Calcaneal spur

Definition:
A calcaneal spur is a small bony projection from the back or underside of the heel bone. The calcaneus, also known as the back or underside of the heel bone, develops bony spurs when the Achilles tendon becomes inflamed and overloaded. The localized tendons are forced to take on the weight that was previously held by the Achilles tendon, causing tenderness in the back of the heel. The tendons are constantly being agitated as the patient rests, then gets up again.

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A calcaneal spur (or heel spur) is a radiological (X-ray) finding, and when it is located on the inferior aspect of the calcaneus, is often associated with plantar fasciitis and ankylosing spondylitis. A posterior calcaneal spur may also develop on the back of the heel at the insertion of the Achilles tendon.

An inferior calcaneal spur consists of a calcification of bone, which lies superior to the plantar fascia at the insertion of the plantar fascia . Posterior heel spurs are often large and palpable through the skin and may need to be removed as part of the treatment of insertional Achilles tendonitis

There is stress at the plantar(bottom of the foot) aspect of the calcaneus(heel bone) at the attachment of the plantar aponeurosis. This stress is caused by excessive running, standing, or walking, especially when the individual is unaccustomed to the activity.

Symptoms:
A sharp, stabbing pain under or on the inside of the heel. The pain is typically relieved during rest, but is worse after getting up again.As a rule of thumb, it is most painful first thing in the morning.The pain is made worse by walking on a hard surface or carrying something heavy, such as a suitcase. The pain can become so severe that it becomes difficult to continue your daily work

Special risk groups
*Most sufferers are people who are overweight and middle-aged. This is due to the shock-absorbing fat pillow under the foot shrinking over the years and becoming less effective.

*Weekend athletes.

*People who have feet that are pronated and not corrected. Pronated means that the foot tends to roll inwards when a person walks or runs.

Causes:
A bone spur forms as the body tries to repair itself by building extra bone. It generally forms in response to pressure, rubbing, or stress that continues over a long period of time.

Some bone spurs form as part of the aging process. As we age, the slippery tissue called cartilage that covers the ends of the bones within joints breaks down and eventually wears away (osteoarthritis). Also, the discs that provide cushioning between the bones of the spine may break down with age. Over time, this leads to pain and swelling and, in some cases, bone spurs forming along the edges of the joint. Bone spurs due to aging are especially common in the joints of the spine and feet.

Bone spurs also form in the feet in response to tight ligaments, to activities such as dancing and running that put stress on the feet, and to pressure from being overweight or from poorly fitting shoes. For example, the long ligament on the bottom of the foot (plantar fascia) can become stressed or tight and pull on the heel, causing the ligament to become inflamed (plantar fasciitis). As the bone tries to mend itself, a bone spur can form on the bottom of the heel (known as a “heel spur”). Pressure at the back of the heel from frequently wearing shoes that are too tight can cause a bone spur on the back of the heel. This is sometimes called a “pump bump,” because it is often seen in women who wear high heels.

Another common site for bone spurs is the shoulder. Your shoulder joint is able to move in a number of directions due to its complex structure. Over time, the bones, muscles, tendons, and ligaments that make up your shoulder can wear against one another. The muscles that allow you to lift and rotate your arm (called the rotator cuff) start at your shoulder blade and are attached to your upper arm with tendons. As these tendons move through the narrow space between the top of your shoulder and your upper arm, they can rub on the bones. Bone spurs can form in this narrow area that, in turn, pinch the rotator cuff tendons, resulting in irritation, inflammation, stiffness, weakness, pain, and sometimes tearing of the tendon. This condition, rotator cuff disorder commonly occurs with age and/or repetitive use of the shoulder. It is also common in athletes, especially baseball players, and in people such as painters who frequently work with their arms above their heads.

Diagnosis:
A bone spur is usually visible on an X-ray. But since most bone spurs do not cause problems, it would be unusual to take an X-ray just to see whether you have a bone spur. If you had an X-ray to evaluate one of the problems associated with bone spurs, such as arthritis, bone spurs would be visible on that X-ray.

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Treatment:
Bone spurs do not require treatment unless they are causing pain or damaging other tissues. When needed, treatment may be directed at the causes, the symptoms, or the bone spurs themselves.

Treatment directed at the cause of bone spurs may include weight loss to take some pressure off the joints (especially when osteoarthritis or plantar fasciitis is the cause) and stretching the affected area, such as the heel cord and bottom of the foot. Seeing a physical therapist for ultrasound or deep tissue massage may be helpful for plantar fasciitis or shoulder pain.

Treatment directed at symptoms could include rest, ice, stretching, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Education in how to protect your joints is helpful if you have osteoarthritis. If a bone spur is in your foot, changing footwear or adding padding or a shoe insert such as a heel cup or orthotic may help. If the bone spur is causing corns or calluses, padding the area or wearing different shoes can help. A podiatrist (foot doctor) may be consulted if corns and calluses become a bigger problem. If the bone spur continues to cause symptoms, your doctor may suggest a corticosteroid injection at the painful area to decrease pain and inflammation of the soft tissues next to the bone spur.

Sometimes the bone spurs themselves are treated. Bone spurs can be surgically removed or treated as part of a surgery to repair or replace a joint when osteoarthritis has caused considerable damage and deformity. Examples might include repair of a bunion or heel spur in the foot or removal of small spurs underneath the point of the shoulder.

Foot care advice:
*Take time to warm up and stretch before taking part in sport or exercise and cool down afterwards.
If you run or jog, it is better to run a short distance several times a week than one long run once a week.
Do not overestimate your abilities. If necessary, seek advice about creating a suitable running schedule that will give your body time to adapt.

*If you experience pain in the heel, you may be overloading your tendons.

*To help the healing process, follow the RICE principle, which stands for Rest, Ice, Compression and Elevation.

*Rest the foot and do not run until it is completely healed. Apply an ice pack, such as a packet of frozen peas that has first been wrapped in a towel or cloth. An elasticated support bandage will compress and support the foot. It should be firm, but not so tight that it affects the circulation of blood. Elevate the foot by resting it on a chair or a pillow.

*Invest in suitable shoes.

*The heel can be supported with a small cushioned insole inside the shoe.

*Arch supports that fit inside shoes will prevent feet from pronating.

*If you are overweight, losing weight can help prevent foot problems.

Click to see :Heel Spur: Calcaneal Spur Treatment

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.webmd.com/a-to-z-guides/bone-spur-topic-overview?page=2
http://en.wikipedia.org/wiki/Calcaneal_spur
http://www.netdoctor.co.uk/diseases/facts/heelpain.htm
http://www.painreliever.com/calcaneal-spurs.html

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