Heel spur block

If a person suffers from severe pain that can not be cured by oral administration of painkillers, intravenous administration or local treatment with solutions and ointments with anesthetic effect, doctors resort to at least a drug blockade of a painful focus. Pains of this nature in the heel area are frequent evidence of plantar fasciitis with the formation of a bone growth in the inflammation focus. It is this build-up which, in itself, is painless, due to pressure on soft tissues and multiple nerve branches, supports the active inflammatory process and causes severe pain. To heal persistent painful pain, significantly reducing the quality of life of the patient and forcing him to lead a sedentary lifestyle, doctors can be offered a blockade of the heel spur with the use of hormonal anti-inflammatory solutions, as the most effective and quickest way to combat pain.

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Indications for the procedure

Suddenly appeared, apparently, from scratch, severe pain in the heel, which does not allow a person to normally rely on the leg, in most cases is evidence of an inflammatory process in the tendon and fascia of the foot. This process often ends with the development of an inflamed area of hyperplastic processes of bone tissue - the formation of osteophytes, called the people's heel spurs.

The inflammatory process in the connective tissue of the sole, called plantar or plantar fasciitis, can develop for various reasons. But the main provoking factor, causing damage and inflammation of the fascia of the foot, is an excessive load on the legs and feet in particular. This contributes to excess weight, improper walking and uncomfortable shoes, enthusiasm for high heels, activities associated with carrying heavy loads, playing sports that involve a heavy load on the legs (this pathology can be called a disease of runners).

It must be said that the increased load on the lower limbs can give and spine diseases. In addition, strong pressure on the fascia of the foot is characteristic of people with flat feet.

Exposed to plantar fasciitis, oddly enough, we can consider people leading a sedentary lifestyle, as a result of which the metabolism is disrupted. As a result, weight increases and obesity develops, the mineral composition of bone and cartilaginous tissue changes, and the characteristics of connective tissue become different (it becomes less elastic and more prone to rupture).

While it is only a matter of inflammation of the plantar fascia caused by microfractures of tissues and their regular traumatization, as a result of which damaged fibers do not have time to recover, traditional medicamental treatment makes it possible to cope with pain as one of the main symptoms of inflammation. But to stop pain - does not mean to cure the disease. Long-healing microtraumas of the fascia lead to the formation of scar tissue, which although more dense, but noticeably inferior to the elasticity of connective tissue fascia.

The non-stretchable tissue of the scars can be damaged even with a small load, and therefore the inflammatory process passes into a chronic form and extends further to the periosteum of the calcaneus. Inflammation weakens the periosteum, which is becoming thinner, despite the fact that these tissues can not recover themselves. The body, trying to compensate for the defect of the periosteum, begins to direct calcium to the site of the lesion. It begins only restores the old contour of the head of the bone, but over time, calcium formations begin to protrude beyond it, forming a small spine.

The organism can not be blamed for this redistribution of the mineral, which is the building material of bone tissue, because there is a compensatory mechanism of this process. However, the disturbed metabolism is not so easy to restore, so calcium continues to flow to the damaged periosteum, even when this is no longer necessary.

A small bone growth can not cause pain, if the motor activity of a person is small, and the inflammation does not affect the sensory nerve endings that pass nearby. Neoplasms of large sizes rarely pass asymptomatically.

As the osteophyte grows and its pressure on the nearby soft tissues increases, so does the strength of pain. Bone growth during the support of it traumatizes the muscular and nervous tissue, provoking and supporting inflammation in them, which is fraught with swelling of the tissues of the heel and severe pain that can torment a person even in a state of rest.

Local treatment with anti-inflammatory drugs in the presence of a calcaneal spur will no longer have a good effect, because an acute spine, continuing to regularly injure the soft tissues of the heel, does not allow completely to stop the inflammatory process. In addition, it is not so easy to penetrate into the inflammatory focus itself through a fairly dense skin and a thick layer of muscle and connective tissue. The internal reception of anti-inflammatory and anesthetizing agents does not give sufficient effect.

