Calcaneal spur

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The heel spur ( or synonymously Kalkaneussporn Calcaneussporn, from Latin calcaneus, heel ( nbein ) ) corresponds to a knöcheren spur on the heel bone. A distinction between a lower and an upper heel spur heel spurs. Another bony changes at the heel bone is the Haglund exostosis. The lower heel spur is sometimes associated with inflammation of the fascia on the sole associated ( Plantar fasciitis or plantar fasciitis ).

Causes

Heel spurs are fairly common. The incidence was 32% in a study in people without Plantar fasciitis and 89 % in people with plantar fasciitis. Major risk factors for Plantar fasciitis is an overweight and pronation of the foot. It affects about 10 % of runners. Women are affected more often than men, usually the age of onset is above 40 years.

Molding

Depending on the location of the heel spur there are two different forms:

  • The more common plantar (bottom ) heel spur is an ossification at the insertion of the tendon plate on the underside of the heel bone ( plantar fascia ). The technical term for this form is plantar Kalkaneussporn.
  • The rarer dorsal (top and rear ) heel spurs, corresponds to an ossification of the calcaneus approach the Achilles tendon. The Haglund exostosis ( orthopedist, Stockholm ) is a bony Ausziehung the upper rear corner of the heel bone and often associated with a painful bursitis.

A thickened and enlarged by inflammation plantar fascia can be represented in the ultrasound image. A heel spur is very visible on the radiograph. To exclude other causes for the symptoms bone scan and especially magnetic resonance imaging (MRI) ( Kier et al., See below) can be used as an aid.

Symptoms

  • Stabbing pain on the occurrence
  • Dull, irregularly occurring pain in the heel area without load (eg lying )
  • Start-up pain ( after prolonged sitting or lying, especially in the morning)
  • Can occur together with heel pain ( sharp pain under the heel )
  • Usually associated with pain in the sense of contracts Senkfußes (called the TM -I joint is irritated )
  • Occasional swelling in the ankle area
  • The lower heel spurs: severe tenderness at the tendon insertion ( laterally in the lower heel area )
  • At the upper heel spurs: severe tenderness of the Achilles tendon, especially at about ankle height
  • Feeling of pressure when walking

Very useful for the subsequent follow-up, including the scientific evaluation is the use of standardized and validated scales and possible scores. To the global pain assessment, the visual analogue scale offers (VAS ). Are recommended (see Appendix 2), which in addition to the detailed classification of pain include information about the use of walking aids to a possible restriction; addition, the Calcaneodynie score according to Rowe ( Rowe et al, su Carlsson et al, see below. ) includes occupational and sports as well as gait.

Forms of therapy

In the great majority of those affected, the symptoms without any specific treatment or with conservative treatment (operational activities) sound off again. The effectiveness of some methods could be secured at a high level of evidence ( radiation therapy, shock wave therapy).

  • Orthopedic insoles, which have a recess in the area of the spur and provide to the pain-sensitive point for pressure relief. This recess has a foam pad in the rule. It must also be supported with these deposits, the longitudinal arch, the padding of the spur alone usually is not enough. It has proven advantageous to the deposits in strongly damped running occurs ( turn) shoes fit. Before the original soles should be removed. These deposits are a prerequisite for example, for radiotherapy.
  • Foot orthotics to correct existing deformities of the foot ( eg Senk-/Spreizfuß ).
  • Physiotherapy exercises where the tendons are stretched to the calf and sole of the foot.
  • Local cryotherapy ( ice massage ) has analgesic, anti-inflammatory and decongestant. It is very easy to use in self-treatment.
  • Cortisone injections, usually with time only limited use. Here, the muscle attachment is infiltrated with an anti-inflammatory and analgesic medications mixture of local anesthetics and corticosteroids. Partial injections are proposed up to three. A common complication after cortisone injection is the rupture of the tendon plate.
  • Operation: In this case the heel spur is chipped. In addition, work on the plantar fascia can be performed, nerves severed and usually inflamed bursa be removed. Wait time approx 2-4 days, then release the tendon by special shoes with additional deposits, which are gradually reduced over a period of about six weeks. In mild cases, a two-sided surgical is, if required, is possible. In more severe cases only needs one foot to heal before the other can be operated as a load on the operated foot is not initially possible. Through these operations, however, can the discomfort that causes the heel spurs, come additionally complaints by the scar tissue.
  • Anti-inflammatory drugs: Mostly are non-steroidal anti-inflammatory drugs ( NSAIDs) used the pain- reducing effect, antipyretic and reduce swelling.
  • Extracorporeal shock wave therapy (ESWT ): The administration of moderate intensity focused sound waves may help relieve chronic pain, the mechanism of action is clear in its infancy. The cost of this procedure shall not be reimbursed by the statutory health insurance, according to legislation. Most private health insurance companies cover the costs, on request, as are aid agencies when the conventional measures have been exhausted. The effectiveness of shock wave therapy is supported by nine randomized trials with positive results (compared to four negative study results).
  • Pain treatment by X- radiation: The radiation treatment acts by engaging the biochemical mechanisms of inflammation. The heel spur itself is of course not influenced by radiation treatment. In this respect, the regulation of deposits before radiotherapy is required.

Below is a painful heel spur with radiotherapy for a minimum duration of symptoms of 4-8 weeks (that is quite acute pain problems should be treated by physiotherapy / deposits). Patients should be over 40 years old, at 30 - to 40 -year-olds radiation treatment is only useful if all previously simpler methods have been exhausted. Radiation therapy is usually carried out in two to three weekly sessions over three times four weeks. The heel bone and the plantar fascia (Energy 4-6 MV) (energy 150-250 kV) in this case be (see above) by means of photon radiation from a linear accelerator or orthovoltage unit is irradiated; usually a total dose of 3-6 Gy with single doses of 0.5-1 Gy is given. Pain relief can be expected in 70-80 % of patients and may persist for a year or longer. In 2012, the effectiveness of this treatment could be demonstrated by a randomized study at a high level of evidence ( Niewald et al., See below). As a typical side effect of pain increase is possible during or immediately after radiotherapy, it must be intercepted by taking painkillers and is temporarily if necessary. Lesions are almost never observed. Discussed is a small increase in the natural tumor risk ( at ppm level ) by the radiation therapy, tumors after radiation treatment of benign diseases are, as far as known, has not been observed. Each patient is informed in detail about these possible side effects. The cost of treatment can be easily transferred from statutory and private health insurance.

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