Heel spur

This article describes the heel spur as a pathological change, for the climbing device of the same name see crampons # heel spur .

Classification according to ICD-10
M77.3	Calcaneus spur
ICD-10 online (WHO version 2019)

Lateral x-ray of the metatarsus (right) and heel (left), with a lower heel spur (bottom left) and a small upper heel spur (left center)

The heel spur (synonymous calcaneus spur or calcaneus spur , from Latin calcaneus , heel bone) is a bony spur on the heel bone . A distinction is made between a lower ( plantar ) and an upper ( dorsal ) heel spur. The lower heel spur is occasionally accompanied by an inflammation of the plantar tendon on the sole of the foot (plantar tendonitis or plantar fasciitis ). The bony change in the rear (upper) part of the calcaneus is called Haglund's exostosis .

Causes and frequency

The cause of the plantar heel spur is an increased tensile load on the plantar fascia on the heel bone. The result is calcification of the tendon attachment, which can be seen in the X-ray as a spur-like change in the calcaneus. This visible change is often asymptomatic and is found as an incidental finding during X-ray diagnostics of the foot and / or the adjacent regions. The symptoms that actually require therapy occur in so-called plantar fasciitis, i.e. an inflammation in this area.

In different studies, the incidence was 13–32% in people without plantar fasciitis and 50–89% in people with plantar fasciitis. Significant risk factors for plantar fasciitis are a lowered arch of the foot with subsequent overstretching of the plantar fascia, for example due to overweight and / or misalignment of the foot. About 10% of runners are affected by the clinical symptoms of plantar fasciitis. Women are more often affected than men, and the age of onset is usually over 40 years.

Forms and diagnostics

Differentiation between cranial (upper) heel spur and plantar (lower) heel spur

Depending on the location of the calcaneal spur, a distinction is made between two forms:

• The more common plantar (lower) heel spur on the heel is ossification or calcification in the attachment area of ​​the tendon plate on the underside of the calcaneus ( plantar fascia ). The technical term for this form is plantar calcaneus spur .
• The rarer dorsal (upper or rear) heel spur on the heel corresponds to an ossification at the heel bone attachment of the Achilles tendon . The Haglund exostosis is a bony outgrowth of the upper rear edge of the heel bone, and often with a painful bursitis connected.

Heel spurs can be diagnosed very easily on an X-ray . The so-called heel spur can also be seen during the ultrasound examination of the heel, usually at the origin of the quadratus plantae muscle . In addition, calcifications can occur on the abductor hallucis muscle or, less often, on the tendon attachment of the abductor digiti minimi muscle ( enthesopathy ).

Therapies

Since a lowered longitudinal arch of the foot is the cause of chronic tensile stress on the tendon attachments on the heel bone, which can lead to attachment calcification (the so-called heel spur as X-ray diagnosis), the most important therapeutic measure is passive correction using shoe insoles. The central part of the lowered arch of the foot is erected on the inside (using an inner edge support or supination wedge), which among other things relieves the tension of the tendon attachment of the plantar fascia.

In contrast to the often symptom-free heel spur (see incidental finding in X-ray diagnostics), plantar fasciitis is an inflammation in this area. Anti -inflammatory measures, i.e. anti -inflammatory measures in plantar fasciitis, should be mentioned as accompanying therapy options in addition to the supply of insoles.

The shock wave therapy is another treatment option that is paid under certain conditions by state health insurance. Sound waves with high pressures are generated outside the body and introduced into the body or concentrated in the target area without damaging the skin. The effect does not lie in the disintegration of the heel spur, but occurs through the effect of the shock waves on the inflammatory tissue. An initiation of the healing process through an improved metabolism and increased blood flow was proven.

A rare but possibly successful therapy is so-called pain radiation. This form of heel spur radiation therapy is indicated if the aforementioned measures did not improve the symptoms within 2 to 3 months. Radiation treatment is used cautiously in patients aged under 30 to 40 years. The prerequisites are a clear pain history , a corresponding x-ray report and the therapy options already mentioned should be exhausted. After the patient has been informed by a doctor in radiological facilities for radiation therapy and nuclear medicine, the pathological-anatomical conditions are determined, the heel is then measured and radiation therapy is started. For this purpose six sessions with 1.0 Gy (total dose 6.0 Gy) twice a week are planned. The therapy therefore lasts three weeks. In a small study with 66 participants allegedly an improvement of the pain symptoms of 70–100% of the treated patients could be achieved, whereby the pain relief can occur immediately after the radiation therapy, but also up to three months later. The effects can last a few months to years. If there is insufficient or no improvement, a second irradiation cycle is possible after 3 to 4 months.

literature

• C. Rowe, HT Sakellarides, PA Freeman, C. Sorbie: Fractures of the os calcis. In: JAMA: the journal of the American Medical Association. 1963, 184, pp. 920-923

Web links

Commons : Heel Spur  - Collection of images, videos and audio files

Individual evidence

1. ↑ ^{a b c} K. S. Johal, SA Milner: Plantar fasciitis and the calcaneal spur: Fact or fiction? In: Foot Ankle Surg. 2012 Mar; 18 (1), pp. 39–41. doi: 10.1016 / j.fas.2011.03.003 . Epub 2011 Apr 13
2. ^ ^{A b} S. Cutts, N. Obi, C. Pasapula, W. Chan: Plantar fasciitis. In: Ann R Coll Surg Engl. 2012 Nov; 94 (8), pp. 539-542. PMID 23131221 .
3. ↑ Plantar Fasciitis in StatDX, Amyrsis 2014.
4. ↑ O. Micke, R. Mücke, MH Seegenschmiedt: Calcaneodynia: Plantar and dorsal heel spur / heel spur syndrome. In: MH Seegenschmiedt, H.-B. Makoski, K.-R. Trott, LW Brady (Ed.): Radiotherapy for non-malignant disorders. Springer, Berlin / Heidelberg 2008, pp. 295-315.
5. ^ ^{A b} S. Bianchi, C. Martinoli: Ultrasound of the Musculoskeletal System. Springer, 2007, ISBN 978-3-540-28163-4 , pp. 863f.
6. ↑ Management of the "Medical Treatment" working committee of the Federal Committee of Doctors and Health Insurance Funds: Extracorporeal Shock Wave Therapy (ESWT) . Cologne, July 22, 1999. Last accessed September 23, 2018.
7. ↑ [1] Physical basics of shock wave therapy
8. ^ S. Cutts, N. Obi, C. Pasapula, W. Chan: Plantar fasciitis. In: Ann R Coll Surg Engl. 2012 Nov; 94 (8), pp. 539-542. PMID 23131221 , PMC 3954277 (free full text)
9. ↑ Radiotherapy for heel spurs. Retrieved August 5, 2019 . 
10. ↑ Marcus Niewald: Radiation therapy of the heel spur. Retrieved August 5, 2019 . 
11. ^ Deutscher Ärzteverlag GmbH, editorial office of the Deutsches Ärzteblatt: Radiation therapy relieves heel spur pain. December 26, 2011, accessed August 5, 2019 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !