Heel spur removal

The growth of the heel spur is an unpleasant and painful syndrome, which is especially susceptible to women over the age of 40. The appearance of unpleasant sensations is associated with the processes of aseptic inflammation of the calcaneal fascia.

In the region of the heel bone, the rigid connective tissue begins to increase in volume due to the formation of a neoplasm in the form of a wedge or spike.

Initially, it causes inconvenience only when walking or during intense physical exertion, but over time it begins to disturb the affected person even if the leg is at rest. A heel spur is a pathology that requires treatment, as it progresses more and more over time.

What is a heel spur and why does it appear

A neoplasm called a heel spur is an overgrown and inflamed connective tissue in the area of ​​uXNUMXbuXNUMXbits attachment of the Achilles tendon, or in the zone of the tubercle on the side of the sole of the foot. Another name for the pathology is calcaneal fasciitis.

If we consider its overall prevalence, among all diseases of the musculoskeletal system, heel spurs are diagnosed in approximately 10% of cases. The age category of the affected is people over 40 years old, mostly women. Although, in the presence of provoking factors, fasciitis also affects younger people.

The appearance of a heel spur is directly related to the functioning of the fascia in the heel, a high-density fibrous tissue that extends in a layer along the sole of the foot. The fascia is a ligament that connects the calcaneus and metatarsal bones. It bears the load of the longitudinal arch of the foot.

The most common reason for the formation of a spur is the presence of constant, prolonged and intense loads on the calcaneal fascia. During walking, this area of ​​the foot bears the load of the weight of the whole body. Thus, the inflammatory process of the fascia is formed in almost every fourth person in old age.

Doctors consider heel and foot injuries, for example, fractures and bruises, to be factors provoking the appearance of pathology.

More common causes of heel spur formation are circulatory diseases, metabolic disorders, diabetes mellitus and overweight, connective tissue diseases, and gout.

The lifestyle of a person leaves an imprint on his gait, directly affecting the distribution of the load on the foot. So, for example, wearing high heels, exhausting physical training, as well as the presence of longitudinal flat feet can lead to the development of the disease.

How does a heel spur manifest itself, 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 disperses, unpleasant feelings decrease, but by evening they arise with the same force;
• formation of calcium compounds around the spur;
• change in gait, the appearance of lameness.

Initially, heel pain bothers a person while running or walking. The further the disease progresses, the more pain and discomfort manifests itself. Over time, even a slight load on the heel responds with pronounced pain in it. The pain has a burning, sharp character and resembles a sensation as if a nail had stuck into the heel. At the same time, 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 in any way. It does not pose a significant threat to the life of the affected person, but gives him a lot of discomfort, because because of its existence, the process of walking is constantly accompanied by severe pain.

Diagnosis and treatment: how to deal with the disease

Already by the presence of characteristic complaints in the patient, the doctor during a preliminary survey may suspect the formation of a spur in him. After examining, the doctor assesses the presence and degree of flat feet, as well as how the foot is limited in movement.

To make sure that the preliminary diagnosis is correct, the patient will need to undergo several examinations – first of all, this is an x-ray of the foot.

The picture makes it possible to assess the location and size of the formation, as well as draw a conclusion about the degree of its neglect. In some cases, the doctor may refer the patient for an MRI.

What to do if a heel spur is found? Medicine today offers various methods of treating this disease – conservative and invasive. For treatment, the wearing of special insoles and arch supports, the use of orthoses or braces, immobilization of the limb, reduction of physical load on the foot, physiotherapy, the appointment of external local preparations in the form of creams and ointments, local injections of glucocorticoids, removal of the heel spur can be prescribed.

Heel spur treatment and removal techniques

Various methods can be used to treat the disease:

• x-ray therapy;
• ultrasonic exposure;
• laser method;
• shock wave treatment.

All these methods, in fact, do not save a person from a spur, but only help get rid of pain, normalize the process of tissue repair, reduce swelling, but they do not remove the growth itself.

X-ray therapy involves the directed local effect of x-ray radiation on the affected area. It is prescribed in the most extreme cases, when any other method of therapy does not work. As a result of the action of X-rays, pain receptors are blocked in the tissues, and the patient feels relieved.

