What is a Heel Spur?
Heel spurs explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
The heel of the foot is a structure mainly composed of a large bone (the calcaneus) surrounded by connective tissue. These form the base of the foot. If this connective tissue degenerates or wears down, this can cause a painful condition known as plantar fasciitis, which is associated with the abnormal build-up of calcium on the exposed heel bone. This process, known as calcification, eventually results in the formation of bony spurs protruding from the calcaneus. These are called heel spurs, and are mostly seen at the back or bottom of the bone. In some cases, the spurs are visible through the skin of the foot. It is not clear if heel spurs cause fasciitis, or are in fact a symptom of it. Heel spurs can be a source of constant pain, as can fasciitis alone. Heel spurs can adversely affect normal movement, even reducing the ability to stand, and may, in severe cases, require surgery to remove them.
Causes of Heel Spurs
Heel spurs are usually the result of straightforward wear and tear; the connective tissue of the heel simply wears down over time. This may result from occupational hazards such as prolonged standing, or wearing shoes with a lack of arch support and a poor fit. It is also associated with inflammation, produced in diseases such as arthritis. Heel spurs are also often a symptom of ankylosing spondylitis, an inflammatory condition affecting a range of bones, including those of the feet.
Heel spurs can also be associated with prolonged athletic or sporting activity, and with high body weight. Some researchers categorize heel spurs as a repetitive stress injury. Pain from heel spurs is normally perceived as an intense piercing sensation, as if the bone is pushing through skin.
Treatments for Heel Spur
Sacral nerves, located in the lower spine, are involved in sending information about inflammation or injury of the heel to the brain. If heel spur pain is resistant to conventional treatment such as pain-killing drugs, these nerves can be inhibited, using minimally-invasive clinical procedures. Spinal nerve blocks are pain-blocking injections of local anesthetics and/or steroids (to treat inflammation if applicable) delivered directly to the nerves in question. The injections are administered under local anesthetic, using imaging techniques such as fluoroscopy to ensure accurate placement of the needles or catheters used.
There is a slight risk that this placement may miss the nerve, and inject a blood vessel or incorrect region of the spine by mistake. This may result in mild to moderate numbness, paralysis, or discomfort. These effects may also be caused by adverse reactions to the local anesthetics (e,g, lidocaine or bupivacaine) used. Steroids, if also included, can cause side-effects such as weight gain, and immune system depression that can result in increased susceptibility to arthritis and illness. Nerve blocks in the lower back can often cause transient neurological reactions, mostly in the form of a headache.
Interestingly, only certain areas of nerves transmit painful stimuli to the brain. These are known as pain fibers, and can be located with the use of advanced imaging techniques. As such, it is possible to target these and temporarily disrupt them, in order to treat chronic pain in conditions such as heel spur. Radiofrequency ablation (RFA) is a process where this is done using thermoelectric probes. RFA is performed under local anesthetic, as the probe must be inserted through skin and tissue to access and destroy pain fibers. There is a risk of infection and bleeding at this infection site. In rare cases, radiofrequency ablation errors may cause more damage than intended to the nerve, resulting in reduced motor control.
Heel spurs are associated with plantar fasciitis, in which the connective tissue surrounding the calcaneus degenerates, leading to calcified protrusions on this bone. These spurs may cause chronic pain. Most heel spurs are caused by wear and tear, but in some cases they are caused by diseases such as ankylosing spondylitis. Heel spur-related pain can be treated with nerve blocking injections or radiofrequency ablation. These can result in weeks to months of pain relief.
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