Heel spur block: what is it?
A heel spur, medically called plantar fasciitis, causes severe pain in the heel that increases over time.
By blockade we mean an injection into the area of the most severe pain: the needle is inserted directly into the bone growth.
The medicine used is corticosteroid drugs, most often diprospan or kenalog, which have a prolonged (long-lasting) effect.
Sometimes doctors prescribe a blockade with a combination of diprospan with anesthetics (novocaine, lidocaine), which have a pronounced but short-term analgesic effect.
Reasons for formation
The appearance of a heel spur depends on a number of factors. This can be either an acquired or a congenital syndrome. Throughout life, when walking, the load falls on the area where fasciitis occurs. It can also be caused by infection, injury, or vascular dysfunction.
Let's consider a number of factors causing spurs:
- Excess body weight leads to increased stress on the foot.
- All types of flat feet, as well as deformations caused by improper walking.
- Infectious diseases.
- Poor circulation in the body.
- Atherosclerosis.
- Rheumatism.
- Increased blood sugar levels.
- After 50 years, reduction of fat in the heel bone area.
- Damage to nerve endings.
- Severe heel injury, fracture.
- Muscle strain and inflammation.
- Age-related changes.
- Diseases of the vertebra and joints.
- Excessive physical activity on this area.
To avoid symptoms of heel spur disease, you should examine the entire body and begin treatment for other existing diseases. Against the background of these deviations from the norm, small tears appear in the tendons. Over time, this leads to inflammation. Healing occurs very slowly. Inflammation spreads to the muscles and the area under the heel tubercle. Fluid forms, which slows down the healing process and disrupts blood flow. Salts are deposited on the mound. A growth begins to appear.
Advantages
Blocking the spur on the heel provides a number of advantages compared to other methods of drug therapy:
- The blockade is effective when other methods of pain relief fail.
- The maximum amount of the drug accumulates at the site of inflammation, and the side effects on the body are minimal.
- A small amount of the drug is enough to relieve pain.
- The pain is relieved quickly, and the therapeutic effect is long-lasting.
- The procedure takes a few minutes.
"Kenalog 40" - what kind of drug is it
The active ingredient of the drug "Kenalog 40" is the synthetic glucocorticosteroid triamcinolone. This substance is slightly reminiscent of Dexamethasone in its chemical structure and action, therefore it has many of its properties. The only difference is in the structure, where one group is replaced by another. Due to this seemingly insignificant difference, Kenalog 40 is much better absorbed and has fewer side effects compared to its predecessors.
There are several dosage forms of Kenalog, but for joint problems, an injection suspension is most often used.
The drug is not a first-line therapy; it is never prescribed at the first signs of joint diseases. To recommend it, significant indications are needed when other painkillers no longer work.
Is Kenalog 40 a hormonal drug or not? - yes, this is an artificially created chemical analogue of adrenal hormones. It has all the functions of natural hormones, but requires a lower dosage, and the drug is devoid of some unwanted side effects.
Indications, contraindications
Unlike spinal diseases, when the block must be carried out immediately when intense back pain appears, a heel spur does not require an immediate injection into the heel.
A blockade is necessary in cases where:
- the applied methods of conservative treatment do not bring the desired result;
- heel pain is so intense that the patient requires constant pain relief to be able to move;
- There are no contraindications to the use of the above drugs.
The list of contraindications is limited to the adverse effects of the drug on the body and, first of all, hypersensitivity (risk of developing anaphylactic shock).
Diseases such as osteoporosis, endocarditis, and diabetes mellitus are relative contraindications for the blockade.
The decision to perform a heel block is made individually, taking into account the condition of the individual patient.
Kenalog
Kenalog (active ingredient - triamcinolone) belongs to the group of glucocorticosteroids. The drug has antipruritic, anti-inflammatory, immunosuppressive and antiallergic effects and can be used both locally and systemically, which determines a wide range of its use: from chronic obstructive diseases of the respiratory tract to dermatological diseases, from various forms of joint damage to hay fever (hay fever).
Kenalog suppresses the activity of tissue macrophages and leukocytes, preventing the latter from penetrating into the site of inflammation. Interferes with the processes of interleukin-1 synthesis and phagocytosis, “disarming” macrophages. Stabilizes lysosome membranes, thereby reducing the level of proteolytic enzymes at the site of inflammation. Reduces the permeability of small blood vessels caused by the release of the mediator of allergic reactions, histamine. Inactivates connective tissue cells fibroblasts, thereby suppressing collagen formation. Kenalog inhibits the synthesis of inflammatory mediators prostaglandins and leukotrienes by suppressing the activity of phospholipase A2 and the release of cyclooxygenase-1. Reduces the number of lymphocytes, monocytes, basophils and eosinophils circulating in the blood by moving them into the lymphoid tissue, suppresses the process of antibody formation.
Kenalog is available in two dosage forms: suspension for injection (in this case, “40” is added to the name of the drug, indicating its dosage:) and tablets. Before using the injection form, the ampoule with its contents must be shaken. The suspension is not administered intravenously: only intramuscularly (systemic action) and inside the joint (locally). In all cases, the dose of the drug is determined individually: it depends on the pathogenesis of the disease and must strictly correspond to the goals of treatment.
When using Kenalog systemically in adults and adolescents over 16 years of age, the injection is made deep into the buttock. The drug is administered slowly, the standard dose in such cases is 1 ampoule (40 mg), in severe cases it can be doubled. With this method of administering the drug, it is necessary to prevent possible tissue atrophy. Immediately after the injection, a sterile napkin is pressed to the injection site for several minutes. To eliminate hay fever, as a rule, a one-time use of kenalog during the season of mass flowering of allergenic plants is sufficient. If one injection is not enough, then the next one is allowed to be given no earlier than after 1 month.
The dose of Kenalog for intra-articular administration is determined by the degree of damage and the size of the joint. If it is necessary to quickly eliminate symptoms, Kenalog can be combined with local anesthetics with mandatory observance of aseptic conditions. Suffice it to say that the injection site should be prepared as if a surgical procedure was planned. Repeated use of the drug in case of local use is allowed no earlier than after 14 days. Another option is to inject Kenalog under the skin. In such cases, local anesthesia is also used (in the same syringe with Kenalog). When injecting, the syringe should be held horizontally so that its contents are injected into the area between the skin and the subcutaneous layer. The duration of use of Kenalog is determined by the doctor and varies from a single administration for hay fever to courses lasting several years, as for bronchial asthma. When using Kenalog systemically, the patient's diet should be rich in proteins and vitamins.
How is the procedure performed?
The difficulty of blocking a heel spur is to avoid getting the needle into a nearby vessel and damaging the fascia.
That is why you should contact only qualified specialists.
The unbearable pain from the injection is too exaggerated: the procedure lasts only a few seconds, and relief occurs immediately.
The main rules for conducting a blockade:
- The anesthetic (0.3-0.8 ml) is mixed with the corticosteroid directly in the syringe.
- The doctor “feels” the bone with a needle and pulls the syringe plunger towards himself to make sure that it does not get into the vessel.
- The injection site is sealed with a plaster, and the patient is prohibited from stepping on the sore leg for 1 hour.
I have a heel spur, which doctor should I see?
The best option is to see a podiatrist or orthopedic surgeon. Such specialists work on the staff of district and regional clinics, as well as in commercial medical centers.
If fasciitis is suspected, the doctor will make an appropriate diagnosis of a heel spur based on an x-ray. If the bone spine is clearly visible in the image, the doctor diagnoses plantar fasciitis.
To clarify the location and nature of the growth, a specialist may prescribe an ultrasound or tomography of the foot. In some cases, an MRI of the foot is used to clarify the diagnosis, showing pathologies of the fascia and ligaments.
The doctor also carries out a detailed questioning of the patient, asking how long ago the spur appeared, how it manifests itself, etc. This is necessary because the symptoms of heel spurs are different and it is necessary to correctly differentiate it from other diseases.
Before prescribing treatment, the orthopedic doctor refers the patient to a biochemical study of venous blood, and, if necessary, to specialized specialists.
If your clinic does not have an orthopedic doctor, then you can contact a surgeon or therapist to treat fasciitis.
Result
The blockade not only has an analgesic effect, corticosteroids weaken the inflammatory response.
The effectiveness of a one-time heel spur blockade is more than 90%.
In rare cases, a repeat procedure is performed.
It is worth understanding that the blockade, although it quickly brings relief, does not treat the cause of the pain.
Only complex therapy, and sometimes only surgical intervention. can permanently save the patient from an unpleasant disease and return him to the ability to move freely.
How do orthopedic doctors treat heel spurs?
The orthopedist prescribes complex treatment, monitors the treatment process and its effectiveness. If necessary, the doctor makes adjustments to the prescribed treatment regimen.
The number and frequency of visits to a specialist depends on many factors: the patient’s condition, the workload of the clinic, etc. As a rule, during the treatment process you have to visit an orthopedist once every 7-10 days.
Treatment is aimed at eliminating the following manifestations of the disease:
Relief from pain syndrome.
The doctor explains in detail how to relieve pain from a heel spur using medications, heating, and compresses.
Reducing stress on the heels.
To do this, the specialist selects orthopedic heel pads, shoe insoles, instep supports, etc.
Restoration of damaged fascia.
The orthopedist recommends vitamins and dietary supplements that improve regenerative functions and metabolism.
Also, the Strasbourg sock is well suited for restoring the fascia; it fixes the foot in a stretched position, which allows for rapid healing of damaged tissue.
Removing a bone spur.
It is known that crushing the growth with a laser, UVT, electrophoresis and other physical procedures helps with heel spurs.
I use “Pyatkashpor” ointment based on medical bile to soften and eliminate spurs. These products moisturize the rough epidermis on the heel, soften the thorn and gradually dissolve it.
Pyatkashpor creams in combination with physiotherapy give an excellent effect and help remove the growth without surgery.