Ultrasound operates on a similar principle – therapy, carried out by courses, makes it possible to get rid of swelling and inflammation, as well as crush salt deposits. The procedure has some contraindications – the period of pregnancy, thrombophlebitis of the veins of the extremities, disorders in the work of the heart and nervous system.

The use of a laser against a heel spur is a modern way to help an affected person live a full life. The technique does not involve the removal of the build-up, but allows you to get rid of the manifestations of the disease.

Shock wave therapy is a gentle way to influence the neoplasm. Shock sound waves, on the basis of which the treatment method is based, act on pain nerve receptors and block their sensitivity.

Heel spur removal: types of operations

Removal involves the physical removal of the build-up from the tissues, where its presence forms the symptoms characteristic of the disease. This is the only way to get rid of the formation, which is localized in the tissue layers of the heel zone.

The appointment of an operation is possible only if the main conservative methods of treatment were previously applied to the patient, and they did not give a positive result within 4-6 months.

According to statistics, operations of this type are successful in 95% of all cases. The clear advantage of this type of treatment is the short recovery period, given that surgical removal of the spur in any case involves some degree of tissue intervention.

Depending on how the instruments penetrate into the heel, there are:

• classical or open operations;
• endoscopic;
• minimally invasive under X-ray control.

How is the classic operation performed?

An open type of intervention is currently considered the most traumatic, outdated and inappropriate. It is rarely prescribed.

Classical open surgery can be performed in any surgical department – in a clinic, hospital or specialized medical institution. In any case, it is carried out only in a hospital setting.

An open operation is possible only with the use of local anesthesia, in some cases – general anesthesia. In the process, the surgeon makes an incision in the skin in the region of the Achilles tendon or heel bone, through which the tumor is removed. Postoperative rehabilitation can take up to 2-4 months.

Removing a spur with an endoscope

Endoscopic fasciotomy was first performed in 1991 and has since been considered the preferred method for removing heel fasciitis.

Endoscopic procedures usually do not require large incisions. The introduction of surgical instruments to remove the spur is performed using an endoscope – a long and flexible hollow tube equipped with special optics. To insert the endoscope into the operated area, it is enough to make two or three punctures less than a centimeter long.

The operation is performed under conduction anesthesia, with the installation of a compressive tourniquet under the lower leg. An incision 5 mm long is made on the medial surface of the heel region – it is located about a centimeter distal to the aponeurosis attachment area.

The endoscopic trocar and cannula are inserted superficially in relation to the location of the spur, to the opposite edge of the heel area – there is an exit hole. Next, the surgeon removes the cannula and inserts the endoscopic camera into the medial opening, and the retrograde cutting scalpel into the lateral portal. An incision is made with a scalpel. The whole process is carried out under the control of the endoscope camera – it displays a picture of what is happening in the operating field on the monitor of the device.

Minimally invasive technique with X-ray control

For the implementation of a minimally invasive operation, only one incision up to 3 millimeters long is needed. A trihedral sharpened scalpel is inserted through the hole – it cuts off the fascia at the place of its attachment to the calcaneus. The spur itself is removed with a cutter, which is inserted into the same puncture.

The process practically does not cause injury to the operated person – after 2-3 days he can stand on his feet. In addition, there is no need to apply plaster during rehabilitation.

X-ray equipment in this case is used to control the operation – it performs a role similar to the endoscope camera in endoscopic surgery.

How is recovery after surgery

Due to the fact that each person has an individual level of pain threshold, the duration of rehabilitation may differ in each case. It also depends on how the surgery was performed.

So, the postoperative recovery period can last from 2 days to 2 months. If the operation was carried out in a minimally invasive or endoscopic way, the application of a cast after it is not required, and after a few days a person can gradually load the leg with walking.

If the spur was removed by an open technique, after the operation is completed, a cast must be applied to the affected leg. The patient can recover after such an intervention within 2-4 months.

All the time until complete recovery, it is necessary to limit the load on the sore leg. After the operation, it is recommended to wear special orthopedic insoles, especially for patients with flat feet.

Feedback from people diagnosed with heel spurs suggests that surgical removal is the only guaranteed effective way to get rid of pain and discomfort, unlike conservative therapy or physiotherapy methods of exposure, which are not always able to alleviate the patient’s condition. If the operation is performed in an endoscopic or minimally invasive way, a person will quickly be able to recover and begin to live a full life, without pain and swelling in the heel area.