Heel spur and heel spur syndrome.
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Adult↗
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History and mechanical control of heel spur pain.
The symptom of heel pain from heel spur syndrome has both a cause (abnormal pronation) and an effect (inflammation at the heel spur area). I believe that heel spur syndrome cause and effect can best be treated mechanically by a two-stage approach. This two-stage approach uses a different orthotic for each stage. The first stage is to prescribe an orthotic to alleviate the cause through control of abnormal pronation by posting or wedging, and also to alleviate the effect by local accommodation and shock absorption of the inflamed area. The second stage of mechanical treatment is begun after the effect (local inflammation) has subsided. This second stage consists of treatment with a rigid functional orthotic to treat only the cause. This orthotic is more durable and controlling and will therefore maintain the patient and prevent abnormal pronation from occurring. Thus, the cause of pain at the heel spur area will be eliminated. Orthotics can be a great adjunct to treatment of heel spur syndrome. But, as is the case with any other method you use to treat your patients, orthotics are only as good as the theories on which you base them. There are a variety of excellent materials and computerized methods being used today for fabrication of orthotic devices, but they are only as effective as the knowledge on which you base them. If you do not understand the etiology of the mechanical problem and do not observe what treatment is successful and the reasons behind this success, the orthotic you prescribe is not going to have a high level of success, regardless of new materials or technology. You will be like the laboratory technician who can fabricate an orthotic, but cannot predict, with any level of confidence, whether it will alleviate the mechanical problem.
Biomechanical Phenomena↗
Heel spur formation and the subcalcaneal enthesis of the plantar fascia.
OBJECTIVE: To describe the structure and significance of subcalcaneal heel spurs associated with the plantar fascia. METHODS: The enthesis of the plantar fascia was removed from 17 elderly cadavers by sagittal saw cuts either side of the medial tuberosity, radiographs were taken, and the tissue was processed for routine histology. Sagittal sections were stained with toluidine blue, Masson's trichrome, or alcian blue, and sections were matched with the corresponding radiographs. RESULTS: Spurs develop on the deep surface of the plantar fascia but their formation is heralded by degenerative changes that occur within it. According to differences between small and large spurs, we propose that there are 3 stages in their development: (1) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (2) thickening of the subchondral bone plate at the enthesis as small spurs form; (3) development of vertically oriented trabeculae buttressing the proximal end of larger spurs. The spurs grow by a combination of intramembranous and chondroidal ossification. CONCLUSION: Contrary to popular belief, subcalcaneal heel spurs cannot be traction spurs as they do not develop within the plantar fascia itself. They are thus fundamentally different from heel spurs in the Achilles tendon. We suggest instead that they develop as a consequence of degenerative changes that occur in the plantar fascia enthesis.
Aged↗
Heel spur: radiation therapy for refractory pain--results with three treatment concepts.
PURPOSE: To evaluate radiation therapy (RT) to treat refractory pain in plantar heel spur. MATERIALS AND METHODS: From 1984 to 1994, 141 patients with refractory painful plantar heel spur (170 heels, because of bilateral disease) underwent RT. Quantitative criteria were used to evaluate heel pain and ankle function prior to RT, 6-12 weeks after RT, and at last follow-up (median, 4 years). Patients were divided into three treatment groups: group A (n = 72 heels [two courses, 1.0-Gy fractions, 12-Gy total RT dose]), group B1 (n = 50 heels [one course, 0.3-Gy fractions, 3-Gy total dose]), and group B2 (n = 48 heels [one course, 0.5-Gy fractions, 5-Gy total dose]). RESULTS: At last follow-up, complete pain relief was achieved in 48 (67%) of 72 group A heels and in 71 (72%) of 98 group B heels. Statistically significant (P < .05) differences between groups were found for insufficient pain relief (< 80%) in patients in whom the response time after RT was longer than 4 weeks or in whom pain recurred during follow-up. The best results were achieved with the 5-Gy total RT dose (P < .05). Prognostic factors for complete pain relief were acute pain and short duration of pain prior to RT. The prognostic factor for insufficient pain relief was total RT dose. CONCLUSION: Refractory heel pain is effectively treated with RT, which should be considered a primary treatment approach rather than a last resort.
Adult↗
Long-term follow-up of heel spur surgery. A 10-year retrospective study.
A comparative retrospective study of 48 open heel spur surgeries and 20 endoscopic plantar fasciotomies was conducted involving 59 patients over a 10-year period. There was a significant reduction in heel pain at the time of follow-up (average, 3 years) for both groups. Overall, 85% of procedures were associated with patient satisfaction with the results, and patients said that they would recommend heel spur surgery for relief of severe heel pain in 94% of cases. Factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity, are discussed.
Calcaneus↗
Heel spur radiotherapy and radiation carcinogenesis risk estimation.
