Heel spur blockade

If a person suffers from severe pain that cannot be relieved by taking painkillers orally, intravenously, or locally with solutions and ointments with anesthetic action, doctors resort to the last resort - a medicinal blockade of the painful focus. Pain of this nature in the heel area is a frequent sign of plantar fasciitis with the formation of a bone growth in the inflammation focus. It is this growth, which is painless in itself, that, due to pressure on soft tissues and multiple nerve branches, maintains an active inflammatory process and causes severe pain. In order to relieve persistent excruciating pain that significantly reduces the patient's quality of life and forces him to lead a sedentary lifestyle, doctors may suggest a blockade of the heel spur using hormonal anti-inflammatory solutions, as the most effective and fastest way to combat pain.

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Indications for the procedure

A sudden, seemingly out-of-nowhere severe pain in the heel that prevents a person from putting normal weight on the foot is, in most cases, evidence of an inflammatory process in the tendons and fascia of the foot. This process often ends with the development of hyperplastic processes of bone tissue in the inflamed area - the formation of osteophytes, commonly called 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 excessive load on the legs and the foot in particular. This is facilitated by excess weight, improper walking and uncomfortable shoes, passion for high heels, activities associated with carrying weights, sports that involve a lot of load on the legs (this pathology can be called runner's disease).

It should be noted that spinal diseases can also cause increased load on the lower limbs. In addition, strong pressure on the fascia of the foot is typical for people with flat feet.

People who lead a sedentary lifestyle, which disrupts metabolism, can also be considered susceptible to plantar fasciitis, oddly enough. As a result, weight increases and obesity develops, the mineral composition of bone and cartilage tissue changes, and the characteristics of connective tissue change (it becomes less elastic and more susceptible to ruptures).

While we are only talking about inflammation of the plantar fascia caused by micro-tears of tissues and their regular traumatization, as a result of which the damaged fibers do not have time to recover, traditional drug treatment makes it possible to cope with pain, as one of the main symptoms of inflammation. But stopping pain does not mean curing the disease. Long-term healing micro-traumas of the fascia lead to the formation of scar tissue, which, although denser, is noticeably inferior in elasticity to the connective tissue of the fascia.

Scar tissue that is not prone to stretching can be damaged even with a small load, due to which the inflammatory process becomes chronic and spreads further to the periosteum of the calcaneus. Inflammation weakens the periosteum, which becomes thinner, while these tissues cannot recover on their own. The body, trying to compensate for the defect of the periosteum, begins to direct calcium to the site of damage. At first, it only restores the previous contour of the bone head, but over time, calcium formations begin to protrude beyond its limits, forming a small spike.

The body cannot be blamed for such a redistribution of the mineral, which is the building material of bone tissue, because there is a compensatory mechanism for this process. However, it is not so easy to restore the disrupted metabolism, so calcium continues to flow to the damaged periosteum even when there is no longer a need for it.

A small bone growth may not cause pain if the person's motor activity is low and the inflammation does not affect the sensitive nerve endings nearby. Large growths are rarely asymptomatic.

As the osteophyte grows and its pressure on the surrounding soft tissue increases, the pain intensity also increases. When a person leans on it, the bone growth injures the muscle and nerve tissue, causing and maintaining inflammation in them, which is fraught with swelling of the heel tissue and severe pain that can torment a person even at rest.

Local treatment with anti-inflammatory drugs in the presence of a heel spur will no longer have a good effect, because the sharp thorn, continuing to regularly injure the soft tissues of the heel, does not allow the inflammatory process to be completely stopped. In addition, it is not so easy for the medicine to penetrate the inflammation itself through fairly dense skin and a thick layer of muscle and connective tissue. Internal use of anti-inflammatory and painkillers does not give sufficient effect either.

When the pain becomes unbearable and local treatment with medications does not bring relief, doctors resort to a not very popular procedure associated with a certain risk. Medicinal blockade of the heel spur will relieve pain and relieve symptoms of inflammation almost instantly, but the injection is so painful that not everyone can decide to do it. In addition, the procedure requires high professionalism of the doctor, because any mistake is fraught with serious complications.

