Treatment of plantar fasciitis ointment

Causes of neuromuscular depression:

heel spur

The heel spur is an ossification of the tendon that is the result of an inflammatory process that affects the soft tissues in the heel bone. This inflammation is caused by a variety of abnormalities that can cause bone growth and affect fibrous tissue. The growth in the heel varies in size and looks like a thorn or a beak.

Nowadays, heel spurs are diagnosed quite frequently. It is most commonly seen in women over 50 years old. However, this does not mean that spurs cannot appear in the opposite sex at a younger age.

If the disease is in its early stages, there are no problems with treatment. The situation is different with advanced spurs - the treatment is lengthy and complicated. It is worth noting that in elderly patients, spurs occur in 25 % of cases.

causes

Spurs in the heel can occur for various reasons. These can be both congenital and life-long factors, such as

• excess weight, which puts a lot of strain on the feet;
• flat feet and other problems associated with incorrect walking;
• infections that occur in the body;
• abnormal blood circulation;
• atherosclerosis
• diabetes of all kinds;
• Shrinking of the fatty layers on the heel in older people;
• Rheumatism;
• diseases affecting the nerve endings;
• Fractures or bruises of the heel;
• Inflammatory processes in the muscles or muscle tension;
• Natural changes that accompany the aging process;
• abnormalities of the spine;
• Excessive strain on the heels due to sporting activities.

To rid a person of an unpleasant pathology, it is necessary to conduct a complete examination of the body and understand the cause of the spur. If the problem is left untreated, the tendons begin to tear. This leads to an inflammatory process that spreads to the muscles and heel bulb. Fluid builds up in the area, hindering blood circulation and slowing healing. A salt deposit forms in the heel and a spur forms.

symptoms of the disease

At the beginning of the disease, the person affected usually does not notice the problem. The disease is already developing, but it is not yet noticeable.

At a later stage, when the disease is already actively progresses, a number of complaints arise:

• Discomfort and pain when walking and exercising. Initially only when walking briskly, but in severe cases the pain occurs with almost every contact of the foot with the floor, the couch, the shoes, etc. The pain is similar to the feeling of driving a needle or nail into your heel.
• Acute pain in the morning after waking up, the intensity of which may decrease throughout the day.
• As the disease progresses, calcium scars and deposits as well as osteophytes form in the heel spur, which cause discomfort and pain even when at rest.
• Changes in gait as the patient tries to protect the affected foot and not step on the heel.
• Flat feet, which are caused by the constant transfer of weight from the heel to another part of the foot.
• Heel spurs affect the quality of life and are a major obstacle to sporting activities.
• There may be slight swelling and redness of the heel in the area affected by the spur.

How is the disease diagnosed?

Diagnosing the problem is usually straightforward:

1. Collecting complaints. – The patient complains of pain in the heel, especially after a sleepless night and after exercise.
2. Investigation – The specialist feels the foot and determines the location and intensity of the pain.
3. X-ray – to determine the size and location of the spike
4. MRI – determines the condition of the soft tissues around the heel spur.
5. It is important to understand that an ultrasound examination is not the recommended one and recommended method for diagnosing heel spurs, but can be used to monitor progress and treatment outcome.

Symptoms and signs of heel spurs

In a study conducted by an American doctor, DuVries divided the bony growths in the heel into three main types:

1. Large spurs that cause no pain. They are often only discovered by chance during an X-ray examination of the foot as part of the investigation of other diseases. According to contemporary authors and researchers, about 63 % of people with heel spurs do not have heel pain.
2. Large and painful bony growths. Their position is such that the entire body weight falls on them.
3. Small and very painful spurs, around which inflammation is clearly visible.

Heel spur pain is not always caused by bony hypertrophy, but is the result of an inflammatory reaction in the surrounding soft tissues and degeneration (destruction) of the plantar fascia.

Plantar fasciitis of the foot is manifested by pain in the heel, with symptoms being most severe at the beginning of movement or in the morning when getting up after sleep. This is referred to as 'start-up pain'. Heel pain can occur suddenly or gradually.

