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Synonymous
Spur of the heel, lower calcaneal spur, upper calcaneal spur, dorsal calcaneal spur, Fasciitis plantaris
Definition
The lower calcaneal spur (frequent) is a painful bone growth at the inner calcaneal bone body under the heel.
One describes a painful bone growth as an upper or dorsal calcaneal spur (rare) at the heel bone approach of the Achilles tendon.
Anatomy/construction
Illustration lower calcaneal spur
Midfoot bone (os metatarsale)
Cuneiform bone (os cuneiforme)
Navicular leg (os naviculare)
Cuboideum bone (os cuboideum)
Anklebone (Talus)
Heel bone (Calcaneus)
Shin (Tibia)
Achilles tendon
Calcaneal spur
The heel bone (Calcaneus) is part of the foot and involved in the design of the lower ankle joint. Numerous ligaments, tendons and muscles insert at it. The Achilles tendon inserts at its back (dorsal) part. The foot can be lowered and you can stand on the tip of the toes by pulling the Achilles tendon. Some little foot muscles as well as the Plantarfaszie responsible for the lengthways vault tension of the foot (Plantaraponeurose) have their origin at the lower share of the heel bone. The heel bone is connected to the bones of the root of the foot, to the top it is connected to the anklebone (Talus) by the lower ankle bone joint.
Frequency
It is a frequent, degenerative (wear-related) illness. The illness frequency increases consequently with the age. The average age of the patients amounts between 40 and 60 years. Furthermore the strainings due to profession and leisure activities seem lower why a calcaneal spur more seldom gets therapy needy.
Women are concerned a little more frequently than men. A calcaneal sporn is provable in approx. 50% of the cases with older people. Not every calcaneal spur is therapy needy or causes troubles.
Cause and emergence = ethiopathogensis
The cause of development of the calcaneal spur is caused by increased pressure and tensile straining of the tendon approaches at the heel bone body. By this stimulation reorganization processes are started in the tendon fibers, which in the end leads to a spur-like, suited towards the foot, new growth of the bone. The calcaneal spur can lead to an inflammation reaction of the surrounding tissue by its pressure strainings.
Triggering factors for the emergence of a calcaneal spur are
Age
Overweight (Adipositas)
bad footwear
strainings (profession)
Malformations of the foot with stretching of the foot lengthways vault (frequent: talipes planovalgus, partially also splay foot).
Symptoms/troubles
Patients with a painful (symptomatic) lower calcaneal spur report about a strain dependent pain in the area of the heel. Depending on illness stage the pain can appear or exist permanently only after longer straining. The morning attempt pain under the heel which at first improves in the further day again is also typical.
The pain character becomes mostly described as piercing, also as burning occasionally. A pain radiation in the foot as well as into the lower leg is possible. To the relief of the hurting area the patients partly walk on the outside of the foot.
The upper calcaneal spur also causes straining dependent pains in the area of the Achilles tendon approach.
Both forms of the calcaneal spur can lead to a clear restriction of the activity level.
Diagnostics
The medical history (case history) of the patients gives the decisive reference to the underlying illness since the pain is usually indicated very selectively. The described pain can be provoked at pressure on the heel on the side of the sole of the foot a little inside sided.
The suspicion diagnosis made so is confirmed mostly in the x-ray of the lateral heel bone (Calcaneus). However, there also is the possibility that the classic calcaneal spur troubles first announce the beginning of a spur education and at first the radiograph is still unobtrusive. MRT and Sonography are dispensable for the calcaneal spur illness for the diagnosis position and are rather of importance in the exclusion diagnostics of other illnesses. Because of the clear symptoms, differential diagnoses are, however, of minor importance.
Therapy
The therapy of the upper and lower calcaneal spur is not different.
The calcaneal spur is a domain of the conservative therapy. A recovered calcaneal spur of course does not have to be given therapy to. The aim is the elimination of the soft partial inflammation surrounding the spur.
Everything which contributes to a reduction of the pressure and tensile straining at the calcaneal spur belongs to the general measures.
Being included:
Correction of foot malpositions (deposits supply).
Heel cushion with hole deposits/gel inlays over the calcaneal spur area
Weight reduction
Reduction of the physical strain.
Cold and warmth applications as well as ultrasound treatments belong to the physical therapy measures.
An accompanying medicinal therapy with NSAR and cortisone (e.g. Voltaren ®, Ibuprofen ®) in tablet form and ointment associations can provide with complaint alleviation. The concentration of the active ingredient in the area of the calcaneal spur is, however, too low for a sufficient anti-inflammatory effect. Local infiltrations more successfully are used by anesthetics and cortisone. The pain relieving and anti-inflammatory effect lasts much longer, the Infiltration for the patient in this sensitive area however unpleasantly.
The shock wave therapy is also used successfully. Very high-energy mechanical waves are pointed at the calcaneal spur. By the growth of blood vessels the inflammation shall be taken away. This process lasts for 6 weeks. Patients are being treated in approx. 2-3 meetings whereas the distance of one week. The costs of the individual meetings amount to 50-100 euros and are not taken on by the health insurance company which is not convinced of the mode of action of the shock wave therapy. In the literature you report, however, about up to 70-80 % of good till very good results. Contrary to the expectation of many patients the calcaneal spur is not smashed by the shock wave. As a rule, the calcaneal spur persists even after the successful shock wave treatment as an non symptomatic calcaneal spur.
Another proven therapy method in the treatment of the calcaneal spur is the radiotherapy. Therefore ionizing beams (e.g. gamma- rays) are pointed at the calcaneal spur region (e.g. complete dose of 6 Gy with individual doses of 1 Gy).
Operative therapy
With most of the patients a clear complaint alleviation can be obtained up to a complaint liberty by the conservative therapy. A frequent problem concerning the therapy success is the continuous straining / over straining in the profession, often, which can not be reduced and therefore hinders a successful therapy.
The operative intervention is only needed if the conservative therapy is exhausted. The aim of the operative therapy is not different from that one of the conservative therapy. To the strain relief at a calcaneal spur surgery the plantar aponeurosis (attaching tendon plate) is taken off the bone near at the calcaneal bone.
The distance of the calcaneal spur is not recommended generally itself. Very large calcaneal spurs should be removed, however. A soft bedding of the heel after the intervention is necessary. The success rate of the operation amounts to 80-90 %. The follow-up treatment phase extends over months.
It comes to a gradual reassuring of the inflammable region, noticeable to the easing load pain at this time.
As a complication of this operation fatigue fractures of the heel bone (Calcaneus) are described, which are caused by the abruptly missing tension on the calcaneal bone by the so-called plantar apeunorosis as a counterbalance for the body load.
Complication
The usual operative complication possibilities are valid:
Infection, infection of the bones (Osteomyelitis), cicatrization disturbance
Nerve injuries
Thrombosis/ pulmonary embolism
Relapse (renewed troubles)
Remaining troubles
Forecast
The forecast for a successful calcaneal spur treatment is good. Almost always (> 90%) a clear complaint alleviation or complaint liberty is achieved. Among other things the therapy success depends on the possibility of the physical rest in the treatment time period. Since this is only seldom possible patients suffer not seldom several months of till several years of phases of complaint.
Moreover, the syndrome of the calcaneal spur tends to the relapse (renewed troubles). Even if a conservative or operative therapy is proceeded successfully, relapse complaining can appear any time.
Combination
The calcaneal spur more frequently appears also in the combination with a so-called Haglund´s deformity. The reason for the combination with this Haglund´s deformity is not quite cleared.
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