Removing the calcaneal spur: basic methods
Last reviewed: 23.04.2024
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In 95% of cases, calcaneal spur is successfully treated with conservative methods, and surgical removal of the heel spur is an extreme measure.
The criterion for its conduct is a serious degree of the disease, when the intensity of pain can not reduce all the tried methods and means of treatment, and the quality of life of patients is significantly reduced.
Indications for the procedure
If in the morning the first steps are accompanied by stitching pain in the heel, and so continues from day to day (with increased acute pain with increasing stress on the feet), then, most likely, the cause lies in the plantar fasciitis - inflammation of the supporting arch of the foot plantar (plantar) ligaments in the place of its attachment to the calcaneus.
It is in this place, as a result of deformation and inflammation of the fibers of the tendon of the calcaneus aponeurosis, that scar tissue is first formed, which gradually ossifies (ossified) to form a build-up on the bone-the marginal osteophyte, which is called the heel spur. Its pressure on the surrounding heel of the tissue and the termination of the lateral and medial plantar nerves leads to the appearance of acute pain.
The location of the marginal osteophyte is the area of the calcaneal tubercle from the plantar side or the Achilles tendon attachment zone, and sometimes the lateral surface of the heel. By the way, bone spurs (large and very painful) can develop even on the anterior part of the ankle due to arthritis of the ankle.
It should be borne in mind that the presence of a calcaneal spur is not necessarily accompanied by pain: according to some estimates, up to 15-20% of people have an asymptomatic marginal osteophyte, which can be detected accidentally - during the radiograph of the foot on a completely different occasion.
Therefore, only a strong pain syndrome, which can not be removed within 6-9 months from the start of treatment (administration of non-steroidal anti-inflammatory drugs, injections of glucocorticoids, physiotherapy procedures, exercise therapy for plantar ligament dilatation, etc.) may be an indication for an operation in which removal of the heel Spurs are performed surgically.
Surgical removal causes a lot of conflicting opinions, and clinical studies show a high risk of complications after surgery. An alternative to surgery is non-invasive removal of the heel spur by shock wave therapy (extracorporeal shock wave therapy, ESWT). Laser removal of the heel spur is also possible.
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Preparation
Usually the preparation for surgical intervention for a calcaneal spur requires the submission of a general blood test and a coagulogram.
To identify the plantar osteophyte, an X-ray of the foot is needed, but the doctor may assign an ultrasound or an MRI to better visualize the defect, since it is very important to differentiate between fasciitis and ankylosing spondylitis, Reiter's syndrome or rheumatoid arthritis.
One to two weeks before surgery, laser or shock wave therapy, one should not take anticoagulants, do GSK injections and use non-steroidal anti-inflammatory drugs to relieve pain.
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Technique of the removal of calcaneal spur
Surgical operations to remove the calcaneal spur involve partial dissection of the plantar fascia, resulting in a decrease in its tension and improvement in the functioning of the foot.
The technique of carrying out such an operation involves the simultaneous removal of the marginal osteophyte. Plantar fasciotomy can be performed through direct access to a bundle with tissue dissection on the inside of the leg (medial approach) or through a cut at the sole. The plantar incision is used more often, since it gives easy access to the bone spur on the lower part of the heel with its direct visualization (absent with medial access).
Practiced in modern orthopedic surgery, minimally invasive heel spur removal - percutaneous (percutaneous) endoscopic fasciotomy. This is an endoscopic method of eliminating the permanent overstretch of the fascia of the sole by cutting it from the lower surface of the calcaneus (at the site of the localization of the osteophyte) and removing the bone growth through two ports (small incision). Like the usual fasciotomy, this operation is performed under spinal anesthesia.
Also, the heel spur is removed through one small incision - with X-ray monitoring of manipulations. First a special mini-scalpel is performed by fasciotomy, and then a cuticle cut from the bone with a miniature cutter.
Foreign orthopedists use the method of percutaneous fasciotomy TX MicroTip, which combines traditional ultrasound technology and microsurgery.
