Generality
The heel spur is an abnormal bone spur (osteophyte), similar to a pink thorn or a claw, which develops in the back or lower part of the calcaneus.
The calcaneus is one of the 7 bones of the tarsus; the tarsus is one of the three bone groups that make up the skeleton of the foot.
The most characteristic symptom of heel spurs is foot pain.
For a correct diagnosis, the most important exam is the radiograph of the foot.
The first line treatment is conservative; in case of failure of the latter, the alternative is surgery.
Brief anatomical reference to the foot: localization of the calcaneus
The anatomists divide the bones of the foot into three groups: the tarsal bones (or tarsal group), the metatarsal bones (or metatarsal group) and the phalanges .
- Tarsal bones or tarsal group or tarsus. Located just below the ankle joint, there are 7 irregularly shaped bony elements: the talo (or astragalus), the calcaneus, the navicular, the cuboid and the three cuneiforms (lateral, intermediate and medial).
- Metatarsal or metatarsal group bones or metatarsals. Belonging to the category of long bones, they are in all 5 elements, arranged parallel to each other. The proximal section is bordered by the cuneiform tarsal bones and the cuboid; the distal section, on the other hand, borders on the phalanges.
- The phalanges. There are a total of 14 and they represent the bony elements that make up the toes. Except the first finger - the only one formed by 2 phalanges - all the other fingers have 3 phalanges each.
What is heel spur?
The heel spur is an osteophyte located at the level of the calcaneus.
Osteophytes are small bone spurs, similar to a rose thorn, a beak or a claw, which form along the articular margins of bones subjected to erosive and irritative processes with a chronic character.
TYPES OF CALCANEOUS PLUG
There are two main types of heel spurs: the inferior heel spur and the posterior calcaneal spine . As can be guessed from the names of the two types, the element that distinguishes the two conditions is the localization of the osteophyte on the heel.
- Lower calcaneal spine: the osteophyte resides on the sole of the foot, below the calcaneus, precisely at the level of the insertion point of the plantar fascia .
In most cases, this condition is associated with plantar fasciitis ; more rarely, to ankylosing spondylitis .
- Posterior heel spur: the osteophyte resides in the back of the calcaneus, at the level of the Achilles tendon insertion. As a rule, it is also visible to the naked eye.
Very often, this condition is associated with inflammation of the Achilles tendon .
What is the plantar fascia?
The plantar fascia is a ligament, located on the lower edge of the foot (plant), which runs from the heel bones (calcaneus) to the finger bones. Morphologically similar to an arch, it allows the curvature of the foot and acts as a cushion that absorbs the shocks of walking, running, etc.
Like any ligament, the plantar fascia is composed of connective-fibrous tissue.
The formation of osteophytes is a phenomenon of bone neo-apposition, triggered by erosive and irritative processes affecting the bone on which the anomaly appears.
In the case of heel spurs, the causes of the latter are generally injuries to a tendon or a foot muscle, excessive stretching of the plantar fascia or repeated tearing of the periosteum of the heel (NB: the periosteum is the whitish membrane that covers the bones).
CAUSES LESS COMMON
More rarely, the heel spur may also be the result of inflammatory diseases, such as reactive arthritis, ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis.
RISK FACTORS
The risk factors for heel spurs include:
- Walking with an abnormal gait, which involves excessive stress to the heel, ligaments located near the heel and / or the nerves that run near the heel bone;
- Running or jogging on very hard surfaces;
- Wear unsuitable shoes, especially those that involve an excessive modification of the arch;
- Being overweight or suffering from obesity.
RISK FACTORS OF LIMESTONE AND PLANTAR FASTS
Since the heel spur is often associated with plantar fasciitis, it is worth remembering the risk factors of this second condition:
- Old age. Aging involves a reduction in the flexibility of the plantar fascia and a thinning of the fat pad located below the heel;
- Diabetes;
- Spend many hours of the day standing;
- Inadequate physical activity (ex: over-training, inadequate heating, etc.);
- Suffering from flat foot or hollow foot.
What is plantar fasciitis?
Plantar fasciitis is a very annoying injury to the plantar fascia.
Its presence involves pain in the heel and, sometimes, also in the central part of the foot and forefoot.
Plantar fasciitis is often the result of a combination of favoring factors; in fact, it is rarely the result of a single cause.
Symptoms
To learn more: Symptoms Spine Calcaneare
The heel spur can be asymptomatic - that is, it does not cause any disturbance - or symptomatic.
