Laser therapy for heel spurs: how it works, results, reviews

Plantar fasciitis, or heel spur, occupies one of the leading places in the ranking of the most common causes of pain in the foot. It is most common in athletes, patients with endocrine pathologies, and overweight individuals. Surgical treatment of heel spurs is resorted to in extreme cases, when other methods of therapy do not bring the desired results or are contraindicated for one reason or another. In our clinic, bone growth is removed through a minimally invasive procedure, which allows the patient to quickly return to normal life.

Heel spur removal

This disease is the second most common cause of pain in the foot after damage to the ligamentous apparatus of the ankle joint.
It is more common in patients with diabetes, obesity, and in athletes. The problem is indeed very pressing. According to foreign authors, about 10% of the population suffers from this pathology at some point in their lives. Those. Every 10th of us experiences problems associated with plantar fasciitis at least once in our lives.

Surgery to remove heel spurs is considered only after unsuccessful attempts at conservative treatment for 4-6 months. Severe heel pain can often be almost unbearable. Fortunately, surgery is successful in treating heel spurs in the majority of cases (95%).

Rehabilitation

The recovery period after removal of a spur lasts 10-14 days, but it will be possible to verify the effectiveness and efficiency of the operation only after several months.

The operated leg can be partially loaded almost immediately after the intervention, but in order to avoid delaying the healing process, care must be taken in choosing the load. To prevent the wound from festering, the attending physician examines and bandages it according to the planned schedule.

After removal of a heel spur, wearing shoes with orthopedic insoles (to relieve the load on the foot) becomes a prerequisite for successful rehabilitation. To strengthen ligaments and muscles, therapeutic exercises and massage are recommended. Your attending physician will help you select a comprehensive program on an individual basis.

Endoscopic dissection of the plantar fascia and removal of heel spurs.

Endoscopic fasciotomy. First completed in 1991. Performed under general anesthesia. Under the tourniquet on the shin. A 5 mm access is made on the medial surface of the calcaneal region, approximately 1 cm distal to the insertion of the aponeurosis. An endoscopic trocar and cannula are inserted superficially from the plantar fascia to the opposite edge of the heel area, where an outlet is formed. The cannula is removed and an endoscopic camera is inserted into the medial portal. In the lateral direction - a retrograde cutting scalpel. And the dissection is performed.

The camera allows the surgeon to see the surgical area. The plantar fascia is incised from the heel spur (bone), which relieves tension.

How is heel spur treated with laser?

Laser therapy includes two courses:

Daily laser exposure to the heel area from 4 projections.

Light waves are applied to the affected heel with a frequency of 50-60 Hz and a power of approximately 80 mW. Low frequency radiation heats fascial tissue and triggers regeneration.

The laser also affects receptors, reducing their sensitivity, thereby reducing pain. Session duration is up to 30 minutes.

The number of procedures is at least 10. The second course of laser therapy begins no earlier than 2 weeks after the end of the first.

Exposure to laser with a frequency of 80-90 Hz and a power of 90-100 mW.

Number of procedures - 10, lasting up to 10 minutes. Exposure to a higher frequency laser stops the deposition of salts, and therefore prevents the growth of spurs.

Note! Laser therapy for heel spurs does not eliminate the growth and the causes of its appearance. To crush a bone spur with a laser, another course is used, which is called “surgical laser removal of a spur” with high-frequency exposure.

During the treatment period, it is recommended to follow everything that helps with heel spurs, including timely taking of prescribed medications, unloading the heel with the help of orthopedic heel pads and stretching the fascia with the help of Strutz insoles.

Minimally invasive dissection of the plantar fascia and removal of heel spurs under X-ray control.

Unlike the endoscopic technique, in this case only 1 incision 3 mm long is made. Through which a scalpel with a triangular sharpening is inserted to dissect the plantar fascia at the site of attachment to the heel bone.

And then - a cutter to remove the exostosis of the heel bone (spur). A huge advantage of this method is minimal trauma to the heel area (the base of the foot support). Consequently, the rehabilitation period is reduced to 2 days.

Many patients ask me: can flat feet get worse after cutting the fascia?”

No! Flat feet will not get worse, because... During the operation, we dissect only the medial leg of the fascia (inflamed); there remains the lateral one, which is attached to the same tubercle of the calcaneus. Much more dangerous is gait disturbance with severe heel pain. The patient reflexively begins to shift his body weight to the forefoot and second leg. Lameness and poor posture appear. All this can result in accelerating the progression of osteochondrosis or the development of scoliosis!

The results of operations to remove heel spurs with photographs of radiographs can be viewed here.

Treatment of heel spurs with laser: reviews and prices

Among patients, laser treatment for heel spurs has mostly positive reviews. Doctors also highly appreciate the effectiveness of this physiotherapy.

One of the significant disadvantages that people point out in their reviews is the high cost of laser therapy. On average, the price of 1 procedure is 800-1200 rubles, which is quite expensive, considering that the full course includes 20-30 sessions. However, in many clinics laser therapy is performed absolutely free of charge, because it is included in the list of compulsory medical insurance procedures.