Heel spurs can cause foot pain of varying intensity. This is related to the severity of the inflammatory process and the extent of destructive changes to the plantar fascia. There is often a sharp pain as soon as the foot is put under pressure and a feeling as if something sharp was stuck in the heel.

A heel spur can lead to a shortening of the plantar fascia and thus a reduction in its strength, which in turn can result in foot deformity, limited mobility of the ankle joints and a pain-related change in gait. Patients begin to walk on their toes or on the outer edge of the foot because they are afraid of stepping on their heel.

With a heel spur, pain in the back of the foot can spread to the toes and muscles of the lower leg, and these symptoms can worsen in the evening or with prolonged walking and standing.

Conditions and causes of heel spurs

The main causes of heel spurs are due to impaired neuromuscular damping. Neuromuscular cushioning ensures smooth interaction between the muscles of the back and lower limbs, reducing shock loads on the foot when walking and running. The most important cushioning instruments are the muscles of the foot and forefoot and the spine. The coordination of joint muscle movements takes place at the level of the spinal cord.

Impairment of neuromuscular attenuation

Causes of impaired neuromuscular damping:

1. diseases of the spine – Osteochondrosis of the spine and herniated discs lead to tissue swelling, circulatory disorders and pinching of the spinal cord and nerve roots. The result is slowed or disrupted transmission of nerve impulses along the nerve pathways, leading to muscle maladaptation and reduced neuromuscular attenuation.
2. Kidney problemsKidney problems that lead to a disturbed electrolyte and water-salt balance in the blood and thus to a reduced supply of resources to the muscle tissue.
3. muscle weakness. Causes of muscle weakness:

• Sedentary lifestyle (hypodynamia). The 'sedentary' lifestyle leads to untrained, 'sluggish' muscles due to insufficient tissue micro-vibration.
• Lack of resources for the work of muscles, which leads to insufficient kidney function.

Weak muscles do not provide adequate cushioning when walking and running, leading to damage to the spine. This closes a cycle that is sometimes difficult to break.

In healthy, sporty people, the body reduces the impact load to a safe level through a well-coordinated interaction of the back, leg and foot muscles and protects the joints, fascia and spine.

Reduce physical stress

The most important principle in treating heel spurs is relief. Heel pain usually subsides quickly with rest. Therefore, patients should take a break from sports and walk or stand as little as possible. This remedy is the third most effective after orthoses and corticosteroid injections.

Heel spur problems can be relieved with various exercises. The aim is to correct the curvature of the foot, strengthen the foot and stretch the tendons and ligaments.

Training the foot muscles: Suitable exercises include walking on uneven ground, lifting and tearing paper with your toes.

Stretching exercise for heel spurs: Place a tennis ball under the sole of your foot and roll it back and forth with firm pressure.

Another exercise for heel spurs: stand with your forefoot on a step and then lower your heels until you feel a slight stretching pain in the sole of your foot.

Exercises that stretch the plantar fascia and Achilles tendon relieve the initial pain and reduce the severity of overall symptoms.

Insoles for heel spurs

People with heel spurs should always wear comfortable shoes. The shoe should provide sufficient longitudinal arch support, have a low heel (2 - 3 cm) and a stiff sole at least 5 mm thick. Tight or too large shoes can worsen plantar fasciitis, while shoes that meet orthopedic criteria can, on the contrary, reduce the pain itself. In addition, the shoes can be supplemented with orthopedic insoles. This relieves pressure on the foot and avoids the risk of heel spurs.

If you already have a heel spur under the sole of your foot, an orthopedically customized insole with a cavity (perforated sole) can help.

Insoles filled with a type of gel also help as they distribute the pressure over the entire foot and cushion shocks better.

If you have a heel spur (Achilles tendon), a heel pad or piece of felt can be glued in to cushion the heel.

Causes of emergence

The main cause is a long-term, repeated small tear of the plantar fascia (plantar fascia), followed by inflammation of the heel area where the fascia attaches due to excessive stress. Chronic inflammation leads to the formation of a bony protrusion.

Other causes that contribute to this condition include flat feet, degenerative-dystrophic foot diseases, and metabolic disorders.

Risk factors for this disease:

• Flat foot deformity – the feet bend inward too much when walking (excessive heel pronation).
• High arch or flat foot (prolapse of the longitudinal arch).
• Excessive strain on the foot when standing or walking.
• Overweight due to obesity.
• Shoes that are too tight and narrow with flat soles or high heels.
• Excessive physical activity.

Treatment

Treatment can be surgical or conservative. Surgical treatment is performed when all other treatment methods fail. Such a situation is rare.

On surgery The fibula process is removed, the tissue around the process is excised, the soleus aponeurosis is divided (not excised).

Non-surgical (conservative) treatment includes:

• Sufficient rest. Restricting activities that cause pain in the feet, walking or running on hard surfaces.
• Exercise therapy and massage therapy.
• Wearing special orthoses.
• Physiotherapeutic treatments.
• Shock wave therapy, radiation therapy.
• Topical administration of steroidal anti-inflammatory drugs (dipropane, flosterone, etc.).

Methods for treating heel spurs

A comprehensive approach is required to treat heel spurs. It is worth following certain recommendations for prevention. If you are at risk of developing heel spurs (see causes), you will benefit from exercise, stretching and massage.

An important point is therapeutic movement. Gymnastics is almost always recommended and for various reasons. Gymnastics not only strengthens the body in general, but is also good for the feet. It is recommended when acute pain and its intensity are reduced. Basically, all exercises are aimed at strengthening the foot muscles. Stretching is very effective in treating plantar fasciitis or heel spurs. You can also massage your feet and shins to improve blood flow to the tissues.

Remember that when treating heel spurs, it is important not to overuse or strain the foot, especially the inflamed area. Do everything with joy, because one of the main reasons for any physical activity is to improve your health.

Complementary therapies

In addition to therapeutic exercises, massages and medication, other modern treatments are of course also used to treat heel spurs. These include radiation therapy or injectable medications.

The currently most popular treatment for heel spurs is shock wave therapy, which is considered the most effective. With this method, it is possible to eliminate pain in a short time, activate tissue regeneration and even completely dissolve the calcium deposits (if the spur is small).

However, the various treatments will not have any effect if you repeatedly resort to wearing uncomfortable shoes in which the load on the foot is distributed unevenly. The solution is orthopedic insoles.

Types of plantar fasciosis

The classification of the condition depends on where it occurs. In the more common plantar fasciosis, the spur is located in the area of the sole of the foot. In Achilles tendon fasciitis, the growth develops on the back surface of the heel (where the ligament-tendon structures attach).

The pathological process progresses slowly. Symptoms depend on the size of the osteophyte and the location of local inflammation.

As the disease progresses, the patient tries not to step on the heel area to avoid acute pain. This changes gait, leading to a reduction in the transverse arch of the foot and the development of flat feet. In the worst cases, the ability to walk independently occurs.

Causes of the disease

Due to the high load on the plantar fascia caused by body weight, micro-injuries to the ligament are possible, which lead to chronic inflammation and, as a result, the formation of heel spurs. The disease mainly affects patients over 40 years old (mainly women).

• obesity;
• joint pathologies;
• Gout;
• impaired blood circulation in the feet;
• Multiple injections of glucocorticoids.

Abnormalities of the spine and large joint structures of the lower limbs also contribute to heel spurs. If this condition is diagnosed, treatment of the spine and joints may be required.

How to get the right injection

It is difficult for a person with heel spurs to decide on heel injections. The reason for this is that the procedure is painful for the patient and difficult for the doctor: the former has to endure the pain that the procedure causes in the epicenter of the pathology, the latter has to insert a thin needle into a specific point - the center of the bone spur .