It should be said that the blockade is not a full-fledged treatment procedure, although in some cases it allows you to get rid of pain forever. If the bone growth is not removed, it will continue to injure the surrounding tissues. After a while, the pain may not only return, but also become even stronger. Therefore, doctors consider the blockade of the heel spur only as an extreme measure to combat unbearable 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 heel area that does not respond to traditional treatment methods is an indication for a drug blockade only when the necessary examination of the patient has been carried out and a final diagnosis has been made. After all, the pain itself only indicates that there is some pathological process in this area of the body. But what exactly it is, can be found out after the diagnosis.

Acute or severe dull pain when pressing on the heel and swelling of the tissues in this area, of course, prompt the doctor to think that they may be caused by inflammation of the plantar fascia in the area of attachment to the heel bone or the formation of an osteophyte in this place. But such symptoms are also characteristic of a dislocated leg, a bone fracture, or a sprained ligament. In this case, pain relief will only hide the symptoms of the injury and can cause irreparable harm.

X-ray diagnostics helps differentiate heel spurs from plantar fasciitis, traumatic foot injuries, and some bone and joint pathologies. An X-ray of the foot will show a characteristic spiky bone growth in the heel area, which is surrounded by inflamed soft tissues. No palpation can provide such comprehensive information about the presence, location, and size of the osteophyte. But these points are very important for the doctor who will need to perform a heel spur block, because he must know the location of the source of the most severe pain with millimeter accuracy.

Urine and blood tests will confirm the presence of an inflammatory process in the body, and although they cannot provide information about its localization, they can identify some metabolic disorders that affect the course of the disease. In addition, laboratory tests provide information about the state of various organs, including those involved in the metabolism and excretion of drugs entering the body. This is important to consider when choosing a method for treating heel spurs and the drugs used, each of which may have its own contraindications and side effects.

If we are talking about treating a heel spur in a woman of childbearing age, she will need a consultation with a gynecologist, after all, we are talking about the introduction of hormonal agents, which, although slightly, can affect the hormonal background. In some pathologies of the female reproductive system, hormonal drugs can even cause some harm.

When a patient comes for a procedure, he or she should have the test results and an X-ray film with a description. No special preparation is required. But doctors may recommend performing foot hygiene procedures the day before, including steaming the hardened skin on the heel, cleaning it and, if possible, partially removing it with a special foot brush or pumice stone. This will make it easier for the doctor to access the sore spot, since this will require a puncture of the skin and internal tissues.

The severe pain of the procedure is one of the main factors for the low popularity of the blockade. And if a person has decided to have an injection, he or she must first prepare themselves for the fact that they will have to endure several excruciating minutes. In case of severe nervous tension and fear, sedatives can be taken, but painkillers are highly undesirable.

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Technique heel spur blockades

Heel spur blockade is a special injection into the heel area that allows you to quickly relieve severe pain and stop the inflammatory process. Despite the apparent simplicity of the procedure, it is a rather responsible procedure. In order for everything to go smoothly and give good results, it requires, one might say, the fine work of the surgeon who will make the injection.

The procedure is performed in a hospital setting in a specially equipped room, which implies maintaining sterility. All manipulations are coordinated with an X-ray image, according to which a diagram is applied to the heel area, and the image displayed on the monitor by the ultrasound machine. Before inserting a needle into the flesh, the doctor must carefully consider various points: mark the puncture site, the direction of the needle, the depth of its immersion, because the goal of the injection is to get directly into the source of pain - the point where the pain is maximum.

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

The desired point is determined by the doctor by palpation, but the depth of penetration of the needle can be determined using X-rays and ultrasound of the foot. After the necessary information is obtained, the patient can be injected with a mixture of anesthetic and corticosteroid (novocaine, lidocaine, etc.).

During the procedure, the patient should be in a horizontal position, which will reduce muscle tension and allow the person to relax and calm down as much as possible. Since the injection is very painful and the patient may twitch during the manipulation, which will lead to the needle being displaced inside the tissue, the affected limb should be firmly fixed in a position convenient for the doctor, but the heel should hang freely.

