introduction

The heel spur is a bony retraction on the heel bone (calcaneus). Often the spur is located at the bottom of the sole of the foot (plantar heel spur) as an ossification at the base of a tendon plate running there. Less common is the posterior heel spur located at the posterior margin of the heel bone at the base of the Achilles tendon.

Symptoms and causes

Not every patient with a heel spur has symptoms. Above all, these are typically load-dependent pain in the heel area. Characteristic is a morning pain right after getting up, which initially improves after a few steps. Whether the pain occurs during the day permanently or only after prolonged exposure (walking distance), depends on how far advanced the disease is. Those affected describe the pain as bright and piercing, whereby a radiation in the entire hindfoot or into the calf is possible.

The heel spur arises on the basis of a degenerative wear of the heel bone, which is why the occurrence in the population increases with increasing age. The heel spur is a very common disease, so that about every second elderly person is affected by a heel spur. A calcaneal spur develops due to increased pressure and load on the tendon insertion on the heel bone. Through this permanent stimulus, the tendon fibers build up bony, it comes to a spur-like bone formation at the base of the tendon. In response, an inflammatory reaction often occurs in the surrounding tissue.

In addition to age, overweight and unsuitable footwear are considered to be prime risk factors. Also various foot malformations (especially a kink-Senkfuß) contribute to the emergence of heel spurs.

diagnosis

If, on the basis of the medical history, the doctor suspects heel spurs, he may try to induce a pressure pain over the appropriate place. For confirmation, the X-ray is used, which represents a heel spur well. In early stages, the radiograph may still be inconspicuous despite the onset of symptoms. In such cases, MRI or ultrasound may be helpful in assessing incipient ossification of the tendon structures.

insoles

Especially in the early stages deposits in the heel spur can provide relief quickly. Buyable gel cushions can be placed in the shoe under the heel, cushioning the weight on the heel when walking and standing. These gel pads are available for little money and do not need to be prescribed by the doctor. However, they do not eliminate the trigger of a heel spur like a foot deformity and so only relieve the symptoms (pain), instead of treating their cause.

Alternatively, you can have an insert made to the specifications of an orthopedist at the orthopedic technician. The insoles are often provided with hollows or padding around the heel. Since often a kinked foot or a countersunk foot or a combination of both is the cause of the heel spur, an orthopedic insole should additionally treat this deformity. The aim here is to support the arch of the foot and to distribute the pressure of the body weight sensibly on the foot. As a result, a relief of the heel can be achieved. The insoles should be worn as long as possible and can be used in different shoes. So the pain should decrease significantly after 4 to 8 weeks of regular wear of deposits or even disappear completely.

It is important that the deposits continue to be worn regularly even after a cure in the sense of a temporary symptom-free, in order to prevent a recurrence. The insoles are thus not only used for the treatment, but also for the prophylaxis (prevention) of heel spurs. If the heel spur is pronounced, so that deposits can not achieve adequate relief, orthopedic health shoes can be used. They, like the insoles, can more fully compensate for foot deformity and relieve the discomfort caused by the heel spur by relieving the heel. Both the costs for custom-made inserts and those for health shoes are taken over by the statutory and private health insurance, a small proportion of cost has to be borne by the patient. It should be kept in mind, however, that insoles and orthopedic footwear are merely symptomatic therapy, while the cause of heel spurs remains unaffected.

For this reason, parallel exercises should always be performed to strengthen the muscles, which can be carried out initially as part of physiotherapy and later independently. In acute pain phases, painkillers and anti-inflammatory drugs (NSAIDs such as diclofenac, ibuprofen) can be taken. However, as these damage the gastric mucosa, they should not be used as a permanent medication in this case. Furthermore, weight loss is definitely recommended for overweight sufferers, as it reduces the burden on the heel weight.

prognosis

The heel spur is clearly an area of ​​conservative orthopedics, so much of the patients without surgery can be helped to a significant relief. However, the duration of therapy varies from patient to patient. Especially the conservative measures such as the wearing of deposits are usually tedious, since they are significantly less risky than an operation. Some patients may experience significant improvement after one week by wearing custom insoles, while others may take up to six weeks. The heel spur is usually caused by a foot deformity and develops over years, so it is easy to imagine that the healing takes time.

A cure in the sense of conservative therapy means long-term freedom from complaints through stimulation relief and relief in the surrounding soft tissue. Years can go by in many cases until complete healing. In order to maintain a long-term cure, it is important to continue wearing the insoles regularly even after the symptoms have temporarily disappeared and to perform conscientious exercises to strengthen the muscles over an extended period of time.


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