, otherwise complications are possible (inflammation of the Achilles tendon, decreased bone density of the heel bone, tissue necrosis). To avoid complications, the choice of drug should be made by a doctor on an individual basis. The use of glucocorticosteroids in people with an increased risk of complications should be excluded.

Contraindications

Long-term use of glucocorticosteroids in any form is not recommended. Contraindications to the use of external forms are associated with viral and fungal skin lesions, bacterial skin diseases, syphilis, skin tuberculosis, skin tumors, ulcers and wounds in the heel area.

Glucocorticosteroids are contraindicated to be taken orally, administered intramuscularly or in the form of drug blockades when:

allergies to components of the composition;
active form of tuberculosis;
diabetes mellitus;
AIDS;
epilepsy;
renal and liver failure;
decreased strength and increased fragility of bones (osteoporosis);
ulcer of the esophagus, stomach;
severe hypertension;
systemic mycosis;
in the period before and after BCG vaccination.

The use of steroid hormones in pregnant and lactating women is possible according to the recommendations of a specialist, when the expected effect exceeds the risk of possible complications for the fetus or child.

Warming and locally irritating ointments

Ointments with a distracting and warming effect are often prescribed in addition to other methods of conservative treatment. They reduce the severity of pain, restore lymph and blood circulation, normalize metabolism, and relax smooth muscles. In addition, they enhance the effect of massage, reduce the dosage and the need for tablet forms.

Depending on what components are present in the composition, the therapeutic effect, duration of action, and possible adverse reactions depend. Formic acid, bee venom, red pepper extract, camphor, turpentine, and snake venom provide analgesic and local irritant effects. Substances such as diclofenac, ibuprofen, ketoprofen, and indomethacin have analgesic and anti-inflammatory properties.

When using ointments and gels, you need to pay attention to the condition of the skin. The drugs are not used for eczema, wounds, infected abrasions, or dermatoses in the heel area. Temporary contraindications include pregnancy, breastfeeding, and children under 12 years of age.

Heel spur treatment

A heel spur is a bony growth that occurs where the plantar fascia attaches to the heel bone. At the initial stage of the disease, the ligament cannot cope with the load and micro-tears form in it, leading to inflammation and the development of plantar fasciitis. Over time, the fascia loses its elasticity, thickens, stops responding to stretching, and an additional bony protrusion forms in the heel bone. The resulting heel spur is the most common cause of pain on the plantar surface of the foot (the point of contact of the soft tissue with the bone growth Fig. 1).

The structure of the ligaments of the foot.

The plantar fascia is a long, thin ligament located just under the skin on the plantar surface of the foot. It, like a bowstring, connects the heel bone with the bones of the anterior section, forming a flexible elastic structure that forms the longitudinal arch. (Fig.2)

Cause of heel spurs

Heel spurs are a fairly common disease. According to statistics, it occurs in every tenth resident of a modern metropolis over 35 years of age. It is noteworthy that women suffer from this disease several times more often than men. In most cases, plantar fasciitis develops in people who experience regular stress on their feet and are predisposed to this disease. The main factors contributing to the formation of heel spurs include: excess weight, flat feet, excessive loads (athletes), wearing shoes with poor shock absorption and poor arch support. People whose jobs require them to be on their feet all day are also at high risk of the disease.

What are the symptoms of plantar fasciitis?

The development of the disease begins gradually, with mild pain in the hindfoot, which intensifies after physical activity. Most often, pain is most pronounced in the morning. (Fig. 3)

How to recognize plantar fasciitis?

Diagnoses of plantar fasciitis and heel spur are established based on the patient’s complaints and visual examination of the feet. To visually confirm the thickening and swelling of the fascia, the doctor prescribes an ultrasound, as well as x-rays of the feet, which allows identifying heel spurs. (Fig. 4)

Prevention and treatment of heel spurs.

If you experience pain in the hindfoot, you should consult a podiatrist as soon as possible. In the initial stages, a few simple recommendations will help you cope with the disease:

excess weight loss;
treatment of pathologies of the musculoskeletal system;
avoid excessive exercise (running, jumping, long walks);
wearing orthopedic insoles;
treatment of flat feet if present;
Regular stretching exercises for the plantar fascia and Achilles tendon.

Drug treatment for heel spurs:

The use of non-steroidal anti-inflammatory drugs in the treatment of heel spurs can relieve inflammation, eliminate swelling, reduce pain, and improve tissue regeneration processes. However, this group of drugs has a number of contraindications, so before purchasing and using, you need to consult a specialist.