When symptomatic, the most common clinical manifestations consist of:
- Intermittent or chronic pain during walking, jogging or fast running activities.
- Sense of soreness at the level of the tissues surrounding the heel spur;
- Sense of pain in the tissues that reside around the heel spur.
SYMPTOMS OF THE CALCANEAN PLUG ASSOCIATED WITH PLANTAR FASTS
The symptomatic picture of when the heel spur is associated with plantar fasciitis includes:
- Pain, similar to a sharp pain, in the heel. The painful sensation is due to an inflammatory process affecting the plantar fascia;
- Pain in the sole of the foot, after long periods of standing, long walks, running activities, etc .;
- Morning pain in the foot. The presence of morning pain is a consequence of the shortening of the plantar fascia, which takes place during night rest, due to the position taken by the toes. Upon awakening, the movements of the feet require a lengthening of the plantar fascia and this results, where the plantar fascia is injured, the appearance of an annoying painful sensation.
The intense morning pain is transient.
Diagnosis
The most suitable test to identify a problem such as the heel spur is foot radiography (or X-ray at the foot).
The radiograph of the foot provides sufficiently clear images of the bones of the foot and the anomalies they may possess. It is a painless procedure; however, it is good to point out that, during its execution, the patient is exposed to a small dose of ionizing radiation harmful to the health of the human being.
DIAGNOSIS OF ASSOCIATED CONDITIONS
To diagnose the possible conditions associated with the heel spur (eg plantar fasciitis, Achilles tendon problems, etc.), objective examination and medical history are essential.
The physical examination is the set of diagnostic maneuvers, carried out by the doctor, to verify the presence or absence, in the patient, of signs indicative of an abnormal condition.
The anamnesis is the collection and critical study of symptoms and facts of medical interest reported by the patient.
Treatment
The treatment of heel spurs depends on the presence or absence of symptoms and may include conservative (or non-surgical) therapy or surgical therapy .
In general, the use of conservative therapy is the first-line therapeutic choice. Recourse to surgical practice, in fact, takes place only when the conservative treatments have not provided the desired results and the symptomatology is still in progress.
In the absence of symptoms, the heel spur requires no treatment whatsoever.
CONSERVATIVE THERAPY
Conservative therapy does not eliminate the heel spur, but still guarantees excellent results against painful symptoms.
The most common conservative treatments, adoptable in the case of heel spurs, consist of:
- A period of rest from all those activities that favor the appearance of pain (eg: running, long walks, etc.);
- The administration of pain-relieving drugs, to reduce the painful sensation. Examples of administrable painkillers are: paracetamol, ibuprofen and naproxen;
- Stretching exercises (or muscle stretching) and strengthening for all the muscles of the leg that refer to the Achilles tendon. This is useful both in the case of heel spurs associated with problems in the Achilles tendon, and in the case of heel spurs associated with plantar fasciitis;
- The use of shoes that do not press against the heel spur;
- The use of orthotic insoles to be included in everyday footwear and more. They are useful in reducing the painful sensation both in the presence of plantar fasciitis and in the presence of Achilles tendon problems;
- Physiotherapy exercises aimed at the prevention of plantar fasciitis and Achilles tendon disorders.
SURGICAL THERAPY
Surgical therapy for heel spurs includes removal of the osteophyte and, for cases associated with plantar fasciitis, distension of the plantar fascia (NB: readers interested in this second surgical operation can consult the article present here ).
After surgical therapy, it is important that the patient adheres to the advice of doctors, for effective and uncomplicated healing.
Medical advice includes: rest until complete recovery of the foot's function, application of ice to ignite the site of intervention, elevation of the leg and avoidance of immediately loading the operated foot (it is indicated the use of crutches).
Some possible complications of surgical practice are: infections, neuropathic pain due to the injury of some nerve endings, numbness in the foot and scars at the site of surgery.
Normally, in the case of heel spurs, doctors consider surgical practice indispensable when conservative therapy has not had any success and when the symptoms continue incessantly for 9-12 months.
Prognosis
The prognosis of heel spurs is generally positive.
According to some recent statistics, in 90% of cases, conservative treatment is successful and the patient can be considered cured.
The use of surgery, therefore, is a rather infrequent circumstance.
Prevention
Wear comfortable and well-made shoes, choose quality footwear to perform sports such as running or jogging, always do a proper warm-up before any physical exercise, train consistently without overdoing it and inserting any supports, insoles or shoes into your shoes. orthotics (where, of course, it is recommended) are the main preventive measures against the heel spur.
