Osteophyte of the heel bone

With a large number of elderly people neck and shoulder pain occurs due to cervical spondylosis.

etiology. Osteophytes form on the edges of vertebral bodies as a result of dehydration and narrowing of the intervertebral disc. Depending on their location (orifice or canal), compression of spinal nerve roots or spinal cord, or both, may occur simultaneously. Deforming facet joint arthrosis and ligament hypertrophy also narrow the spinal canal and openings. Over time, the process affects more than one disc. The pathology usually spreads from C4 to C7.

Examination for pain due to osteophytes

1. anamnese. This pathology is more common in elderly patients than in those with a herniated disc, although the two groups may overlap. In 90 % of the patients, the pain starts gradually in the neck and eventually spreads to the upper limbs. The pain radiates to the shoulder joint and arm. There are dermatome zones to determine the degree of radicular pressure. Patients complain of pain in the occipital region, between the shoulder blades, numbness, tingling and weakness. The pain often occurs at night and causes the patient to wake up. In 10 percent of cases, the course of the disease is asymptomatic, and the occurrence of neck and shoulder pain is often due to excessive stretching/straightening of the neck (whiplash) after trauma (car accident). A high percentage of patients have more than one disc, making it difficult to determine the level or levels at which radiculopathy is present.

2. Clinical examination
Examination of the neck. On palpation, pain is noted on the spinous processes, especially near the lesion, and on the periorbital soft tissues. The classic symptom is a painful limitation of extension and rotation of the head toward the affected limb.

osteophytes

risk factors

The risk factors for Haglund's disease are as follows

high arch of the foot;
flat feet;
clubfoot;
Poor tendon flexibility;
valgus deformity of the foot;
Anatomical features of the heel;
Chronic tendon injuries and dislocations;
Chronic metabolic diseases such as gout;
pregnancy

The appearance of a bone spur is actually a kind of defense reaction of the body to an irritant. However, if the stress continues to increase, the tissue around the bony overgrowth can become inflamed and cause pain.

When does foot strain become strenuous?

When walking and especially when running fast, the feet are exposed to an extreme load that is many times the body weight. Understandably, obese people put more stress on their ankles than normal-weight people.

If the muscles are too loose, e.g. B. through a lack of hypodynamic training, during a long-term rehabilitation or after an injury, the legs tire quickly.

A shortened calf muscle can also adversely affect the tendons of the foot and cause heel arching.

Postural changes and misalignments of the pelvic bones change the biomechanics of movement and thus lead to foot problems.

Unsuitable footwear can lead to unfavorable pressure distribution in the foot. Patients often suffer from heel pain when wearing high-heeled shoes with thin leather soles (e.g. slippers). The problem can also be caused by shoes that are too tight and sturdy, which systematically traumatize the periosteum. Inadequate cushioning of the heel can lead to overloading of the heel.

During sports or when standing and walking for a long time, the feet are under a lot of strain and osteophytes can form - especially if the shoes are also poorly padded. Warming up your feet before a sporting competition or even a simple workout should not be neglected. Experts point out the importance of proper technique when running, jumping, etc. In addition, the right footwear should be chosen for each sport.

So the cause of the problem is not so much the formation of a bony nodule, but rather long-term overloading of the foot. The more often the foot is overloaded, the greater the heel growth can be and the more often inflammation and pain occur. However, the size of the osteophyte does not allow any conclusions to be drawn about the extent of the disease. Sometimes a clear exostosis does not make itself felt at all, while a small, difficult to detect mass can cause severe pain with every movement of the foot.

species

Specialists distinguish four main stages of osteophytes based on clinical signs, volume and type of bone lesions:

In the first stage there are no external symptoms and no pathological foci of ossification can be seen on radiographs;
In the second stage, the patient begins to feel pain in the affected area during exertion, sharp twists and movements, and isolated outgrowths and narrowing of the joint spaces can be seen on the x-rays;
in the third stage, severe symptoms appear (pain, limitation of movement, swelling), the distance between the articular elements is significantly narrowed, and numerous exostoses can be seen on the x-rays;
In the fourth stage, the joint is severely restricted in its movement, the patient suffers from constant pain and stiffness, and the x-rays do not show the joint space, but clear traces of numerous osteophytes.

