Spur

The calcaneus is a bone located in the heel of the foot. It is a bone with an irregular parallelepiped shape and on which a large part of the weight of the foot usually falls, so it is a solid and compact bone. On its posterior face the Achilles tendon is inserted and on its lower face, the one closest to the ground, there are three protrusions, one anterior and two posterior.

• What it is: an inflammation caused in the sole of the foot and the heel due to excessive load and pressure.
• Symptom: severe pain in the heel area, in the form of pricks, when standing up.
• Tips: reduce physical activity and rest, correct excess weight, and adopt correct postural hygiene without overloading the heel area and using suitable footwear.

How is it produced?

At the base of the calcaneus and due to excessive and continuous pressure exerted on the bone, the bone tissue becomes chronically inflamed and an abnormal formation occurs that is usually hooked, spiky, like that found in some gallinaceous birds in the bottom and back of its legs; hence the name of spur.

At each step that is made, the heels have to support the entire weight of the body and with walking this load can reach 20 times the body weight. The repeated load of the gait movement is mitigated by the fat pad in the heel and on which the calcaneus bone sits, and by the plantar fascia, a fibrous layer that runs along the surface of the sole of the foot from the heel up to the fingers. If a continuous pressure of the musculature is made on these plantar structures, the bone can damage the plantar fascia, producing a wound, before which the bone will react as if it were a fracture, producing inflammatory tissue that will later calcify. forming the calcaneal bone spur.

In a third of cases the spur and the consequent inflammation of the plantar fascia, plantar fasciitis, affects both feet. It is usually common in people between the ages of 40 and 60. Obesity, professions that involve walking a lot or standing for a long time, and flat feet or cavities are risk factors for the appearance of a calcaneal spur. Its appearance is also related to trauma or the use of inadequate footwear with little support for the arch of the sole of the foot.

Symptoms

The symptoms of the calcaneal spur will be those derived from the pressure and injury that is exerted on the plantar fascia. There is severe pain, in the form of stitches, in the area of ​​the heel (called a heel pain). The pain improves with rest but reappears when moving again, that is why it is a pain that initially usually lets you rest but is especially noticeable when you stand up when you get up. The pain worsens with walking, especially when walking on hard ground that exerts more resistance to walking.

Diagnosis

The diagnosis will be based on the description of the pain that the patient makes. With a simple profile of the foot, the presence of the calcaneal spur can be appreciated. In general, no other supplemental test is required.

It is important to perform the differential diagnosis with Ledderhose disease, a rare connective tissue alteration that affects the entire plantar fascia, causing it to retract and causing deformation and pain.

Treatment

Hygienic posture and ambulation measures are essential in the treatment of heel spurs and consequent plantar fasciitis. The use of ergonomic footwear is required, with sufficient plantar support so that the heel does not practically rest on the ground. It is convenient and make a relative rest. If you do a physical activity such as running, it is advisable to warm up properly before physical activity and apply local cold at the end. It is also important to correct excess weight.

For the treatment of pain, more or less prolonged courses with non-steroidal anti-inflammatory drugs (NSAIDs) can be carried out. Sometimes corticosteroid injections can be performed in the area of ​​pain, but their effect is only short-term and they are usually quite painful. In cases of severe pain that does not respond to medical treatment after more than a year, surgery can be used, although 80% of cases usually improve in less than a year of conservative treatment.

Precautionary measures

The calcaneal spur can be prevented with correct postural hygiene, not overloading the heel area and trying to use appropriate footwear, as well as moderating physical activity. Before the appearance of pain it is important to contact the traumatologist.