Heel Spur/ Calcaneal Spur

Heel Spur/ Calcaneal Spur

A heel spur, also known as Calcaneal spur is a pointed bony outgrowth of the heel bone (the calcaneus bone) that extends from the underneath of the heel towards the arch (the middle of the foot).

                                    Figure: Heel Spur

Chronic local inflammation at the insertion of soft-tissue tendons or plantar fascia is a common cause of bone spurs (osteophytes). Heel spurs can be located at the back of the heel or under the heel, beneath the arch of the foot. Heel spurs at the back of the heel are frequently associated with inflammation of the Achilles tendon (tendinitis) and cause tenderness and heel pain made worse while pushing off the ball of the foot.

Causes:

• Heel spurs occur when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of long time.
• Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone.
• Tearing the membrane that covers the heel bone is also a cause

Risk Factors:

• Athletic activities: Running and jumping can wear down the heel and arch of the foot.
• Activity on hard surfaces: Frequently walking, running, or jumping on hard surfaces can wear down the heel.
• Trauma to the heel: Bruising the heel and tearing the membrane that covers it can lead to heel spurs.
• Getting older: heel spurs are common in older men and women.
• Being female: heel spurs are more common in women than men.
• Being overweight: heel spurs were related to obesity.
• Improper footwear: Frequently wearing shoes that do not fit properly, have lost their support, or are not supportive, such as flip-flops, can lead to heel spurs.
• Frequent short bursts of physical activity

There are some medical conditions that can risk of heel spurs

• Having either flat feet or high arches
• Diabetes
• Arthritis
• Ankylosing Spondylitis
• Diffuse idiopathic skeletal hyperostosis
• Reactive arthritis (Reiter’s disease)
• Peroneal tendonitis
• Haglund’s deformity (with or without bursitis)
• Sever’s disease (calcaneal apophysitis): inflammation of the calcaneal apophysis due to overloading
• Traumatic Influences
• Calcaneal fractures (and stress fractures): fractures as a consequence of repetitive load to the heel
• Baxter nerve entrapment: chronic compression of the first branch of the lateral plantar nerve
• Tarsal tunnel syndrome (sinus tarsi): Impingement of the posterior tibial nerve
• Clinical (Tinel’s sign, dorsiflexion-eversion test)
• Heel fat pad syndrome: Atrophy or inflammation of the shock-absorbing fatty pad or corpus adiposum
• Chronic lateral ankle pain with other causes.

Symptoms

• sharp pain like a knife in the heel when standing up in the morning
• a dull ache in the heel throughout the rest of the day
• inflammation and swelling at the front of the heel
• Burning, hot sensation
• Tenderness that makes it painful to walk barefoot
• heat radiating from the affected area
• small, visible bone-like protrusion under the heel
• point of tenderness at the bottom of the heel that makes it hard to walk barefoot

Investigation

X-ray: X-ray shows the bony protrusion

Diagnosis

Your Physiotherapist will ask you about your history of heel pain and examine your foot for tenderness at the bottom of the foot, near the heel which makes it difficult to walk barefoot on hard surfaces, and check the range of motion of the foot.

With this assessment and sign symptoms, an X-ray will confirm the diagnosis of the heel spurs.

Treatment

For the majority of people, heel spurs do get better with conservative treatment that may include:

1. Rest: Getting plenty of rest and taking pressure off the feet can help to reduce pain and swelling in the affected area.
2. Icing: Cold therapy used to relieve inflammation and reduce pain, Ice Massage- Ice on the area of inflammation for anti-inflammatory effects. Use ice in a paper or Styrofoam cup (peeled away) for 5-7 minutes, make sure to avoid frostbite
3. Hot compression: Heat therapy to loosen tense muscles and promote oxygen and blood flow to the affected area. Thermotherapy might be useful for the reduction of pain during exercises.
4. Ice and hot compression: Cold compresses are preferable over heat packs for heel spurs because heat works better for joint and muscle aches.
5. Using custom-made orthotics (shoe inserts): These donut-shaped inserts go inside the shoe to take the pressure off the heel.

Figure: Heel cushion

• Wearing cushioned sports shoes: These may also help to relieve pressure and reduce pain.

Figure: Cushion modified Shoe

• Night Splints: A conservative treatment in combination with the use of a night splint that keeps the ankle in 5-degree of dorsiflexion for eight weeks.

Figure : Night Splint

• Tapping: The Kinesiology Taping Concept has a successful application that can help with heel pain complaints, such as heel spurs.

Figure: Tapping

• Physiotherapy Treatment:

Therapeutic Exercise:

• MFR (Myofascial Release): It is done mildly with hands with combination of lotion and any kind of diclofenac Sodium.
• Heel spur massage exercise: releases tightness in the sole of the foot
• Standing up sit down on a chair
• Place the golf or tennis ball centrally under the sole of your foot
• Let your toes hang loosely down.
• Shift your weight onto the foot that’s on the ball fascia roller.

