Heel spur

Definition

A heel spur is a bony overgrowth (osteophyte) located in the calcaneal tubercle on the plantar side or in the area of the Achilles tendon attachment. Symptoms of heel spurs are caused by constant traumatization of the surrounding tissues with the development of bursitis, periostitis, and dystrophic changes. Initially, patients complain of periodic pain when walking, and then there are acute starting pains, decreasing in the process of walking. To confirm the diagnosis, radiography of the foot in lateral projection is performed. Treatment includes physiotherapy, blockages, and massage.

General information

Heel spur is an extremely widespread disease, accounting for about 10% of the total number of diseases of the musculoskeletal system. It usually develops in patients over 40 years old. According to statistics, pathology affects about 20% of people in this age group. Women are sick more often than men. In old and old age, the number of cases of the disease decreases, which is explained by the insignificant physical activity of patients. In children, pathology is extremely rare.

Causes

The disease belongs to enthesopathies – inflammatory-degenerative lesions of tendons in the area of their attachment to the bone. The pathological process, provoked by overload, occurs in the area of fixation of the plantar aponeurosis to the calcaneus, less often – in the place of attachment of the Achilles tendon to the posterior surface of the calcaneus. Predisposing factors are:

• flat feet (diagnosed in 90% of patients), high or low arch of the foot;
• overweight;
• diseases of large joints (arthritis) and the spine;
• neurodystrophic and vascular pathologies (obliterating endarteritis, atherosclerosis of lower limb vessels);
• prolonged stay on the feet, associated with the conditions of professional activity (in salesmen, hairdressers);
• the use of uncomfortable shoes;
• endocrine and metabolic diseases (diabetes mellitus, gout);
• prolonged overloading of the foot in running athletes.

Some rheumatic diseases, including psoriatic and rheumatoid arthritis, increase the likelihood of developing heel spurs. Repeated corticosteroid blockades, which provoke degeneration of plantar aponeurosis fibers, are one cause of heel spur development in these pathologies.

Symptoms of a heel spur

At first, walking causes unpleasant sensations and non-intense pain. After a while, the pain syndrome acquires vivid characteristic features. The patient complains of burning sharp pains, similar to the sensation of a nail in the heel, occurring at the beginning of walking (after sleeping or a long break)—the so-called “starting pains.” The first steps are the most painful.

While walking, the pain syndrome decreases and gradually intensifies in the evening. The pain may become persistent and cause long-term disability. A characteristic gait is formed—the patient steps not on the whole foot but on the toe or the tiptoes. Sometimes, patients with heel spurs are forced to move on crutches to unload the foot and reduce pain. In severe cases, the pain syndrome bothers not only when moving but also at rest.

The size of the spur is not related to the severity of the disease’s symptoms. In the case of a large bony overgrowth, there may be a complete absence of clinical signs and disability in the case of a complete or almost complete absence of signs of the overgrowth, according to radiography. The greatest influence on the intensity of pain is the severity of inflammation of the nearby tendon sacs (bursa).

Pathologic changes are usually absent when examining the foot and ankle joint. There is pain when squeezing the heel from the sides, pressure on the heel bone tubercle, or the area of the Achilles tendon attachment. In some cases of posterior spurs, there is a callus and slight swelling of the heel area.

Diagnosis

Pathology is detected during a consultation with an orthopedist. The grounds for diagnosis are characteristic complaints and objective examination results, middle-aged or elderly. Some specialists consider carrying out additional diagnostic procedures with a typical clinical picture redundant. To differentiate from other pathologies and clarify the plan of treatment, measures are used:

• Radiography of the heel bone is the most common examination, often performed in typical cases of the disease, and mandatory in the examination of children and the elderly. The images show a bony outgrowth in the form of a ridge, spike, or wedge. The size of the outgrowth varies considerably. The absence of exostosis is not a reason to exclude the diagnosis of heel spur.
• Ultrasound of the foot. Signs of inflammation and thickening of the plantar aponeurosis are detected. The method is informative even in the absence of exostosis on radiographs and allows you to determine therapeutic tactics, taking into account the severity of heel spurs and the presence of signs of Achilles bursitis or carpal bursitis.
• Other imaging techniques. If the disease is atypical and there are no changes on X-rays, an MRI of the foot and radioisotope scanning may be ordered.

Differential diagnosis is particularly important in children, the elderly, and young adults. In young patients, especially athletes, foot trauma is first excluded. In elderly patients and children, the pathology is differentiated with primary bone tumors, metastatic bone lesions, and osteoporosis.

Heel spur treatment

Treatment is usually conservative and carried out in outpatient settings. Surgical interventions are performed only in cases of prolonged disease course and severe disability.

Conservative therapy

Non-medication methods play a decisive role in the treatment of heel spurs. Medications are rarely prescribed. Following treatment methods are usually used:

• Optimizing the load on the legs. It is recommended that patients reduce the time spent standing and walking. By correcting the mode of motor activity, most patients, regardless of the use of other methods of treatment, notice a reduction of pain within six months.
• Therapeutic gymnastics. The complex of exercises for heel spurs aims to stretch the plantar aponeurosis. It is performed for a long time without intense pain syndrome.
• Orthopedic devices. According to experts, the most effective orthopedic insoles are custom-made. Standard insoles and heel pads can also be used. At night, orthoses can lengthen the plantar fascia.
• Immobilization is indicated for severe intractable pain. An orthosis boot is placed on the foot, providing foot support. The technique’s limitation is the undesirability of prolonged fixation due to possible muscle atrophy.
• Corticosteroid injection. It quickly eliminates even severe pain but increases the likelihood of rupture of the plantar fascia, so it is done only if other therapeutic measures do not produce results. The injection is performed from the inner surface of the foot to the point of greatest pain. The course includes no more than three procedures, and the interval between courses should be at least six months.

Shockwave therapy is considered a promising way to treat heel spurs. Taping is effective, but due to the need for bandaging and inconvenience to the patient, the method is usually used only in the initial stages of therapy, before the manufacture of insoles.

Surgical treatment

Surgical interventions are rarely performed. The indication for surgery is intense pain syndrome with no effect of conservative treatment for 6-12 months. Fasciotomy of the plantar aponeurosis is performed, sometimes in combination with neurolysis of the nerve innervating the V toe withdrawal muscle. Operations are performed by traditional or endoscopic methods.

In the postoperative period, analgesics, physiotherapy, and gymnastics are prescribed. The immediate results of interventions are usually good. In the long term, due to the weakening of the foot arch, flat feet may progress, which limits the use of surgical techniques.

All these treatment options are available in more than 760 hospitals worldwide (https://doctor.global/results/diseases/heel-spur). For example, Corticosteroid injections of joints and soft tissues can be done in following countries:

China – price by request in 3 clinics

Germanyby price by request in 5 clinics

Israelby price by request in 5 clinics

Turkeyby price by request in 5 clinics

United States price by request in 2 clinics.

Prognosis and prevention

The prognosis is favorable. Pain usually disappears completely within 1-2 years. Exostosis persists until the end of life but does not subsequently cause unpleasant symptoms. With chronic bursitis, the duration of the disease may increase. Prevention includes normalizing body weight, excluding overloads, using comfortable shoes, and timely treating diseases that increase the risk of heel spur formation.