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  • www.sportordination.at

Foot and Hock

Hock

Soccers' Ankle
[Translate to English:]

Calcaneal spur 

I am always talking to colleagues who enjoy running and who complain about uncomfortable pain in the region of the heel. Some explain that the pain is occasionally so bad when getting up in the morning that they feel as though they have stood on a nail. Walking is often possible again after a few limping steps.

The cause of this pain is often a calcaneal spur. This concerns an acanthoid osseous change to the bottom of the calcaneus at the attachment of the overstretched aponeurosis of the sole of the foot (plantar aponeurosis). Plantar aponeurosis is an aponeurosis that supports the arch of the foot in longitudinal and transverse loading (see also anatomy). If it is inflamed due to constant overexertion, the typical symptoms occur primarily on the medial side and/or on the bottom of the heel: stabbing pain that is mainly more severe in the mornings and when starting to run.

This means that there does not always have to be a definite ossification for the symptoms of a calcaneal spur, but rather the pain is caused by chronic inflammation that also involves the bursa at the calcaneus.

A calcaneal spur visible on an X-ray occurs in around 10% of the population, however the majority of people have no symptoms. Pain in the region of the calcaneal spur, however, can occur as a result of overexertion (age, obesity, running).

Anatomy:

 

The osseous foot has an arch shape. So that the arch of the foot does not constantly become flatter, it is stretched by the plantar aponeurosis, like an arch stretched by a cord. The plantar aponeurosis, also known as plantar fascia, consists of fibrous material and originates in the medial section of the calcaneus. From there, it divides into ligaments that are fixed to the toes. A lack of function can very rapidly lead to collapse of the arch of the foot with formation of a flat foot, midfoot symptoms and later to joint arthrosis.

Cause:

 

The trigger for the symptoms in the symptoms complex for calcaneal spur is inflammation of the plantar aponeurosis (= plantar fasciitis) caused by prolonged overexertion of the foot and the tendons, as a result of too much pressure and traction on the aponeurosis of the sole of the foot, the underneath of the heel. At the overstretched sites, repeated microscopic tears of the tendon and chronic inflammation of the surrounding tissue develop and, as a result, calcified deposits (in the same way the body deposits calcium after a bone fracture to heal tears of the tendon and achieve an element of stability) - a calcaneal spur develops. We also usually find such changes in tennis arm, as well as frequent additional inflammation of the periosteum.

The fact that heel pain can occur in obese patients as well as very active people and athletes also supports this explanation. Patients with a fallen arch/splay foot but also with a high arch have a tendency to heel pain.

In the same manner, a spur formation can also occur in the context of other inflammations (e.g. in rheumatic diseases). A fallen arch promotes formation of the calcaneal spur by changing the position of the calcaneus and causing pressure on the origin of the tendon.

The most common causes, however, are poor footwear and excessive or incorrect loading of the foot, for example caused by malpositions such as flat foot. Long periods of standing and running on hard ground, obesity, inadequate warm-up periods during sport and shrinking of the fat pad at the heel due to age produce a calcaneal spur.

Symptoms:

 

  • Severe stabbing pain occurs underneath or on the medial side of the heel when standing or walking.
  • The pain disappears when the foot is not used and is immediately more severe when standing up, particularly in the mornings. When the foot is relaxed (e.g. at night), the bursa swells significantly. The first step is then especially painful.
  • The symptoms worsen considerably when running over long distances. Running on hard ground is also painful.

 

Diagnosis:

 

The calcaneal spur can measure up to 10 mm in size. It can be investigated by means of palpation because the pressure on the middle of the calcaneus triggers pain. X-ray images are often taken to rule out other diseases such as rheumatism or tumours - or even a fatigue fracture of the calcaneus.

If no calcaneal spur is visible on the X-ray, an MRI can also be carried out to show chronic inflammation (plantar fasciitis).

Who is particularly at risk?

 

  • Long distance runners
  • Middle-aged weekend runners, as the shock-absorbing fat pad at the heel shrinks over the years
  • Persons with uncorrected malposition of the foot.

 

Treatment:

 

In terms of treatment, it can be said that surgery is generally the last resort. Non-surgical treatment options often quickly lead to success.

  • Inserts relieve the painful point on the heel by preventing direct contact of the heel with the floor when walking. Preferably in combination with physiotherapy (stretching exercises - these can also be carried out at home: e.g. in the mornings in bed, hold the leg up with the knee stretched, with a towel under the sole of the foot. Then stretching of the calf musculature when standing) and physical therapy (e.g. ultrasound treatment)
  • Night splints: these are special splints that are worn at night and pull the forefoot towards the head at an angle of approx. 5° during the course of sleep
  • Short or medium-term switch to alternative types of sport (cycling, swimming)
  • Anti-inflammatory medication (e.g. Diclofenac, Ibuprofen) can be prescribed as tablets. If that does not lead to success, cortisone can be injected in combination with local anaesthetics into the painful region (this is, however, very painful!!!).
  • Shock wave therapy: bundled sound waves (shock waves) are aimed at the painful site - short-acting anaesthesia is often required for this.
  • An operation is the last resort. The doctor separates the aponeurosis of the sole of the foot (plantar aponeurosis) and a part of the short foot musculature and removes the osseous calcaneal spur.

 

Prevention:

 

Take time before partaking in sport to warm up and stretch. Ensure you carry out stretching exercises after running.

In the case of obesity, you should start your training on a bicycle until you have achieved an adequate weight loss. You should not forget that each step when running exerts a weight loading of up to three times your body weight onto the arch of the foot.

Pain in the heel is an indication of overstraining. It is recommended that you elevate the leg, cool with ice and rest. You should refrain from doing sport whilst you still have pain.

Take advice from your doctor if you have a foot malposition.

 

Please note that medical indications and treatments change constantly. Sometimes these changes occur more rapidly than I am able to update on my homepage. Some information regarding dosage, prescription and compositions of medications may have changed in the meantime. Reading an internet page cannot replace visiting a doctor - it may be that during an examination and subsequent discussion with your doctor, other information is also communicated as a result of new scientific knowledge.