• Stretching :

 Achilles stretch:

Achilles stretch is a lot like a calf stretch you may already know how to do:

1. Start by standing near a wall or other support, like a chair, with your hands on the wall at eye level.
2. Place your left leg a step behind your right leg.
3. Keep your left heel on the floor and bend your right knee until you feel a stretch in your left leg.
4. Here’s the trick: Bend your back knee bent slightly to stretch your Achilles tendon.

Hold this stretch for 15 to 30 seconds, repeating 2-4 times on each leg.

 Figure: Tendo Achilles & Calf muscle stretch

Cross leg ankle stretch:

1. Sit in a chair and cross one leg over the other knee, so your ankle is on top of your other leg.
2. With one hand holding your ankle and the other holding your toes, gently pull your toes backward until you feel a stretch in the bottom of your foot.
3. Hold this position for 20 seconds and repeat three times for both feet.

Do this exercise once daily.

 Figure: Ankle and  plantar fascia stretch

Toe towel grab:

This stretch strengthens and stretches the arches of your feet and improves flexibility.

1. Place a small towel under your foot.
2. Curl your toes to grip the towel.
3. Raise the front of your foot off the floor.
4. Hold this position for a few seconds.

Release the towel as you lift up your toes and spread them as far apart as possible.

Figure: Tow towel grabbing

Foamroll rolling

This stretch loosens up the fascia along the bottom of your feet, helping to relieve pain in your heel.

1. Place a foam roll under your foot
2. Roll a foam roll forward and backward with your foot.
3. Continue for up to 1 minute.
4. Do each foot two to three times.

Figure: Foamroll rolling

Towel stretch:

To do this:

1. Sit on the floor with your legs extended straight out in front of you.
2. Wrap a towel around your toes on both feet.
3. Pull back slightly until you start to feel a stretch at the very bottom of your feet and the back of your lower legs.
4. Aim to hold this stretch for 30 seconds and repeat it 3 times total.

Figure: Towel Stretch

Calf stretch on a step:

This exercise provides a deep stretch to the calves. This alleviates tension in your feet and improves mobility.

1. Stand on the ball of your right foot at the edge of a step, with your heel hanging off the step.
2. Slowly, lower your heel down as far as you can.
3. Hold this position for 15 to 30 seconds.

Repeat on the left foot. Do each side two to four times.

Foot flex:

This simple stretch is especially beneficial to do right when you wake up when you’re sitting up in bed. It stretches the plantar fascia that tightens while you sleep.

1. Use your hand to pull your toes back toward your shin.
2. Hold this position for about 30 seconds.
3. Do each side two to three times.

Ankle circles:

Ankle circles help with range of motion. You can do ankle circles from either a sitting or lying position.

1. Start by turning your ankle around slowly in circles to the left, then the right.

2. You may even find it easier to try drawing the alphabet in the air with your foot. Lead with your big toe.

3. Keep your movements small and focus on only use your foot and ankle, not your entire leg.

For circles, try doing 10 in each direction with each foot. If you’re doing the alphabet, complete 2 sets of this exercise on each foot.

Chair Pose

You may want to try some yoga poses to help stretch your ankles. Chair Pose (utkatasana), for example, is a good choice for yogis of all levels:

1. Stand tall in tadasana. Inhale as your raise both of your arms overhead, palms inward.
2. As you exhale, bend both of your knees slightly, working toward getting your thighs parallel with the ground.
3. Your torso should make a right angle with the tops of your thighs.

Try holding this pose for 30 seconds to a full minute. To come out of it, inhale and straighten your knees.

                                              

Electrotherapy:

1. Ultrasound: UST is therapeutic modalities that generate ultrasound causes deep heat, provide micro-massage to soft tissue, increase flexibility, promotes healing of tissue as well improve localized blood supply to area. And ultimately pain relief.
2. Paraffin wax bath: paraffin wax bath therapy is an application of the molten wax on the body parts. It acts as a form of heat therapy and can help increase blood flow, relax muscles, and decrease joint stiffness. Paraffin wax can also minimize muscle spasms and inflammation as well as treat sprains.
3. Extracorporeal Shock Wave Therapy (ESWT): ESWT appeared effective in relieving heel pain among patients with calcaneal spur especially when given within the first 4 months after the start of a patient’s symptoms.
4. Low -level laser therapy: laser therapy is found to be an effective method for treating heel spurs.
5. Electrical Stimulation: Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief involving the use of a mild electrical current.
6. IRR (Infrared Ray): Infrared ray is delivered to the site of injury or inflammation at certain wavelengths, promoting cell repair.