When the pain becomes unbearable, and local treatment with medicines does not bring relief, doctors resort to a not very popular procedure involving a certain risk. Drug blockage of the calcaneal spur will allow to remove pain and to stop the inflammation symptoms almost instantly, but the prick is so painful that not everyone can decide on it. In addition, the procedure requires a high professionalism of the doctor, because any error is fraught with serious complications.

It must be said that the blockade is not a full-fledged treatment procedure, although in some cases it allows you to get rid of pain permanently. If the bone growth is not removed, he will continue to injure the surrounding tissue. After a while, pain can not only return, but become even stronger. Therefore, the blockade of the heel spurs doctors are considered only as an extreme measure of the fight against the intolerable pain syndrome. But in the future the patient will need additional treatment aimed at removing the source of subsequent tissue injuries and inflammation.

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Preparation

Severe pain in the region of the heel, which does not respond to traditional methods, is an indication for a drug blockade only when the necessary examination of the patient and the final diagnosis is made. After all, the pain itself only indicates that in this place of the organism there is a certain pathological process. But which one, you can find out after the diagnosis.

Acute or severe blunt pains when pressing on the heel and swelling of tissues in this area, of course, suggest the doctor that their cause may be inflammation of the plantar fascia in the area of attachment to the calcaneus or the formation of an osteophyte in this place. But after all, these symptoms are typical for the dislocation of the leg, bone fracture, sprain. In this case, anesthesia will only hide the symptoms of injury and can cause irreparable harm.

To differentiate the heel spur from the plantar fasciitis, traumatic foot injuries and some pathologies of bones and joints, X-ray diagnostics helps. On the X-ray of the foot, a characteristic spine-shaped bone outgrowth will be seen in the region of the heel, which is surrounded by inflamed soft tissues. No palpation can give such exhaustive information about the presence, location and size of the osteophyte. But these moments are very important for a doctor who will need to carry out a blockade of the heel spur, because he must know the location of the focus of the most severe pain to the nearest millimeter.

Analyzes of urine and blood will confirm the presence of an inflammatory process in the body, and although they can not give information about its localization, they are able to detect certain metabolic disorders that affect the course of the disease. In addition, laboratory studies provide information on the state of various organs, including those that participate in the metabolism and excretion of drugs that enter the body. This is important to consider when choosing a method for treating the heel spur and the medications used, each of which can have its contraindications and side effects.

If we are talking about the treatment of the calcaneal spur in a woman of childbearing age, she will need a consultation from a gynecologist, yet it is a question of introducing hormonal drugs, which, although insignificantly, can affect the hormonal background. At some pathologies of a female sexual sphere hormonal preparations can even cause certain harm.

When a patient comes to the procedure, he should have the results of the tests and an X-ray film with a description. A special preparation is not required. But doctors can recommend the day before to carry out hygienic procedures for the feet, which include steaming the coarsened skin on the heel, cleaning it and, if possible, partially removing it with a special foot or pumice brush. This will facilitate the doctor's access to the sore spot, because this will require a puncture of the skin and internal tissues.

The severe morbidity of the procedure is one of the main factors of the low popularity of the blockade. And if a person decided to take an injection, you must first adjust yourself to the fact that you will have to endure a few painful minutes. With a strong nervous tension and fear, you can take sedatives, but painkillers are highly undesirable.

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Technique of the blockage of calcaneal spur

Blockade of the calcaneal spur is a special injection in the heel area, which allows you to remove the strongest pains and to stop the inflammatory process in a short time. Despite the apparent simplicity of the conduct, it is a fairly responsible procedure. For everything to go without complications and give good results is required, we can say, the jeweler's job of a surgeon who will make an injection.

Carry out the procedure in a hospital in a specially equipped office, implying the preservation of sterility. All manipulations are consistent with the X-ray image, along which the scheme is applied to the heel area, and the image displayed on the monitor by the ultrasound machine. Before introducing the needle into the flesh, the doctor must carefully think through various points: to identify the puncture site, the direction of the needle movement, the depth of its immersion, because the purpose of the injection is to go directly to the focus of pain - the point where the pain is maximum.

As with normal injection, the skin at the injection site is treated with an antiseptic solution. But unlike injections into the buttock and other soft parts, the doctor will be more difficult to insert a needle into the tissue. Plus, the blockade of the heel spur is a very painful procedure, where the pain from the puncture of the skin will seem like a mosquito bite compared to the sensations when the needle reaches the pain point inside.

