A heel spur is characterized by the presence of a bony spine in the center of the heel and inflammation within the fascia. The bone-salt thorn damages the connective tissues, so when placing weight on the foot, a person feels severe pain.
Due to intense pain, gait is disrupted and the center of gravity of the body shifts. The patient tries to put less stress on the painful heel area. This leads to a decrease in working capacity and physical activity.
In this case, drug treatment and special devices for unloading the foot - orthopedic insoles for heel spurs - will help you return to a full life.
Orthopedic insoles
When placed in low-heeled shoes, they act as a kind of corset for the foot and are selected individually for the patient, in consultation with a surgeon. The choice of size and shape depends on weight, anatomical features, and degree of disease.
Products are made from felt, silicone, special gel or other materials. In the area of the foot they are made soft to create a spring effect, in which ligaments and muscles are included in the work, stimulating blood circulation while walking. The cost varies from 700 to 1500 rubles.
Symptoms
The pain is often comparable to the feeling of a “nail” or “needle” in the heel and is especially severe in the morning. While walking, the pain becomes less severe or may disappear altogether. However, if no action is taken to correct the situation, the pain can become chronic and almost around the clock, covering not only the inner surface of the heel, but its entire area.
As the disease progresses, the pain intensifies after long periods of stress on the legs. The intensity of the manifestations depends not so much on the cause of the disease and the size of the “spike”, but on its location relative to the heel. When the spur is close to the nerve ending, the pain is felt more strongly. Also, a provoking factor for pain is, for example, sudden support on the heel area when getting out of bed or a chair, or climbing stairs.
Sometimes an asymptomatic manifestation of a heel spur occurs, but inflammation also occurs, and the bone “spike” itself is detected by a doctor during examination.
When the plantar fascia joins the process of inflammation, the following reactions occur:
- tingling and burning sensation in the heel area;
- redness of the skin in the affected area and its roughness;
- worsening pain when moving.
Over time, a person gets used to the pain syndrome and unconsciously changes his gait. When walking, they begin to place the foot in such a way as to relieve the affected area, trying to rest on the toe and lateral surface of the foot. Sometimes this can become one of the reasons for longitudinal flat feet, which also aggravates the situation.
What is it for
Surgeons who prefer laser removal of atheroma to other surgical methods adhere to conservative treatment tactics here too. Moreover, the use of orthopedic insoles and heel supports brings serious relief to patients with heel spurs:
- they fix the arches of the foot (transverse and longitudinal) in the anatomical position;
- reduce the load on the foot and lower limbs, spine;
- improve blood circulation;
- act as a powerful preventative against diseases of the musculoskeletal system;
- prevent foot fatigue.
Plantar fasciitis (heel spur)
The plantar fascia is a special connective tissue structure of the foot, which is attached on one side to the heel bone and on the other to the phalanges of the toes. This fascia, sometimes called the plantar aponeurosis, plays an important role in the formation of the longitudinal arch of the foot. With plantar fasciitis, micro-tears occur in the area where this fascia attaches to the heel bone, the fascia becomes inflamed and therefore pain occurs. At night, when we sleep, micro-tears in the fascia heal, and with shortening, and in the morning, taking our first steps, we tear the fascia again, feeling pain. After the first steps tear the fascia and stretch it, the pain subsides, but during the day it may return. In addition to plantar fasciitis, the causes of heel pain (or heel pain syndrome) can be: diabetes, thinning of the fat pad of the heel area (more often in the elderly) with chronic bruising of the heel bone, obesity, rheumatoid arthritis, ankylosing spondylitis, apophysitis of the calcaneus (Sever disease) , fractures, metastatic disease, tarsal tunnel syndrome (compression of the posterior tibial nerve), compression of the medial branch of the posterior tibial nerve, lateral plantar nerve and a number of other reasons, which can only be understood during an in-person consultation with a doctor. However, in the vast majority of cases, the cause of heel pain is plantar fasciitis. Treatment methods for plantar fasciitis with proven effectiveness are:
- Reduced physical activity.
