Generality
The heel spur is an inflammatory heel pathology. It is, in particular, an exostosis, that is a benign neoformation of bone tissue, which develops in the area of the calcaneus.
The onset of the heel spur is related to the chronicity of pathologies, such as arthrosis of the foot or ankle, plantar fasciitis and inflammation of the Achilles tendon insertion on the heel ( enthesopathy ). Very slowly, these disturbances predispose to the formation of deposits of calcium salts and a bony protuberance (that is, to the true heel spur); in turn, the presence of exostosis in the heel is related to a painful inflammatory state .
Other factors that can favor the development of the heel spur are the anatomical characteristics (eg hollow or pronated foot), the repeated microtraumatism, the excessive weight and the prolonged use of unsuitable footwear, which involve a constant stress on the hindfoot.
The most characteristic symptom of the heel spur is the acute heel pain . Often, this symptom gets worse under load (during the journey) and tends to decrease, instead, with rest.
For a correct diagnosis, the radiographic examination of the foot is indicated, possibly in association with an ultrasound scan of the surrounding soft tissues or an MRI scan . The first-line treatment may include taking NSAIDs, performing stretching exercises and using braces . In more serious cases, physical therapy (tecarterapia, massages, ultrasounds and lasers) may be useful, possibly associated with the infiltration of anti-inflammatories. In the event of failure of these conservative therapeutic options, the alternative is surgery .
What's this
Calcaneare Spur: what is it?
The heel spur is a heel pathology characterized by the formation of an outgrowth of bone tissue, generally in the shape of a beak, a claw or a crest.
This manifestation can be interpreted as a reaction to a situation of chronic irritation : the inflammatory state continued over time, the deposit of calcific material and the exostosis represent a response of the bone tissue, which tries to repair itself spontaneously, establishing a greater surface of contact between worn joint bodies.
Causes and Risk Factors
Foot: how it's done
To understand the causes that can cause the heel spur, it is necessary to remember some notions related to the foot and its anatomy.
- The foot is an extremely complex structure formed by:
- Ankle, which connects the foot to the leg;
- Heel, ie the back of the foot;
- Metatarsus, the central part;
- Fingers at the end.
- In the foot, there are about 28 bones, numerous muscles, joints, nerves and blood vessels.
- As for the bone component, it is possible to distinguish, by convention, three groups:
- Tarsus, comprising the short bones of the ankle and heel;
- Metatarsus, intermediate part of the foot, formed by five metatarsal bones;
- Phalanges of the fingers.
The calcaneus (or heel) is one of the 7 bones of the tarsus.
What are the Causes of the Calcaneal Spur?
The cause of the formation of the heel spur is to be found also in the continuous tractions, in the chronic microtraumatism and in the repeated incorrect movements to which the plantar fascia or the Achilles tendon is subjected. These " stresses " cause small lesions that tend to repair themselves spontaneously with the formation of new bone tissue, from which the heel spur results.
In most cases, the heel spur is a consequence, in fact, of the enthesopathy of the Achilles tendon . This inflammatory pathology involves the heel joint (more specifically, the insertion site of the Achilles tendon on the heel).
Did you know that…
The heel spur is a disorder very similar to the SPINA CALCANEARE with the difference that the latter starts in the lower area of the heel, generally at the medial level, at the point where the plantar fascia originates (rather than at the back of the heel).
After some time, if the insertional tendinopathy becomes chronic, a deposit of calcific material can form. Very slowly, this leads to the formation of a bony protuberance (ie the heel spur), which results in a painful inflammatory state and the development of a bursitis .
For further information: Achilles tendon enthesopathy "The inflammation and calcification preceding the formation of the heel spur can also be favored by important traumatic lesions, such as a sudden stretching or distortion, and by degenerative alterations . In particular, the heel spur is closely related to the chronicity of pathologies such as plantar fasciitis and arthrosis of the foot and ankle .
Risk factors
The factors that contribute to the formation of the heel spur are many and include:
- Anatomical and structural characteristics (eg hollow or pronated foot) which cause an abnormal overload of the back of the foot and lead to an unbalanced distribution of the stresses generated during the journey;
- Some inflammatory, endocrine and metabolic systemic diseases can contribute to the onset of the heel spur; these include gout, diabetes, hypercholesterolemia and rheumatoid arthritis ;
- The risk of developing the heel spur may also increase in the event of prolonged use of certain types of drugs. Some quinolone antibiotics and repeated infiltrations with corticosteroids, for example, may increase the risk of tendinopathy, from which calcification can occur.