PURPOSE: Radiotherapy is a nonsurgical alternative therapy of painful heel spur patients. Nonetheless, cancer induction is the most important somatic effect of ionizing radiation. This study was designed to evaluate the carcinogenesis risk factor in benign painful heel spur patients treated by radiotherapy. MATERIALS AND METHODS: Between 1974 and 1999, a total of 20 patients received mean 8.16 Gy total irradiation dose in two fractions. Thermoluminescent dosimeters (TLD(100)) were placed on multiple phantom sites in vivo within the irradiated volume to verify irradiation accuracy and carcinogenesis risk factor calculation. The 20 still-alive patients, who had a minimum 5-year and maximum 29-year follow-up (mean 11.9 years), have been evaluated by carcinogenic radiation risk factor on the basis of tissue weighting factors as defined by the International Commission on Radiological Protection Publication 60. RESULTS: Reasonable pain relief has been obtained in all 20 patients. The calculated mean carcinogenesis risk factor is 1.3% for radiation portals in the whole group, and no secondary cancer has been clinically observed. CONCLUSION: Radiotherapy is an effective treatment modality for relieving pain in calcaneal spur patients. The estimated secondary cancer risk factor for irradiation of this benign lesion is not as high as was feared.
Adult↗
A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome.
The authors review the etiologies and treatments of plantar fasciitis or heel spur syndrome. They offer results of a retrospective study. Comparison of the return to work time after surgery for this condition, examinations of the effects of patient age at the time of surgery, gender, duration of pain prior to surgery, and type of surgical procedure, either endoscopic plantar fasciotomy or open plantar fasciotomy with heel spur resection, is provided.
Absenteeism↗
Pivotal resection of heel spurs in sports medicine: a case study and presentation.
Using the cresentic pivotal saw for resecting a heel spur in a new method whereby a plantar heel spur can be removed in toto with no irregular osseous margins remaining. Consequently, less trauma to the calcaneus occurs and the process of postoperative recovery is enhanced. This technique is new to the literature. Presently, we are developing a more sophisticated blade.
Calcaneus↗
Low-dose radiotherapy for painful heel spur. Retrospective study of 117 patients.
PURPOSE: Retrospective analysis of 117 patients treated between 1996 and 2000 with low-dose radiotherapy (RT) for painful heel spurs. PATIENTS AND METHODS: 71 women and 46 men were irradiated on 136 painful heel spurs in one (n = 104) or two radiation series (n = 13). The painful spurs were located either at the plantar (n = 94), dorsal (n = 5) or bilateral heel (n = 18). 82 patients had prior treatments, in 35 patients RT was the primary treatment. Low-dose RT was performed twice a week with one 6-MV photon field. Ten fractions of 0.5 Gy were applied to a total dose of 5 Gy. Evaluation was done on completion and during follow-up using the four-scale von Pannewitz score. RESULTS: On completion of RT, 27 patients were free of pain, 40 were much improved, 31 reported slight improvement, and 19 experienced no change. After a mean follow-up of 20 months, 75 out of 100 patients were free of pain, twelve had marked and three some improvement. Ten patients reported no change of symptoms. Mean duration of pain before RT was 6 months. RT applied < or = 6 months after the onset of clinical symptoms resulted in improvement in 94%. By contrast, an interval of > 6 months until the initiation of RT resulted in only 73% of patients with clinical improvement. CONCLUSION: Low-dose RT reveals a benefit in > 80% of the patients. RT should start during the first 6 months of symptoms. Prospective clinical studies with validated symptom scores should be conducted to assess optimal dose and fractionation scheme of RT.
Adult↗
Inferior heel spur surgery.
In most instances, pure mechanical heel spur surgery can and should be avoided. The proper diagnosis is extremely important because many different disorders can cause inferior heel pain like that of a mechanical cause. Described throughout the literature are many surgical approaches and techniques for this problem. Personal preference and experience dictates the choice. In some isolated cases, a specifically designed procedure may be necessary. Postoperative care is as important as the surgical procedure itself because recovery usually takes quite a long time.
Calcaneus↗
Endoscopic plantar fasciotomy versus traditional heel spur surgery: a prospective study.
A comparative study of endoscopic plantar fasciotomy versus traditional type heel spur surgery has been performed involving 76 patients and 92 procedures. Sixty-six of those procedures consisted of endoscopic fasciotomy, whereas 26 involved traditional type surgery. Those patients in which the endoscopic fasciotomy was performed had significantly less postoperative pain, returned to regular activities 4 weeks earlier, and had fewer complications postoperatively than those patients involving traditional heel spur surgery. An overview of the surgical technique involving endoscopic fasciotomies is presented, as well as factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity.
Adult↗
Radiation therapy for painful heel spurs: results of a prospective randomized study.