Rehabilitation after surgery

The recovery period after surgical treatment of a heel spur varies from person to person due to differences in pain thresholds among people. It can vary from 2 days to 2 weeks. Limiting the load on the operated foot until the wound heals. The sutures are removed 7-10 days after surgery. Immediately after surgery, we immediately recommend that the patient have custom orthopedic insoles made.

and wear them in the postoperative period to correct flat feet and reduce pain. Subsequently, it is advisable to wear insoles throughout your life to adequately distribute the load on the foot and reduce the risk of developing other pathologies that are closely related to the problems of flat feet and foot deformities.

Don't self-medicate!

Only a doctor can determine the diagnosis and prescribe the correct treatment. If you have any questions, you can call or ask a question by email.

Indications for surgery

Surgical treatment of heel spurs is indicated in the following cases:

• discomfort in the foot area that persists for more than 8-12 months;
• complaints of pain of varying degrees of intensity;
• pronounced and progressive growth of exostosis, confirmed by x-ray;
• decreased physical activity;
• negative impact of the disease on professional activity and usual quality of life;
• insufficient effect of conservative measures.

The operation is contraindicated in childhood due to the fact that the musculoskeletal system is not fully formed in children, and the bones have not yet acquired the required physiological hardness.

How does a heel spur manifest and why is it dangerous?

It is extremely difficult not to notice the emerging pathology - a constant pain syndrome accompanies the affected person almost from the initial stages of the onset of the disease. Other symptoms are:

• pain in the heel after waking up: as the person moves away, the unpleasant feelings decrease, but by the evening they arise with the same force;
• formation of calcium compounds around the spur;
• change in gait, appearance of lameness.

Initially, heel pain bothers a person while running or walking. The further the disease progresses, the stronger the pain and discomfort. Over time, even a slight load on the heel results in severe pain in it. The pain has a burning, sharp character and resembles a feeling as if a nail had dug into the heel. Moreover, the strength of the pain syndrome does not depend on the size of the spur, but only on its location - the closer the spur is to the nerve endings, the worse the patient feels.

It should be noted that outwardly the disease practically does not manifest itself at all. It does not pose a significant threat to the life of the affected person, but it causes him a lot of discomfort, since due to its existence, the process of walking is constantly accompanied by severe pain.

Heel pain. Treatment

In the vast majority of patients with plantar fasciitis, with treatment, painful symptoms go away within 3 months. The recovery process can be accelerated by prescribing exercises aimed at stretching the muscles of the lower leg and plantar fascia, modifying physical activity without those types of activity that lead to increased symptoms, and wearing comfortable shoes. Standard physical therapy, brace immobilization, corticosteroid injections, and extracorporeal shock wave therapy may also be prescribed.

The most effective method is stretching the plantar fascia. The exercise involves gradual dorsiflexion of the ankle joint and toes. This causes the plantar fascia to stretch. The foot should be held in this position for 10 seconds, and the exercise should be repeated 10 times. The timing of this exercise is important. It should be performed in the morning before taking your first steps, and throughout the day before getting back on your feet after a long period of rest.

Rice. Stretching the plantar fascia.

It is also necessary to stretch the calf muscle while standing with the knee joint straightened. It is recommended to perform the exercise for 30 seconds 6 times a day every day.

Rice. Stretching the calf muscle. Please note that during the exercise the leg is straightened at the knee joint, with the back of the foot looking inward.

After the pain in the heel area has resolved, even if less frequently, it is necessary to continue doing the described exercises to prevent its recurrence.

Any types of activity you have recently started, such as new running routines or new gym exercises, that may place increased stress on your heel bone should be temporarily stopped until your heel pain is completely gone. After the pain has passed, they can be gradually resumed.

The use of custom orthotics that support the arch of the foot may be effective. The effectiveness of custom orthotics for this condition has been proven in many studies. Wearing shoes with rigid or rounded soles also relieves stress on the plantar fascia and can be effective for plantar fasciitis.

Prescribing anti-inflammatory drugs also reduces the severity of pain. A positive effect can be achieved by injecting corticosteroids into the heel area. The use of platelet-rich plasma (PRP) for plantar fasciitis is effective. The PRP method reduces the severity of pain symptoms associated with this disease.

Night splinting of the foot allows you to keep the foot in a neutral position while the patient sleeps and can somewhat reduce the severity of early pain in the morning. This foot position helps prevent some of the shortening of the plantar fascia that occurs at night when the foot is in plantar flexion.

Rice. Night splinting of the foot.

Surgical treatment of plantar fasciitis is indicated when conservative treatment fails. Candidates for surgical treatment can only be patients in whom adequate conservative treatment within 3 months is ineffective. Endoscopic partial fasciotomy involves removing the damaged area of ​​fascia. In many cases, this operation can achieve good results.

Surgical release of the gastrocnemius muscle (Stryer procedure) can also relieve symptoms of plantar fasciitis, since gastrocnemius contracture is a known risk factor.