Osteophytes are differentiated according to their cause and form of growth:

Depending on the location, exostoses can occur on the spine, hip, neck, knee, etc.

symptoms

The clinical symptoms of osteophytes depend on the localization of the pathological process and the stage of proliferation. The most important include:

Dull, aching pain in the area of the affected joints, which increases with exertion, movement and twisting;
muscle weakness;
Rapid physical fatigue;
numbness, tingling in the area of the exostosis focus;
Swelling of the soft tissues in the affected area.

The pain syndrome is more pronounced when the osteophytes are located on the sole of the foot. The condition is called heel spurs (plantar fasciitis) and is associated with severe pain when walking.

The entire syndrome is characterized by resolution of discomfort and pain at rest.

With multiple osteophytes damaging the tissues and compressing the nerve fibers, the following symptoms may also occur

decreased sensation in lower and upper limbs;
difficulty urinating;
irregularity of bowel movements;
Stiffness with movement, especially after staying in one position for a long time (after sleeping, after a long drive in a motor vehicle, etc.).

As the disease progresses, the patient has increasing difficulty moving, his gait changes, movements become slower and more uncertain, and the range of motion decreases.

Treatment of heel spurs

A heel spur can only be treated by a doctor as the condition varies from person to person. Self-treatment without basic knowledge leads to soft tissue damage, flare-ups and other problems.

In terms of treatment, conservative treatment prevails. Surgical methods are used as a last resort, with minimally invasive methods being preferred.

therapeutic;
physiotherapy, including shock wave therapy;
irradiation with ultrasound;
laser therapy;
Massage;
therapeutic exercises.

Drug treatment is selected by the doctor on an individual basis. The drugs aim to reduce inflammation and relieve pain. Various dosage forms are used: tablets, ointments, patches.

Rarely, if indicated, medication is injected into the ankle or into the sole cavity. This measure is performed by the surgeon. Painkillers and anti-inflammatory drugs are prescribed at frequent intervals to avoid dependence.

Physiotherapy is very helpful. Muscle massages on the lower legs and feet, mud baths and treatments, therapeutic electrophoresis and sonophoresis (administration of drugs without damaging the skin using ultrasonic waves) are used. Ultrasound and therapeutic exercises are also used.

Shock wave therapy, in which a sound wave literally 'breaks up' calcium deposits, is widespread. The deposits are flushed out through the bloodstream and excreted naturally. The treatment simultaneously reduces swelling and inflammation and accelerates tissue regeneration.

The laser is used to accelerate metabolic processes, thereby creating the conditions for soft tissue regeneration.

Surgical treatment of heel spurs

Scalpel surgery, which removes the bony process along with the fascia, is no longer performed because it disrupts the anatomy of the foot.

Radiofrequency microtomies are used in indications where the damaged portion of the fascia containing the osteophyte is literally 'burned'. The remaining part of the tape is not cut and remains undamaged. At the same time, the nerve endings are affected, which are also destroyed, as a result of which the pain disappears forever.

The sooner you contact a doctor about foot problems, the less effort and time it takes to heal.

How osteophytes form in the knee joint

When osteophytes have formed in the knee joint, pain occurs and, later on, mobility is restricted and the joint deformed. The intensity of the pain increases, and eventually there are cracking and popping noises. In the morning you will feel a stiffness that will subside after warming up.

The osteophytes in the joint make movement very difficult. Difficulty bending or retracting the leg fully, the knee becomes hot, red, and swollen, and requires constant use of anti-inflammatory medication. Bony growths in the form of long, thin spikes can tear off and completely block the joint cavity. These joint mice can only be removed by surgery.

Conservative treatment helps if the osteophytes are no larger than 1-2 mm.