The manipulation involves a complicated injection technique: the hormonal drug must be injected precisely into the center of the inflammatory process, which is located above the bone spur (it is difficult to penetrate the dense tissue and thickened skin layer).

Special features and techniques of the procedure:

1. Performed exclusively by a doctor in a medical facility.
2. Consequences can be avoided by collecting the medical history in advance and checking the examination data.
3. Heel spur injection is performed using ultrasound (to determine the exact injection site).
4. Sterile conditions must be created to avoid infection.
5. During the procedure, the foot must be in a straight position and the heel must be balanced.
6. First, the anesthetic (0.5-0.8 ml) is drawn into the syringe, then the drug itself. This helps to somewhat reduce the painfulness of the procedure. Most often, novocaine is used as an anesthetic (provided there are no contraindications or individual intolerance).
7. The drug should be injected slowly.
8. A longer rest period (30-50 minutes) is required after the injection.

Thanks to the skill of the doctor, the patient feels relief immediately after the injection of the steroid drug, so the procedure in question receives many positive reviews.

Successful treatment of heel spurs by injections includes a number of measures that, among other things, restore the integrity of the connective tissue fascia and eliminate calcifications in the adjacent tissues:

When an injection into the heel is recommended

A doctor may suggest that a patient with heel spurs receive a special injection treatment only after using the main treatment methods (shock wave therapy, massage, limiting the exposure of the damaged fascia, using ointments, gels, physiotherapy, etc.), since they are of little effectiveness or the worsen pain sensations.

A surgeon or orthopedist may only prescribe Dipropane for the treatment of heel spurs if there are no contraindications. This requires examinations and visits to specialists (for women, to a gynecologist: before and after treatment with steroid injections).

Blocking the heel spur has many negative effects (including foot dysfunction, osteoporosis, necrosis of the heel bone and plantar fascia) and is not a complete treatment, as it only stops inflammation and relieves severe pain, but does not rid the tissue of dead cells.

The effectiveness of treatment does not depend on the steroid formulation chosen.

Heel spurs (plantar fasciitis). Kind of treatment.

– Vascular diseases of the lower limbs (rheumatoid arthritis, deforming osteoarthritis, diabetic polyneuropathy).

There are various methods for treating this disease, the choice of which depends on the severity of the pain and whether treatment was started in a timely manner.

The most harmless treatment method is the medicinal one.

Treatment of heel spurs includes the prescription of painkillers, special physical exercises, therapeutic massage and some physiotherapy treatments:

The medicinal blockade method
If drug treatment does not produce a positive result, a therapeutic blockade is carried out. This treatment relieves the patient of severe stabbing pain, eliminates the inflammation and thus improves the patient's well-being. The main difference from other injections is that with medication blocking, the medication is injected directly into the site of pain. This procedure is more complicated than regular injections and is only performed by a doctor!

In addition, hormonal drugs such as Diprospan and Hydrocortisone are used to relieve pain. These belong to the group of glucocorticoids, which have anti-inflammatory and anti-edematous effects.
Non-steroidal anti-inflammatory drugs are also used.
The injections relieve pain and help the patient regain mobility.

Surgical treatment

If the treatment does not produce the desired results, this is usually the case when the patient comes to the specialist too late and the disease has already progressed. A surgical procedure is performed, usually under local anesthesia. During the operation, the surgeon shrinks the bony process in the heel and returns the foot to its natural state.

This treatment method is very effective if done correctly. The pain and inflammation disappear very quickly. With successful treatment and regular follow-up care, the patient can forget about the disease for several years.

Appropriate preventive measures

The heel spur is treated comprehensively. Even if the pain has subsided, you should follow your doctor's recommendations to avoid recurrence.

– Regularly perform special exercises,

- Take medication if necessary.

It is necessary to visit your orthopedist at regular intervals for preventive examinations. This is necessary to monitor the patient's condition and well-being and to prevent pain syndromes in the future.

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Southern Medical District of Leningrad Region

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