- Physiotherapy
- Insoles with arch support (heel supports are not effective for treating plantar fasciitis, but they may be appropriate for mixed causes of heel pain)
- Taping
- Immobilization
- Night orthoses (braces)
- Local administration of glucocorticoid drugs (for example, blockade with disprospan or hydrocortisone)
- Extracorporeal shock wave therapy
- In rare cases, surgical treatment is used
In this article we will take a closer look at exercises, orthotics and taping because these methods can be considered first-line treatment, i.e. It is with them that the treatment of plantar fasciitis should begin. The exercises are based on stretching the plantar fascia, as a result of which the fascia becomes stronger, more elastic, and its length is adequate. Thanks to this, the likelihood of micro-tears is reduced and heel pain gradually goes away. This ultimately results in not only a reduction or elimination of today's pain, but also a reduced likelihood of future heel pain. However, in some cases, exercise can increase pain: in this case, you need to reduce the intensity of exercise, but not stop it completely. Most often, increased pain after exercise is associated with mistakes: the exercises are started too aggressively, without a warm-up. It is important to remember that exercises are most effective when combined with modifications to the shoes you wear, which you should consult with your doctor in person. Your doctor will evaluate the correctness of the shoes you are using and may recommend insoles and/or heel pads. As we have already noted, the exercises should be performed after a warm-up, the main component of which is stretching and warming up the gastrocnemius and soleus muscles, which, through the Achilles tendon, significantly influence the tension of the plantar fascia. Exercise 1. Place your palms on the wall and place your feet directly behind each other - as if you were standing on a rope. The sore leg stands behind, if both heels hurt, then alternate legs. Without lifting your heels off the floor, squat down, bending your knees until you feel a stretch in the lower shin of the leg that is behind you. Hold this position for 15 seconds, then straighten up and repeat the exercise. This exercise is a warm-up and allows you to increase the elasticity of the lower leg muscles, which, in turn, will reduce the tension of the plantar fascia. Always start your exercises with this warm-up. Exercise 2. The second exercise is also a warm-up (warms up the gastrocnemius and soleus muscles of the leg), but already includes elements of stretching the plantar fascia. A couple of books are placed on the floor in front of the wall, so that their height is about 5 centimeters. Stand with your toes on the support, your heels hanging over the edge. Palms rest on the wall. Standing on two legs, lean towards the wall so as to feel the tension in the lower part of the shin. Stay in this position for 15 seconds. Next, they straighten up and lift on the toes of both legs 15 times, without lowering the heels below the surface of the support. Next, the exercise is performed in the same sequence, but standing on only one leg. Exercise 3. This exercise may seem funny, but it is actually very effective. It is worth noting that it is most useful only if you have completed warm-up exercises beforehand. Take a tennis ball, rolling pin, or bottle, place it under the foot and roll it, pressing it with the foot, so that it rolls along the entire longitudinal arch of the foot. If you are experiencing a period of acute pain, you can pour cold water into the bottle - this will make the exercises more comfortable. Exercise 4. Strengthening the muscles of the foot itself will help reduce the risk of subsequent exacerbations of heel pain due to plantar fasciitis. The fact is that pronation of the heel bone when walking (rolling the heel inward) plays an important role in the development of plantar fasciitis, which is confirmed by more intensive grinding of heels from the inside and characteristic deformation of the heels of shoes. In this case, the tension of the plantar fascia increases, tears appear and pain occurs. In such a situation, it is necessary to train not only the muscles of the lower leg, but also the muscles of the foot - thanks to this, the foot will be less deformed when walking and the tension of the plantar fascia will be normalized. The exercise is performed as follows. While sitting on a chair, scatter various small objects (pebbles, keys, coins, balls, etc.). It is important that the items are different, i.e. it doesn't have to be just coins or keys. Use your toes to collect objects and place them, for example, in a jar. Alternatively, you can collect a towel laid out on the floor with your toes. Exercise 5. Actually stretching the plantar fascia. This exercise ends the lesson. Performed by pulling the foot towards you with your hands or a tape. Having reached the maximum possible dorsiflexion of the feet, linger in this position for 10-15 seconds. It is possible to perform this exercise while facing the wall and resting your palms on it, but you need to move your leg further back than during warm-up.
Taping. After exercises for plantar fasciitis, it is advisable to perform taping. This can be done using a special sports tape - tape, or using an adhesive plaster. If you do not have tape and only an adhesive plaster is available, then I would advise you to use a Hartmann adhesive plaster. When taping, it is important to pull the tape at the moment when it bends around the foot from below, slightly anterior to the heel - in this way the tape will take on part of the function of the plantar fascia and the load on it can be reduced. Below are two videos with taping - a simple and a complex method.
Taping algorithm
Night orthoses (braces). Night braces or orthoses can be very effective in treating plantar fasciitis. As noted above, morning pain is due to the fact that during the first steps, repeated micro-tears of the plantar fascia occur, which has grown together with shortening overnight. Fusion with shortening occurs because at night we sleep with the toes of our feet extended - i.e. the ankle and foot joints are in plantar flexion. This is especially true for those people who sleep on their stomachs. In this position of the foot, the tension of the plantar fascia is minimal, and therefore it fuses with shortening. If you immobilize your foot at a right angle at night - i.e. in a position in which the tension of the fascia is maintained, the morning pain will disappear or become less. For this purpose, night braces, splints, orthoses or Strasbourg socks are used. Since you now know the principle of operation of these devices, then, if you do not have the opportunity to purchase one, you can make such a device yourself: you can use a long golf shoe, the toe of which is tied to a strap, and some of my patients even used felt boots - their rigid design did not allow the foot to stretch. Of course, using a night immobilization device may be uncomfortable because you are not used to sleeping in this position. However, as a rule, the feeling of discomfort gradually passes. If you are used to sleeping on your back, then, as a rule, there is no discomfort at all.
On the left are two options for night braces, on the right is a Strasbourg sock.
Subtleties of operation
Silicone heel pads are considered the most comfortable - their use is almost unlimited. In order to preserve its performance properties for as long as possible, it is necessary to wash the products daily with warm soapy water and then dry naturally without wiping. With proper care, these orthopedic devices, in addition to their therapeutic effect, also prevent unpleasant odors.
Both orthopedic insoles and universal heel supports only relieve the foot and reduce pain. It is completely impossible to cure heel spurs with their help. Surgeons use them as an addition to basic treatment.
Service life and care rules
The service life can usually be found on the packaging or instructions. The average period is 6 months. For proper care:
- We dry the products daily, avoid exposure to the sun or interaction with heating devices. It should dry naturally.
- Do not wash in a washing machine or use running water.
- Avoid exposure to high temperatures.
- Wipe with soft cloths soaked in alcohol or soap solutions.