It is not for nothing that the procedure is performed under ultrasound control, because during the movement of the needle inside the soft tissues 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 control the instruments, control the movement of the needle, bypass obstacles and get to the very point of greatest pain, i.e. directly into the bone growth, and not any other obstacle in the path of the needle.

It is important for the surgeon to hit the center of the bone spurs, which is much more difficult than injecting into soft tissue, so the procedure takes a little longer. And, despite the fact that relief after the injection occurs 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 heel spur blockade is supplemented with a kinesiotaping procedure. An elastic adhesive tape is applied to the area of the foot and calf, allowing the foot to be fixed in a position in which the joint will experience minimal stress during walking. This device will act as a kind of shock absorber when pressure is applied to the foot and a corrector of correct gait.

Preparations for blocking heel spurs

An injection, which is made in the most painful place with a heel spur, is intended to relieve pain in the foot and reduce inflammation symptoms as much as possible. Anti-inflammatory drugs from the corticosteroid category have such properties. An injection of a hormonal drug into the osteophyte area reduces the production of inflammation mediators and antibodies, and also reduces the sensitivity of tissues to them at the site of the lesion, reduces the permeability of small blood vessels, has a supporting effect on the structures of healthy cells, and promotes the destruction of osteophytes by stimulating blood circulation and metabolism.

It is clear that one injection cannot completely destroy a heel spur, but it is quite capable of solving the problem of severe pain and reducing the severity of the inflammatory process, if we are talking not about a simple anesthetic, but about a strong anti-inflammatory agent. To get rid of a bone growth, 2 or more injections may be needed, depending on the chosen drug.

The following steroid agents can be used as drugs of choice for blocking heel spurs:

• injection suspension "Diprospan" and its analogues "Betamethasone", "Flosteron",
• suspension "Hydrocortisone",
• drug for intramuscular and intraarticular administration "Kenalog".

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

The blockade with Diprospan can be carried out in courses. Usually the treatment is limited to one or two procedures, less often a third injection is given. The effect of the injection usually lasts at least 10 days, after which a repeat procedure can be prescribed if necessary.

"Hydrocortisone" is also a steroid based on synthetic hormones, similar to cortisone synthesized in the body. This is a budget treatment option, although it requires a slightly larger number of injections (from 3 to 5) with a minimum interval between them so that the drug accumulates in the tissues, because only in this way can it be highly effective.

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

There is no need to talk about the recommended dosages of drugs used for blockade, because the doctor decides this problem individually, in accordance with the severity of the inflammatory process. An insufficient dose may not give the desired effect, and an overdose of hormones will negatively affect the functioning 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 heel spur blockade directly depends on the talent of the surgeon and the correct dosage of the drug. After all, errors in calculations and during the treatment can lead to various complications, the lack of effect of which and increased pain are the most harmless of them.

Contraindications to the procedure

Heel spur blockade is a procedure that involves injecting anti-inflammatory drugs into the painful area. Like any other injection, it has no contraindications to the procedure itself. But such restrictions may apply to steroid drugs administered during the procedure, which have never been considered harmless medications. It is not for nothing that they are prescribed only when non-steroidal treatment is ineffective.

Each of the drugs used may have its own contraindications for use. For betamethasone-based drugs, these are: acute viral and bacterial infections, fungal diseases at the injection site, diabetes mellitus, ulcerative gastrointestinal lesions, mental disorders, osteoporosis of bones and osteomyelitis, active tuberculosis, Itsenko-Cushing syndrome, diverticulitis, thrombophlebitis, glaucoma. Treatment with the drug is also undesirable for such pathologies as psoriasis, streptococcal heart disease, inflammatory joint diseases (arthritis).

Hydrocortisone blockade is not performed in case of systemic fungal diseases and thrombocytopenic purpura, infectious joint lesions and systemic infections, Itsenko-Cushing syndrome, tendency to thrombosis, herpes infection, chickenpox, severe arterial hypertension.