PURPOSE: To evaluate the efficacy of two different dose-fractionation schedules for radiation therapy (RT) in patients with painful heel spurs. PATIENTS AND METHODS: 130 patients were randomized into two groups: the low-dose (LD) group (n = 65 heels) received a total dose of 3.0 Gy given in two weekly fractions of 0.5 Gy; in the high-dose (HD) group (n = 65 heels), two weekly fractions of 1.0 Gy were applied over 3 weeks (total dose 6.0 Gy). In 24 sites of the HD group and 17 sites of the LD group, a second RT course was given. The results were assessed using a five-level function score which was documented before RT, at the end of each RT course, and at 6 weeks and 6 months thereafter. RESULTS: At 6-month follow-up, RT led to a highly significant reduction of symptoms in both groups. In the HD group, 31 sites were classified as excellent (score: 90-100), 13 as good (score: 70-85), twelve as moderate (score: 45-65), and nine as poor (score: 0-40). In the LD group, 35 sites were classified as excellent, eight as good, ten as moderate, and twelve as poor. The comparison of the difference of the sum score and the single criteria before RT and at 6 months after RT using the Wilcoxon-Mann-Whitney U-test revealed no statistically significant difference of response to RT between both groups. CONCLUSION: RT is an effective treatment option for the management of inflammatory heel spurs. The dose for an RT course should not exceed 3.0 Gy.
Adult↗
The plantar transverse incisional approach for heel spur syndrome. A retrospective study.
The efficacy of the transverse plantar incisional approach for the treatment of recalcitrant heel spur syndrome or plantar fasciitis was investigated by evaluating cases of this procedure performed by the authors from 1991 to 1998. Patient records were reviewed for conservative treatment rendered prior to surgical intervention as well as for the perioperative course of the patient. All patients were asked to complete questionnaires regarding their heel spur syndrome or plantar fasciitis and their opinion of both the conservative and the surgical treatments received.
Adult↗
[Radiotherapy of plantar heel spurs: indications, technique, clinical results at different dose concepts].
BACKGROUND: In a retrospective study the efficacy of orthovoltage radiotherapy for refractory painful plantar heel spur was analyzed for 3 different radiation dose concepts. PATIENTS AND METHODS: From 1.1 1984 through 1.3.1994, 182 patients with refractory painful heel symptoms and radiologically proven plantar heel spur received radiotherapy. A total of 141 patients and 170 heels (due to double-sided symptoms) were completely documented in long-term follow-up. Clearly defined semi-quantitative criteria (9-point score) were used to analyze heel pain and ankle function prior to RT, 6 to 12 weeks post-radiation, and at last follow-up. The treatment outcome, i.e. (un)favourable response, of 3 radiation dose concepts were compared: Group A (n = 72 heels) received 12 Gy total radiation dose in 3 fractions per week and 2 series (6 x 1 Gy per series) separated by 6 weeks; group B (n = 98 heels) received 3 Gy total radiation dose in 10 fractions of 0.3 Gy (n = 50) or 5 Gy (10 x 0.5 Gy) (n = 48) with conventional fractionation in 1 series. RESULTS: Radiotherapy was very effective: at last follow-up 67% (group A) and 71% (group B) remained completely free of pain. The rate of "complete pain relief" (i.e. free of any pain symptoms) was not different between the 3 radiation concepts. However, significant differences were observed with regard to "incomplete or insufficient pain relief", i.e. a subjective pain relief of less than 80%, a delayed pain relief after more than 4 weeks or a relapse of pain symptoms in long-term follow-up. More favourable results were achieved in patients receiving 5 Gy or 12 Gy total dose, while patients with 3 Gy total dose had significantly worse results. Prognostic factors for "complete pain relief" were short duration of pain symptoms and acute pain symptoms prior to radiotherapy; with regard to "in-complete or insufficient pain relief" the total dose was found to be a prognostic parameter. CONCLUSIONS: Patients with refractory heel pain can yield a high response to radiotherapy even after failing various conventional treatments previously. Thus, radiotherapy should not be solely regarded as a last resort due to its low costs and high efficacy at low radiation doses.
Adult↗
Retrospective analysis of minimal-incision, endoscopic, and open procedures for heel spur syndrome.
Forty-four patients with recalcitrant heel spur syndrome who underwent surgical correction (54 procedures) were studied retrospectively. The results of minimal-incision, endoscopic, and open plantar fasciotomy procedures were compared. This study focuses on patient satisfaction, pain reduction, convalescence, and postoperative problems. Although all procedure groups reported high degrees of patient satisfaction and reduction of pain, some notable differences among the three groups were observed.
Adult↗
Transverse plantar incision for heel spur surgery. Four-year follow-up survey of 35 patients.
A transverse plantar incisional approach was used on 35 patients who underwent heel spur surgery from 1982 through 1990. Ten bilateral procedures were performed on a total of 45 feet. A medial approach was used for five of the bilateral surgeries. The average age of the patient was 47 years, and the average follow-up period was 49 months. Of the 34 plantar approach cases in which complete data were obtained, 94% showed either good or excellent results. The authors illustrate a technique using a transverse plantar incision as an alternative to the medial approach for heel spur surgery.
Calcaneus↗
Progressive changes in the pathology of a heel spur.
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Heel↗
Calcaneal heel spurs: etiology, treatment, and a new surgical approach.
The primary symptom of heel spurs is pain in the plantar surface of the heel. The authors illustrate a new approach to heel surgery--a plantar midline incision, which permits good exposure so the surgeon can visualize the soft tissue masses and eliminates postoperative paresthesias.
Adolescent↗