Heel spur

calcaneal spur presentation by a physiotherapist

1. calcaneus spur By Rafi Al-Shamrani

2. outline Anatomy Disorder Treatment

3. Anatomy

4. Disorder

5. Definition A heel spur is a bony growth that forms on the heel bone (calcaneus). Heel spurs are common and do not always cause pain, Pain caused by contact of the spur with the surrounding soft tissue. It can be located at the back of the heel (dorsal heel spur) or under the sole (plantar heel spur). The dorsal spurs are often associated with Achilles Tendinopathy , while spurs under the sole are associated with Plantar fasciitis.

6. Causes The cause of heel spurs is not completely understood. They may be caused by pressure on the heel. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it.

7. Sings and symptoms Pain in the bottom of your heel. Pain that is worse when you first get out of bed. Pain that gets worse after walking or standing.

8. RISK FACTORS older than 40. overweight. Have wear and tear arthritis (osteoarthritis). Have plantar fascia inflammation. Walking gait abnormalities, which place excessive stress on the heel bone, ligaments, and nerves near the heel. Running or jogging, especially on hard surfaces.

9. DIAGNOSIS Sharp pain localized to the heel. X-rays.

10. Examination ROM Observation Palpation Compare bilaterally Test Sensation

11. TREATMENT

12. Medical treatment Medication such as: NSAID(e.g. ibuprofen ) Cortisone injections Botulinum toxin Surgery: Endoscopic plantar fasciotomy In-step fasciotomy

13. Physiotherapy Modalities : Cryo-ultrasound therapy It promises an effective and long-lasting clinical improvement in patients with chronic plantar fasciitis. Ultrasound Ice massage Thermotherapy useful for reduction of pain during exercises. Low level laser therapy laser therapy with 850nm wavelength was applied for 9 sessions 3 times a week Extracorporeal Shock Wave Therapy Iontophoresis

14. Extracorporeal Shock Wave Therapy ECSWT is recommended to be the first choice in treating calcaneal spur. ESWT appeared effective in relieving heel pain among patients with calcaneal spur especially when given within the first 4 months after the start of patient complaint. ESWT should be useful when the treatment is given with an amount of at least 3x500 impulses weekly.

15. Extracorporeal Shock Wave Therapy

16. Iontophoresis Using acetic acid followed by 8 minutes of pulsed ultrasound at 1.5W/cm2 and exercises.

17. Physiotherapy K-tape( if planter faciates present) plantar fascia stretching Calf muscle stretch

18. Orthotics Night Splints Heel inserts Foot wear Modification

19. References https://www.clinicalkey.com/#!/content/patient_handout/5-s2.0-pe_ExitCare_DI_Heel_Spur_en http://www.webmd.com/pain-management/heel-spurs-pain-causes-symptoms-treatments#1 http://www.physio-pedia.com/Calcaneal_Spurs https://www.epainassist.com/sports-injuries/foot-and-heel-injuries/heel-or-calcaneal-spur http://ard.bmj.com/content/71/Suppl_3/757.13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753417/pdf/v060p01064.pdf https://www.clinicalkey.com/#!/content/journal/1-s2.0-S1067251614005742 http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/heel-spur http://www.shockwavetherapy.education/index.php/tutorials/ankle/heel-spurs https://www.clinicalkey.com/#!/content/medline/2-s2.0-24172641 www.revrokineto.com/viewart/111/en https://www.clinicalkey.com/#!/content/medline/2-s2.0-28214811