The desired point is determined by the doctor palpatory, but the depth of penetration of the needle can be determined using X-ray images and ultrasound of the foot. After the necessary information is obtained the patient can introduce a mixture of anesthetic and corticosteroid (novocaine, lidocaine and other drugs).

During the procedure, the patient should be in a horizontal position, which will lower the tension of the muscles and allow the person to relax as much as possible, to calm down. Since the prick is very painful and the patient can jerk during manipulation, which will lead to the displacement of the needle inside the tissues, the diseased limb should be fixed firmly in a position convenient for the doctor, but the heel must be free to hang.

The procedure is not in vain performed under the supervision of ultrasound, because when the needle moves inside soft tissue, the doctor has no right to damage the muscles and nerve fibers. If you act blindly, the risk of such an outcome is very high, and ultrasound allows you to safely manage the instruments, control the movement of the needle, avoid obstacles and get to the very point of greatest soreness, ie. Directly into the bone growth, and not any other obstacle in the path of the needle.

The surgeon is important to get into the center of the bone spine, which is much more difficult than injecting into soft tissues, so the procedure is slightly longer. And, despite the fact that relief after the injection comes within the first 5 minutes, the patient will not be able to step on the heel area for at least 30 minutes.

Quite often, the blockade of the calcaneal spur is supplemented with the kinesiotherapy procedure. The area of the foot and calf of the leg is covered with an elastic adhesive tape, which makes it possible to fix the foot in such a position, during which the joint will undergo minimal load during walking. This device will be a kind of shock absorber with pressure on the foot and corrector of the correct gait.

Preparations for blockage of calcaneal spur

The injection, which is performed in the most painful place with a calcaneal spur, aims to numb the foot and minimize the symptoms of inflammation. Such abilities are possessed by anti-inflammatory agents from the category of corticosteroids. The injection into the osteophyte area of the hormonal preparation reduces the production of inflammatory mediators and antibodies, and also reduces the sensitivity of the tissues to the lesions, reduces the permeability of small blood vessels, supports the structure of healthy cells, and stimulates blood circulation and metabolism, contributes to the destruction of osteophytes.

It is clear that one can not expect complete destruction of the heel spur under the influence of one injection, but it is quite possible to solve the problem of severe pain and reduce the intensity of the inflammatory process if it is not a simple anesthetic, but a strong anti-inflammatory agent. To get rid of the bony growth, you may need 2 or more injections, depending on the drug chosen.

As the drugs of choice for blocking the calcaneal spur, the following steroid drugs can act:

• suspension for injection "Diprospan" and its analogues "Betamethasone", "Flosteron", "
• a suspension of "Hydrocortisone"
• a preparation for intramuscular and intra-articular administration of "Kenalog".

The most optimal treatment for pain in the heel spur is the preparation "Diprospan" based on the glucocorticosteroid betamethasone. This drug is famous for its pronounced anti-inflammatory and immunosuppressive (antiallergic) effect. The ability of the drug to influence the metabolism in tissues allows it to stimulate the process of destruction of bone growth on the heel.

Blockade "Diprospan" can be conducted by courses. Usually treatment is limited to one or two procedures, less often do a third injection. The effect of the injection usually lasts at least 10 days, after which, if necessary, a repeat procedure can be prescribed.

"Hydrocortisone" is also a steroid based on synthetic hormones, similar to that synthesized in the body by cortisone. This is a budgetary treatment option, however, it requires a few more injections (3 to 5) with a minimum interval between them, so that the drug accumulates in the tissues, because only in this way can it achieve high efficiency.

"Kenalog" is a synthetic glucocorticoid, which along with "Diprospan" is able to cope with the pain syndrome and inflammation in a short time, providing a long-term remission of the disease. But choosing this drug, you need to understand that his injections can cause the maximum number of complications.

Talk about the recommended dosage of drugs used for blockade is not necessary, because the doctor solves this problem individually, in accordance with the severity of the inflammatory process. Insufficient dose may not give the desired effect, and an overdose of hormones will negatively affect the work of the body. In addition, many steroids in large doses tend to have a depressing effect on the pituitary-adrenal system, which leads to hormonal imbalance.