The drug "Kenalog" has no fewer contraindications. It is not prescribed for bone diseases, gastric and duodenal ulcers, glaucoma, diabetes, increased susceptibility to vascular thrombosis and bleeding, Itsenko-Cushing syndrome. Extreme caution should be exercised when injecting the drug in people with liver dysfunction, hypo- or hyperfunction of the thyroid gland, immunodeficiencies, epilepsy, heart disorders, and obesity.

General contraindications for performing a heel spur blockade are pregnancy and breastfeeding, the first weeks after surgery, taking oral contraceptives, serious hormonal imbalances, severe cardiovascular diseases, calcium absorption disorders and endocrine diseases. The procedure is not performed in the acute period of infectious diseases without appropriate antibiotic therapy.

An absolute contraindication for the introduction of any medication into the body, regardless of the injection site or method of administration, is 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, which are life-threatening for the patient.

It is important to take into account that the patient may be hypersensitive not to the corticosteroid itself, but to the anesthetic administered with it, which happens even more often. Thus, both drugs must be carefully selected, taking into account the sensitivity of the body of a particular patient to them.

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Consequences after the procedure

Heel spur blockade is considered an effective procedure that allows literally in a couple of minutes to relieve painful sensations in the foot that have tormented a person for a long time. Severe pain in the heel significantly limits the motor activity of patients and, of course, has the most negative impact on the quality of life of a person. Hypodynamia leads to the development of many other diseases, including diseases of the spine, which increase the load on the plantar fascia. It turns out to be a kind of vicious circle, which can be broken out of by injecting corticoids into the sore spot.

The main advantage of the procedure is the rapid relief from pain that could not be relieved by conventional medication. The patient is able to walk normally and prevents complications of a sedentary lifestyle imposed on him by a heel spur.

No less important is the fact that steroid injections help to quickly cope with inflammation, because the longer the process lasts, the more it weakens the periosteum and the more actively the body moves calcium to the heel area. A long-term inflammatory process will thus contribute to the growth of osteophyte, while corticoid injections will help reduce the severity of inflammation and destroy the bone growth.

Theoretically speaking, heel spur blockade seems to be a very useful and effective procedure, but in reality it is very difficult to predict all the consequences of such treatment. Firstly, different people's bodies react differently to pain and hormonal agents. Secondly, it is worth remembering that the effectiveness and safety of the procedure largely depends on the professionalism of the surgeon or orthopedist, experience in performing such injections, and responsible attitude towards them.

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

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

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Complications after the procedure

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

It is not for nothing that heel spur blockade is prescribed to patients only in cases where other available treatment methods (except surgery) have been tried, but pain relief has not occurred. The percentage of patients who have been helped by an injection to get rid of heel pain forever is small. In most cases, patients experience a temporary effect, but the remission time may be different for different patients.

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

The most common side effects of hormonal injections are local reactions in the form of increased pain, redness and swelling of tissues at the injection site, allergic reactions to the drug in the form of rash, peeling, itching, etc. But steroids administered as injection solutions have more unpleasant "side effects": the development of a purulent-inflammatory and necrotic process at the site of the injection. Most often, this happens due to the carelessness or unprofessionalism of the doctor. And most often the matter is not even in the infection, but in the solution getting into soft tissues, and not into the osteophyte.

Remote consequences of the procedure may include the development of osteoporosis, problems with bones and joints due to the active leaching of calcium from the bone at the site of steroid injection (the risk of fracture of the heel bone increases, the structure of the cartilage tissue is disrupted), inflammation of the tendons in the lower part of the leg, located in close proximity to the injection site.

The most dangerous consequence of injection treatment of heel spurs with steroids is considered to be weakening and destruction of plantar fascia tissue, which can result in its rupture. In the absence of cushioning provided by the fascia, the load on the remaining tissues of the foot will be significantly increased, which will cause a change in gait and the development of degenerative processes in the foot.

So far we have only talked about local reactions. But it is important to understand that hormonal agents can negatively affect the functioning of the pituitary gland and adrenal glands, suppressing their function. One or two injections are unlikely to cause much harm. But in the absence of a long-term effect, the course of steroid injections must be repeated, and each time the interval between courses will decrease due to banal addiction.