Principles of osteophyte treatment

The earlier osteophytes are discovered, the easier it is to treat them conservatively. It is not possible to get rid of them completely, but it is possible to inhibit their growth and improve the overall condition of the musculoskeletal system. The first step is to diagnose the underlying condition so that it can be treated.

drug therapy – anti-inflammatory drugs, chondroprotectors, etc;
therapeutic exercises to combat muscle spasms;
Physical therapy;
Emphasis on a healthy lifestyle – more exercise, walking, swimming, cycling, avoiding bad habits;
massage and self-massage;
orthopedic aids;
special diets high in calcium and magnesium, etc.

If this is not possible conservatively, osteophytes can be surgically removed. However, this is a last resort and the problem may recur because the bone attachments that were removed did not eliminate the underlying disease. For this reason, regular intra-articular injections of synovial fluid from the prosthesis are often recommended to prevent osteoarthritis. This therapy method is also indicated for large osteophytes and avoids surgery in most cases.

Treatment of heel spurs in Moscow

First of all, self-treatment is not an option, otherwise the disease will progress and eventually lead to serious complications. Only a doctor can choose the right treatment - the tactics are individual for each patient.

An important element in the treatment of heel spurs is a change in the patient's lifestyle.

For this purpose, he or she must follow 4 rules:

Adhere to strict bed rest.
Reduce the stress on the foot to a minimum.
Use comfortable shoes with thick, springy soles.
Use crutches or canes if necessary.

medication

Several groups of heel spur medications are used to relieve the symptoms associated with the appearance of heel spurs:

Anti-inflammatory drugs (Piroxicam, Voltaren, Diclofenac, Ketorol). These drugs are effective in reducing the pain and swelling in the heel area. They are usually available as ointments and gels.
Topical irritants (medicinal bile, dimexide). These drugs stimulate the metabolism in the tissue and thus accelerate the healing process. They should be applied in the form of envelopes.
Complementary medicine (anti-inflammatory patches, natural creams and other medicines).

Drug therapy only helps the patient relieve symptoms, but does not eliminate the disease. If the patient treats himself and does not consult a doctor, the disease will progress. Conservative therapy should not be the only part of the treatment package, but should also include treatments that address the root cause of the condition.

Causes of bony osteophytes of the calcaneus tubercle

The bony osteophyte of the calcaneus tuberosity is the most common site of this pathology. Possible causes of calcaneus osteophytes include:

Long-term inflammatory processes in the ankle socket (arthritis, capsulitis, chondritis, synovitis);
Tendinitis, tendinosis, scarring of ligamentous fibers and tendons;
Fractures and fractures of bones, including adjacent bones (tibia, fibula, ankle bone, etc.)
degenerative processes in the ankle, leading to the destruction of articular cartilage and the development of deforming osteoarthritis;
Disruption of the innervation process as a result of the development of osteochondrosis of the lumbosacral spine with complications (protrusion, extrusion, intervertebral hernia), piriformis muscle syndrome, entrapment of the sciatic nerve at its branching into the tibial and fibula branches;
toxic and diabetic angiopathy and neuropathy;
deformity of the foot when walking and running (flatfoot, clubfoot, pes cavus, etc.);
curvature of the lower and thigh bones;
aseptic bone necrosis;
sprains and tears of ligaments and tendons;
consequences of an ankle sprain;
plantar fasciitis;
Excessive physical stress on the joint (eg, long walks or continuous footwork);
Malignant tumors in the foot, shin, knee or ankle area;
Excess weight, which significantly increases the load on all joints of the lower limbs.

Osteophytes of the heel bone often form in women during the menopause. Hormonal changes then take place in the body. This has a negative impact on collagen production. This substance builds all types of cartilage tissue in the body. If its synthesis is reduced, the protective cartilage of the bones in the joint cavities is gradually destroyed.

Clinical manifestations of osteophytosis of the heel bone

The clinical picture in osteophytes of the heel bone develops gradually. All manifestations begin with minor discomfort and malaise. Gradually, these symptoms lead to the patient being unable to walk without assistance. This leads to unbearable pain. The knee and hip joints buckle because the affected person is forced to put their foot down when walking to avoid pain.

Classic symptoms of heel bone osteophytosis include the following manifestations

Acute pain in the region of the heel bone, which increases with palpation and walking;
In the morning, after waking up, the pain may be completely gone;
The longer and more intense the exercise, the greater the discomfort;
swelling and redness of the skin due to chronic inflammation;
limited mobility of the foot due to deformation of the ligaments and tendons;
an uncomfortable grinding or creaking sound when walking;
Lameness and changes in gait.

