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The calcaneus spur is one of the deeply entrenched medical myths. “If your heel hurts, it must be spurs.” Meanwhile, a bone process called a spur is a symptom of a completely different disease, and what’s more, most often it does not cause pain.
It would be difficult to identify an element of the human body that does not impress with its structure, operation and functionality, but the foot is one of the most impressive ones. Inconspicuous, sometimes filigree, for some even sensual. It consists of almost 30 bones, keeps us upright for several dozen years of life, allows us to walk, dance, jump, run, bear even several hundred kilograms of loads and when healthy, it works like a mechanism designed by a genius engineer. However, given the challenges that the foot has to face, it is hardly surprising that it sometimes causes pain. Interestingly, the vast majority of mortals with alien orthopedics unwaveringly diagnose any pain in the heel as a heel spur. With whom the same majority is firmly convinced of this, nothing can be done at all.
These infamous heel spurs are bone growths of several millimeters that appear on the plantar side of the calcaneus. True, they exist in fact, they are even visible on an X-ray, but they don’t work as many people imagine. They don’t break through, and the pain when walking doesn’t come from the fact that it’s almost the same as having a nail stuck in your heel. So how do you get a heel spur?
Spur – fire in the heel
If we were to agree to calling this ailment a heel spur, the development of this name would have to be: plantar fasciitis. Because the cause of pain is the inflammation, not the bone process.
The plantar fascia can be imagined as a strong hammock stretched between the heel and the toes. This band of connective tissue plays an enormous role in the process of walking and carries a large proportion of the enormous stresses that arise from various types of movement. It is a mechanism as durable as the sensitive and inappropriate treatment of the foot, e.g. irregularly practiced runs without prior warming up and stretching the muscles of the foot, can cause microtrauma, leading in turn to irritation and inflammation in the place where the aponeurosis is attached to the calcaneus. Where are the spurs in all of this?
– The inflammatory process in the area of the tendon attachment causes additional bone tissue to form in the sensitive area. These are the famous heel spurs. Probably microcalcifications, which gradually turn into a spur, arise at the site of damage to individual fibers of the aponeurosis. However, they are only a symptom of the disease, not the cause of it. What’s more, spurs can be seen on X-rays in about 50% of patients, and 20% of those who have them have never felt any pain because of it – says Paweł Kołodziejski, MD, PhD from the Foot Disease Clinic, the first center in Warsaw specializing exclusively in the treatment of diseases of the foot and ankle.
The painogenicity of these calcifications called spurs is debatable. It is believed that in a few cases they may compress the surrounding nerves and thus contribute to the increase of discomfort, but are not painful in themselves.
Lard with nuts
The condition commonly referred to as heel spurs, whatever the concept of patients and some doctors, is considered incurable by the former. On internet forums, heel pain sufferers compete in descriptions of the ineffectiveness of the prescribed treatment and recommend alternative methods that supposedly worked wonders. Among them, the best is wrapping the heel in bacon at night, putting walnut leaves in the shoe or tapping on the heel with a XNUMX-centimeter wooden spoon every evening.
The reasons for the poor press in the therapy of “spurs” can be manifold. First of all, you need to make an accurate diagnosis, while plantar fasciitis can be confused, among others. with bursitis of the Achilles tendon area, Achilles tendonitis, Haglund’s disease, and other causes of heel pain include, for example, systemic diseases such as psoriasis or Reiter’s syndrome. One should also not forget about injuries such as bruises of the calcaneus, sprains, fractures.
According to Dr. Krzysztof Bryłka from the Foot Disease Clinic, the basis for diagnosis in the direction of the heel spur is a clinical examination, and above all careful palpation of the foot, i.e. a touch test that allows you to find out what and where exactly hurts. It should always be preceded by the so-called a medical interview, i.e. the duration of the symptoms, intensity and onset, as well as factors that aggravate or alleviate the course of the disease. To confirm or rule out the diagnosis, an X-ray can be taken, and in case of doubt, an ultrasound can also be taken, but not all patients require it.
Another reason for the widespread opinion about the ineffectiveness of treatment, the so-called heel spurs may be that the healing process is quite slow and it may take up to a year to fully recover.
Heel spur treatment
Therefore, the patient will have to be patient, but it is worth it, because the data published in one of the American articles on the effectiveness of plantar fasciitis treatment show that 90% of the problem will be eliminated within one year of treating an inoperable problem. patients.
The treatment of the heel spur is multifaceted: in order to eliminate the inflammation, non-steroidal anti-inflammatory agents are administered. At the same time, the patient is taught how to properly perform muscle stretching exercises, thanks to which the invaluable structures of the aponeurosis will not be exposed to injuries in the future. At the initial stage, sometimes splints or so-called splints are used for the night. taping, i.e. special dressings made with the use of patches that prevent the stiffening of stretched and exercised muscles during the day. It is because of the stiffness that the morning pain experienced when taking the first steps is characteristic of plantar fasciitis. The severity of symptoms is also significant when the toes are raised upwards.
An important element supporting the treatment of heel spurs are shoes adapted to the structure and physiology of the foot and soft insoles. There are also orthoses fixed in the shoes.
Physiotherapeutic treatments also work well in therapy.
More advanced effects are topical steroid injections, which some physicians are reluctant to administer due to possible side effects, which in turn worsen the pain, and the administration of topical growth factors to accelerate healing.
Heel spur = surgery?
If the above-mentioned actions did not bring results within the assumed time, the operation may be necessary. This procedure requires great precision, because it may happen that the plasticity of the foot arch will be lost, which will impair its mechanism of operation. The microscopic nerve connections in the vicinity of the plantar fascia can also be torn.
– In the past, spurs were removed surgically, but often the effects were catastrophic, because the unique fat tissue in the heel area was destroyed, which absorbs shocks – explains Dr. Krzysztof Bryłka. – Currently, such surgeries are generally not performed, exceptions are made rarely in cases that are extremely resistant to treatment. The procedure involves a partial cut of the plantar fascia, which reduces the loads transferred to its attachments. However, it should be remembered that carrying out such an operation may lead to flattening of the longitudinal arch of the foot and the formation of longitudinal flat feet – the doctor warns.
The risk of fasciitis is greater in obese people and those working in a standing position. The condition of the heel and the entire foot is also influenced by the fact that around the age of 50, the structure of adipose tissue that absorbs injuries begins to change, which makes them much more severe. Therefore, women and men over the age of XNUMX usually suffer from plantar fasciitis.
Although the treatment does not give immediate results, it is good to patiently carry out all possible non-surgical procedures. Of course, the ones recommended by an experienced orthopedic doctor, because tapping with a wooden spoon and compresses made of hazel leaves are not recommended.