The effectiveness of the blockade of the heel spur directly depends on the talent of the surgeon and the correct dose of the medicine. After all, mistakes in calculations and at the time of medical manipulations can lead to various complications, the lack of effect from which and the intensification of pain are the most harmless of them.

Contraindications to the procedure

Blockade of the calcaneal spur is a procedure consisting in the injection of anti-inflammatory drugs into the pain site. Like any other injection, it has no contraindications to the procedure itself. But such restrictions may have steroid drugs introduced during the procedure, which were never considered harmless drugs. Not for nothing that they are prescribed only if the treatment is not steroid-free.

Each of the drugs used can have its contraindications for use. For betamethasone-based drugs: acute viral and bacterial infections, fungal diseases at the injection site, diabetes mellitus, gastrointestinal lesions, mental disorders, bone osteoporosis and osteomyelitis, active tuberculosis, Itenko-Cushing syndrome, diverticulitis, thrombophlebitis, glaucoma. Undesirable treatment with the drug and with pathologies such as psoriasis, streptococcal lesions of the heart, inflammatory diseases of the joints (arthritis).

Blockade hydrocortisone is not performed with systemic fungal diseases and thrombocytopenic purpura, infectious lesions of joints and system infections, Itenko-Cushing syndrome, propensity to thrombosis, herpetic infection, chicken pox, severe degree of arterial hypertension.

Not less contraindications and the drug "Kenalog". It is not prescribed for diseases of the bones, ulcerative lesions of the stomach and duodenum, glaucoma, diabetes, increased propensity to vascular thrombosis and bleeding, Isenko-Cushing syndrome. It is extremely cautious to treat injections of the drug in people with impaired liver function, hypo- or hyperfunction of the thyroid gland, with immunodeficiency, epilepsy, cardiac dysfunction, obesity.

The general contraindication for blocking the calcaneal spur is pregnancy and the period of breastfeeding, the first weeks after surgery, oral contraceptives, serious hormonal disorders, severe cardiovascular diseases, impaired calcium absorption and endocrine diseases. The procedure is not performed in an acute period of infectious diseases without appropriate antibiotic therapy.

Absolute contraindication for the introduction into the body of any medication, regardless of the location of the injection or the way of administration, is considered to be an individual intolerance to the components of the drug. With increased sensitivity to steroids, it is possible to develop not only allergic, but also anaphylactic reactions that are dangerous for the patient's life.

It is important to consider that the patient's hypersensitivity may not be to the corticosteroid itself, but to the anesthetic injected with it, which happens even more often. Thus, it is necessary to select both preparations carefully, taking into account the sensitivity of the patient's organism to them.  

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Consequences after the procedure

Blockade of the calcaneal spur is considered an effective procedure, which allows literally in a couple of minutes to remove the painful person for a long time pain in the foot. Severe pain in the heel significantly restricts the motor activity of patients and, of course, most negatively affects the quality of human life. Hypodinamy leads to the development of many other diseases, including diseases of the spine, which increase the burden on the plantar fascia. It turns out a vicious circle, to break out of which just allows injection of corticoids into a sore spot.

The main advantage of the procedure is the rapid disposal of pain, which could not be suppressed by usual medication. The patient gets the opportunity to walk normally and prevents complications of a sedentary lifestyle imposed by a calcaneal spur.

No less important is the fact that injections of steroids help to quickly cope with inflammation, because the longer the process lasts, the stronger it weakens the periosteum and the more actively the heel moves the body to the heel area. A long-lasting inflammatory process, thus, will promote the growth of the osteophyte, while injections of corticoids will help reduce the severity of inflammation and the destruction of bone growth.

Theoretically speaking, blockade of the calcaneal spur looks very useful and effective procedure, but in fact it is very difficult to predict all the consequences of such treatment. First, the body of different people reacts differently to pain and hormones administered. Secondly, it would be superfluous to recall that the effectiveness and safety of the procedure in many depends on the professionalism of the surgeon or orthopedist, the experience of such injections, responsible treatment of them.