If the person with heel osteophytes tries to limit physical exertion, then muscular dystrophy of the lower limbs begins very quickly. The leg may contract. In advanced cases, ankylosis, restricted range of motion and contracture of the ankle joint are common.

An orthopedist should be consulted for an examination. The doctor will conduct an examination, perform a series of functional diagnostic tests and recommend additional examinations. It always starts with an X-ray examination. This allows all osteophytes, breaks and fractures of the heel bone to be displayed perfectly.

If it is difficult to make an accurate diagnosis, the doctor may recommend soft tissue ultrasound, MRI or CT scan, angiogram or neurography, arthroscopy, etc.

symptoms

Osteophytes grow to a certain size, then stop growing and usually remain unchanged for a long time. Initially, osteophytes have a cartilaginous structure with foci of ossification. After that, they develop into soft cheekbones. Osteophytes complete their development with the formation of dense, compact bone tissue. Osteoporosis and bone destruction processes by osteophytes have been described, which can lead to partial or complete resorption of the bone outgrowths. An exception are osteophytes, which can lead to compression of nerve trunks or penetrate deep into the muscles. Such osteophytes can cause pain of varying intensity. In some cases, during the development of the pathological process in the joint, osteophytes act as a protective mechanism, restricting movement and thus protecting the joint from further destruction of the bony surfaces and articular cartilage under stress. In some cases, osteophytes themselves become a source of tissue injury and aggravate joint destruction. For example, osteophytes in the ankle can compress the joint capsule between the bony prominence and the articular surface of the heel bone, leading to increased pain, swelling, and inflammation in the joint.

Osteophytes are often found incidentally on radiographs when they are being examined for other reasons. Osteophytes can also be palpated with fingers if they are large and close to the skin's surface.

Treatment

The discovery of an osteophyte alone has no clinical value. It is necessary to identify the disease that causes the osteophyte, otherwise the treatment will not be effective and can only aggravate the situation. If osteophytes do not cause pain and do not significantly limit movement in the joint, treatment is not necessary. A modern and effective treatment of osteophytes is shock wave therapy. Thanks to its unique properties, the shock wave destroys the osteophyte structure and the osteophyte gradually dissolves. A case in point is the treatment of heel spurs. The duration of treatment is five treatments, usually once a week.

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Heel Spur Treatment

When treating heel spurs, we use a comprehensive therapy. Taking into account the size of the osteophyte, the presence of inflammation, the intensity of pain and other individual characteristics the doctor can prescribe a therapy:

Drug therapy helps reduce inflammation and pain. Both systemic drugs and topical ointments, creams, compresses, etc. are used.

With the help of shock wave therapy (SWT), the osteophyte can be broken down or the progression of the disease can be slowed down. Under the influence of ultrasonic waves of a certain frequency, calcifications are broken down and particles are naturally removed from the body. The treatment also helps reduce swelling and inflammation and stimulate tissue regeneration.

If UHT is performed in the early stages of the disease, complete recovery is possible. In later stages, the technique is less effective, but it helps to stop the development of the pathological process and relieve symptoms.

In addition, patients are often prescribed foot wraps, night insoles, and day insoles. Taping fixes the fascia in a specific position, reducing stress and the risk of re-injury. As a result, the inflammation passes more quickly and the tissue regenerates.

In most cases, a heel spur is treated conservatively. This is a rather lengthy process, during which the patient must follow all the doctor's instructions.

Surgical removal of the growths is rarely recommended and is currently only performed using gentle techniques.

Prevention of heel spurs

To prevent the development of heel spurs and the progression of the disease, the following is recommended:

wear comfortable shoes;
to use insoles with a splint;
maintain a normal body weight;
Treatment of flat feet and other musculoskeletal disorders;
eat a balanced diet;
Lead an active lifestyle;
Massage feet and do foot exercises.

At the first signs of the disease, it is best to immediately consult a doctor, because the sooner treatment begins, the more effective it will be.