Some patients may experience purulent rashes on the body (acne), muscle weakness and muscle atrophy (myopathy), decreased libido, menstrual irregularities, neuropsychiatric disorders, ulcers on the mucous membrane of the stomach and intestines, increased blood pressure, and the development of eye pathologies (glaucoma, cataracts, etc.) against the background of hormonal injections. It is not for nothing that hormonal agents are considered unsafe drugs and are not prescribed without special need.

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Care after the procedure

Heel spur blockade is a procedure aimed at relieving severe pain and improving the patient's quality of life. Its effectiveness largely depends on the patient's desire to cope with the disease. Unfortunately, most people regard pain relief as a reason to relax, because if the symptom returns, they can get another painkiller injection. And few people think that each time the effectiveness of the procedures will be lower and the harm to the body will be greater.

Treating the injection site with antiseptics, protecting it from infection and monitoring the condition of the microscopic wound does not solve the problem of bone growth formation. And even protecting the foot from stress for 1 hour after the procedure will not protect it from further "violence", damage to the fascia and their inflammation. And inflammation is a provoking factor in the disruption of metabolic processes in tissues.

Hormonal injections can temporarily help fight inflammation, then everything depends on the person. The main causes of excessive load on the fascia of the foot, causing their damage and inflammation, are considered to be flat feet, running and obesity. Factors that provoke metabolic disorders are considered to be endocrine diseases, for example, diabetes, hypo and hyperthyroidism. It turns out that if a person starts treating the above pathologies, limits sports activities during recovery and closely deals with extra pounds, he has every chance to refuse painful injections after a while, switch to local non-injection treatment, and perhaps even do without it.

Recurrences of heel spurs, i.e. the re-emergence of a bone growth after its destruction, can be considered the result of an incorrect lifestyle and approach to treating the disease. If nothing is done about excess weight and associated pathologies, the inflammatory process will occur again and again, negatively affecting the periosteum of the calcaneus and attracting calcium salts, from which the osteophyte will be built.

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

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Feedback on the procedure

Heel spur blockade is a very painful injection, so few people can boast that they easily managed to endure the pain. It is precisely because of the pain of the injection, as well as the high risk of side effects, that people cannot decide on a blockade for a long time. After all, piercing pain and insufficiently long-lasting results can be called rather unattractive factors, especially since there are safer methods of treating spurs.

And yet, one can understand people who not only agreed to the procedure, but also leave positive reviews about it. After all, what is that minute of pain during the injection worth compared to the hellish torment that a person with a heel spur experiences when pressing on the heel, and sometimes even at rest. There are positive reviews, and there are many of them. Such reviews are left by those patients who managed to get rid of pain for a year and a half or more, and the procedure was successful without any unpleasant consequences.

But judging by the reviews, side effects of the drug to one degree or another are observed in almost half of the patients, so the joy of temporary relief from pain is overshadowed by the need to treat the disorders that arise after the injection.

It is difficult to judge the effectiveness of the heel spur blockade also 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 undergo a subsequent course of injections. But if the first interval between courses was 1-1.5 years, then the second was only six months. Between the second and third courses, the interval was reduced to 2-3 months. Such results indicate a gradual adaptation of the body and that in the absence of other treatment methods, improvement essentially does not occur, while the effect of pain relief gradually decreases.

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, such a result is associated with the fact that the injection was done incorrectly, and the medicinal solution did not reach the destination. In the best case, everything is limited to 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 on the procedure, to entrust yourself to an experienced surgeon or orthopedist with extensive experience in performing such operations.

There are many enthusiastic reviews on the Internet from people who have recently successfully undergone the procedure and received long-awaited relief from pain. But it is difficult to predict how the disease will develop in these people. And will they not be disappointed, just like those who initially boasted about positive results, and then one not very good day the pain returned again, and with it the need to fight pain.

Those who got a lasting result do not write about the efforts it took them, what they did additionally to prevent the pain from returning, how their lives changed due to the need to fight excess weight, give up a career in sports, etc. It’s just that the hellish pain made people look at the problem differently, and the understanding that the effect of the injection is short-lived, made them do everything to achieve a lasting remission.

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