If the drug is selected correctly and the injection reaches its goal, along the way without damaging the muscles, tendons and nerves, the patient will feel almost instant relief. Otherwise, the pain may only increase, and later there will be other dangerous complications, which most often happens if the solution is not injected into the osteophyte, but into the surrounding soft tissues.

And even if the procedure was successful, this does not guarantee a complete cure for the pain for a long time, which is associated with the need for repeated injections, and in some cases it is necessary in the future to resort to surgery to remove the calcaneal spur. The fact is that plantar fasciitis is a chronic disease, prone to exacerbations, and even on the site of a remote osteophyte, a new one can form after a time, provoking inflammation of surrounding tissues and pain.

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Complications after the procedure

We already mentioned that the injection of hormonal drugs into the heel, which is called the blockade of the calcaneal spur, is not a safe operation at all. Therefore, before you decide on such an extreme measure, you need to carefully think and weigh everything, make inquiries about the clinic and the doctor who will conduct the procedure (work experience, the number of successful injections, the results of patients).

Blockade of the heel spur is not in vain appointed to patients only in cases when other available methods of treatment (except surgery) are tried, but relief of pain has not come. The percentage of patients who injected helped to get rid of heel pain permanently is small. In most cases, patients are confronted with a temporary effect, just the time of remission in different patients may be different.

In principle, this procedure for effectiveness is not much different from other methods of drug treatment. It simply gives a faster and stronger effect, but its results can only be viewed in real time, without looking far into the future. Steroids can not fundamentally affect the metabolic processes in the body, and the local effect on the heel area does not have a long-term effect, despite the fact that it is fraught with various unpleasant complications.

The most simple side effects of hormonal injections are local reactions in the form of pain, redness and edema of the tissues at the injection site, allergic reactions to the drug in the form of rash, peeling, skin itching, etc. But steroid injected in the form of injectable solutions, there are more unpleasant "pobochki": the development of a purulent-inflammatory and necrotic process in the place where the injection was made. Most often, this happens because of carelessness or unprofessional physician. And the matter is most often not even in the infection, but the solution gets into soft tissues, and not into the osteophyte.

The long-term consequences of the procedure can be considered the development of osteoporosis, problems with bones and joints due to active leaching of calcium from the bone at the injection site of steroids (the risk of fracture of the calcaneus, the structure of the cartilaginous tissue is disrupted), inflammation of the tendons in the lower part of the shin place of injection.

The most dangerous consequence of injecting the heel spur with steroids is the weakening and destruction of the plantar fascia tissues, as a result of which a rupture can occur. In the absence of depreciation provided by the fascia, the load on the remaining foot tissues will be markedly increased, which will cause a change in gait and the development of degenerative processes in the foot.

So far, it was only about local reactions. But we need to understand that hormonal drugs can negatively affect the pituitary and adrenal glands, inhibiting their function. One or two injections can hardly do much harm. But in the absence of a long-lasting effect, the steroid stitches have to be repeated, and each time the interval between courses will decrease due to banal addiction.

In some patients, purulent eruptions on the body (acne), muscle weakness and muscle atrophy (myopathy), decreased libido, menstrual irregularities, neuropsychiatric disorders, the appearance of ulcers on the stomach and intestinal mucosa, an increase in blood pressure , the development of eye pathologies (glaucoma, cataract, etc.). Hormonal remedies are not inadvertently considered unsafe medicines and are not appointed without special need.

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Care after the procedure

Blockage of the calcaneal spur is a procedure aimed at removing a strong pain syndrome and improving the quality of life of the patient. Its effectiveness largely depends on the patient's desire to cope with the disease. Alas, most people regard the withdrawal of pain as an excuse to relax, because when you return the symptom you can again make an anesthetic injection. And few people think that with each time the effectiveness of procedures will be lower, and harm to the body more and more.

Treatment of the injection site with antiseptics, its protection from infection and monitoring of the microscopic wound condition does not solve the problem of bone growth. And even protecting the foot from the load within 1 hour after the procedure, it will not be possible to protect it from further "violence", damage to the fascia and their inflammation. And inflammation is a provoking factor in the disturbance of metabolic processes in tissues.