When treating ESWT for one session lasting 20-30 minutes use one or two thousand high-energy pulses generated by special equipment; usually, four to five procedures are performed at intervals of one week. The microscopic traumatic effect of these waves on the plantar fascia tissues stimulates the process of natural regeneration of damaged cells (by activating growth factors), which begins with the improvement of blood supply and trophism of tissues that help to relieve inflammation and pain. Read also - Ultrasound with calcaneal spur
The removal of the heel spur by shock wave therapy is performed with intravenous sedation and local anesthesia. The average value of the shock wave in this case is higher (up to 20.6 kV), and the number of pulses reaches 2.5 thousand.
Removal of the calcaneal spur with a laser with a low frequency of radiation is performed on an outpatient basis by several procedures: twice a week for 4-5 minutes each. According to foreign clinical statistics, complete recovery after laser removal of the osteophyte on calcaneus is noted in 32% of cases, a significant improvement in 16%, moderate in 24%, and a lack of result was recorded in 28% of patients. Nevertheless, this is a good method of primary treatment of plantar fasciitis.
Contraindications to the procedure
Laser removal and treatment of calcaneal spur by radiation from an optical quantum generator is contraindicated in patients with tumor formations of any etiology and localization, in the presence of metal bone implants in the corresponding limb, in hyperthyroidism, severe heart failure, vascular or dermatological diseases of the lower limbs. This procedure can not be performed by pregnant women.
Shock wave therapy (with the help of acoustic waves) is not used by oncologists, patients with diabetic polyneuropathy or an implanted pacemaker, with acute infections, bleeding disorders and any problems with the heart or circulatory system, as well as during pregnancy.
Contraindications for surgical removal of the spur include all of the listed cases.
Consequences after the procedure
Possible consequences after the procedure of spur removal by surgical fasciotomy are to increase pain in the ankle (metatarsalgia), swelling, bruising and bleeding. And among postoperative complications there is a probability of infection with the development of inflammation, a decrease in the height of the arch of the foot, the development of compartmental syndrome (increased pressure in the tissues under the plantar ligament resulting in their necrosis), damage to nerve fibers and numbness of the foot (often with weakness in the extremities).
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Complications after the procedure
Complications after the procedure of spur removal by the laser are manifested in swelling of the foot tissues, temporal local (in the heel region and sole) hyperthermia and hyperemia.
Practically there are no complications after the procedure of ESWT-removal of the spur: there may be small and fast enough edema of the foot.
Care after the procedure
It is clear that withdrawal after open fasciotomy requires antiseptic treatment of the suture, which is removed about a week after the operation. And the restoration of patients - to the possibility of walking alone - usually lasts about 6-10 weeks.
If an endoscopic minimally invasive removal of the calcaneal spur was performed, the patients recovered more quickly: in 3-6 weeks. But, as the surgeons say, it all depends on the characteristics of the patient's body and the specific clinical situation.
After removal of the heel spur by laser or shock wave method, special care is not required, it is necessary to reduce the load on the foot in the first two weeks and it is necessary to use orthopedic insoles, which are recommended to be worn constantly.
Alternative means to remove the heel spur
From the point of view of evidence-based medicine, folk remedies for removing the heel spur, in fact, can reduce the pain syndrome, but they can not destroy the marginal osteophyte.
Especially popular are the recipes with vinegar to remove the heel spur that appears on the outside of the heel (behind), this is the so-called posterior heel - Achilles spur or Haglund deformity.
One of these recipes is to prepare a mixture of 100 ml of vinegar (normal or apple) and the same amount of melted butter, which put one raw egg (in the shell). The mixture must be kept in a dark place for three days, then mixed and daily, at night, applied to a sore heel, tying and socking. They say that the pain goes through two to three weeks of such procedures.
It is recommended to use an ointment consisting of their vegetable small, acetic essence and mustard powder, taken in equal proportions.
Good reviews regarding the analgesic effect of paraffin compresses, compresses from cabbage leaf with honey, with warm linseed oil and turpentine, in the foot baths with salt and iodine.
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