Other factors predisposing to the onset of the heel spur are:
- Repeated microtraumatism in athletes and in some work activities;
- Overweight ;
- Postural defects with a wrong foot support;
- Prolonged use of unsuitable shoes (narrow shoes and high heels) that involve constant stress on the hindfoot;
- Psoriatic arthritis .
Symptoms and Complications
Calcaneare Spur: what does it look like?
For some patients, the heel spur is asymptomatic, that is it does not involve particular disorders.
In most cases, however, the pathology manifests itself with acute pain localized to the heel . Often, this symptom gets worse under load, mainly during walking, and can be felt by pressing on the area. The pain in the heel tends to decrease, however, with bed rest.
The heel spur also causes tension in the muscles and ligaments, which can develop into inflammation, with warmth to the touch, swelling of the joints involved and, rarely, redness of the overlying skin.
Calcaneare spur: what are the main symptoms?
The main symptom of the heel spur is acute pain, similar to a puncture or a sharp spot, located in the posterior region of the calcaneus ; this sensation increases or appears by performing a movement that involves the use of the part affected by the pathological process. Pain may ease with rest, but may reappear after some physical activities.
Over time, the heel spur can reduce joint mobility, making even the simplest gestures difficult, such as putting on shoes or taking a few steps. The pain at rest indicates a progression of the disease and can be associated with swelling and joint inflammation, sometimes complicated by mechanical obstructions or compressions of the neighboring structures . As the disease progresses, manifestations may also occur at a distance, in the form of low back pain and knee pain .
Diagnosis
The heel spur is traditionally evaluated by the general practitioner, the orthopedist and / or the podiatrist, with the examination of the foot, through palpation, observation of joint deformity and mobilization of the ankle joint .
To investigate the causes of this pathology, the clinician can ask the patient a series of questions related to the symptomatology and personal medical history, therefore he asks to clearly describe the disorder (eg onset time, type of pain, exacerbating factors etc.). ) and the correlation with other concomitant manifestations.
Usually, the diagnostic confirmation is provided by the ultrasound examination and the radiograph, which allow to establish the degree and extent of the inflammatory process and of the exostosis.
The radiographic examination of the foot is useful to highlight the neoformation of benign bone tissue, especially in the lateral projection.
For a better differential diagnosis, it may be indicated to perform an ultrasound scan of the surrounding soft tissues or an MRI scan to evaluate possible hematomas, edemas, lesions and thickening at the level of the plantar fascia. A baropodometric test is recommended, instead, if an overload disease is suspected.
Treatment and Remedies
The treatment of the heel spur involves different approaches; these are indicated by the doctor mainly on the basis of the extent of the disorder. In any case, the goal is to reduce the pain symptoms and the reduction of joint mobility related to the disease.
The treatment involves taking NSAIDs and performing stretching exercises on the calf muscles and the soft parts of the foot.
Other measures may include the use of braces and orthoses to allow proper loading in the step and weight loss in overweight patients. In the most serious cases, physical therapy (tecarterapia, massages, ultrasounds and lasers) may be useful, possibly associated with local infiltrations of anti-inflammatory drugs.
Drugs and physical therapies
To avoid the aggravation of the inflammatory condition related to the heel spur, the doctor recommends rest and local application of ice.
In addition to resting, the heel spur can also benefit from the use of topical anti-inflammatory drugs (creams, ointments, etc.) or intra-articular drugs (cortisone infiltrations) to reduce the pain and inflammation present in the joint.
Alternatively, it is possible to evaluate a physiotherapy intervention aimed at mobilizing the joint. Conservative treatment may also include the use of physical therapies, such as tecar therapy, massages, ultrasounds and lasers.
Other measures may include:
- Performing stretching exercises on the calf muscles and the soft parts of the foot to alleviate painful symptoms;
- The use of braces and orthoses to restore the structural balance of the foot, cushion shocks and allow a correct load in the step;
- Weight loss in overweight patients.
Surgery
In patients who have not benefited from conservative therapy (or if this is no longer sufficient), surgical removal of the heel spur may be indicated. The purpose of the intervention is to eliminate pain and restore joint movement.
The removal of the heel spur occurs first with minimally invasive surgery, then, in case of recurrence of the pathology, with more complex corrections of the hindfoot.