Injections of hormones can temporarily help fight inflammation, then everything depends on the person. The main causes of excessive stress on the fascia of the foot, causing their damage and inflammation, are flatfoot, running and obesity. Factors provoking metabolic disturbances are endocrine diseases, for example, diabetes, hypo and hyperthyroidism. It turns out that if a person engages in treatment of the above pathologies, will limit for the time of restoring exercise and closely engage in extra pounds, he has all the chances after a while to give up painful injections, go to a local non-injection treatment, and maybe even do without it.

Relapses of the calcaneal spur, i.e. The reappearance of bone growth after its destruction can be considered the result of an incorrect way of life and approach to the treatment of the disease. If you do nothing with excess weight and concomitant pathologies, the inflammatory process will occur again and again, adversely affecting the periosteum of the calcaneus and attracting the calcium salts from which the osteophyte will be built.

Subsequent local drug treatment with anti-inflammatory drugs from the category of NSAIDs, physiotherapy procedures, exercise therapy are all procedures that should not be abandoned until a lasting effect is achieved. But in order to consolidate the results of treatment of the calcaneal spur a person should listen to the doctor's recommendations not to overload his leg, wear orthopedic shoes or special insoles, make a complete and balanced diet and regularly monitor their weight.

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Reviews about the procedure

Blockage of the calcaneal spur is a very painful injection, so few can boast that he easily managed to endure the pain. It is because of the painful prick, and also due to the high risk of side effects, that people can not decide for a long time to blockade. All the same, the piercing pain and insufficiently long-lasting result can be called rather unattractive factors, especially as there are safer methods of treating the spur.

And yet, one can understand people who not only agreed to the procedure, but also leave positive comments about it. After all, what is the minute of pain during the injection in comparison with the infernal agony experienced by a person with a calcaneal spur when pressing on the heel, and sometimes even at rest. Positive feedback is, and there are a lot of them. Leave such reviews those patients who managed to get rid of the pain for a year and a half or more, while the procedure was successful without unpleasant consequences.

But judging by the reviews, side effects of the medication are to some extent observed in almost half of the patients, so the joy of temporary relief from pain is overshadowed by the need to treat the violations occurring after the injection.

The effectiveness of blockade of the calcaneal spur is difficult to judge, and due to the fact that most of the reviews are left by those to whom the injection brought only temporary relief. Relapse of pain required them to conduct a subsequent course of injections. But if the first interval between the courses was 1-1.5 years, then the second - only six months. Between the second and third course, the gap was reduced to 2-3 months. Such results indicate a gradual addiction of the body and that, in the absence of other methods of treatment, there is essentially no improvement, despite the fact that the effect of anesthesia is gradually decreasing.

A relatively small percentage of people claim that the pain after the procedure did not go away at all or became only slightly less. Usually this result is attributed to the fact that the injection was done incorrectly and the treatment solution did not reach its destination. At best, everything is limited by the lack of effect, but it can also lead to inflammation of the soft tissues of the foot, the development of necrotic processes in them. This once again shows how important it is, having decided upon the procedure, to entrust yourself in the hands of an experienced surgeon or orthopedist with extensive experience in conducting such operations.

On the Internet there are many enthusiastic reviews and from people who have recently successfully survived the procedure and have received the long-awaited release from pain. But how these diseases will develop in these people is difficult to foresee further. And will they not be disappointed in the same way as those who first boasted of positive results, and then on one not the best day the pain returned again, and with it also the need to fight with pain.

Those who received a stable result do not write what works they were worth, what they did in addition, so that the pain did not return, how their lives changed in connection with the need to fight excess weight, to give up their careers in sports, etc. Simply infernal pain caused people to look at the problem differently, and the understanding that the effect of the injection is short-lived, do everything to achieve a stable remission.

Blockade of the calcaneal curtain is not a panacea for plantar fasciitis and formation of a bone growth on the heel provoking inflammation of surrounding tissues and transferring it to a chronic form. This is only one of the fastest and most effective methods to cope with severe pain that does not allow a person to normally rest and work. In the future, the person still has a long way to recovery, and the result of treatment will depend on the strength of the patient's desire to forget about the pain forever