CURRENT TREATMENT OF HEEL Spurs
Heel spur is an orthopedic disease that manifests itself with heel pain and reduces the comfort of daily life when left untreated. It is seen in every age group except childhood, but its incidence increases especially after the age of 40. There is no significant difference in terms of incidence in men and women. The main cause of the disease is standing too long. However, since it is not seen in everyone who stays standing for a long time, it is thought that the foot type and the shoes worn are also important in the disease.
Every person has a curve at the base, which is a normal anatomical feature. Thanks to this curve, a partial stretching is provided with the body weight while walking and the wear of the foot joints is prevented. The fact that this curvature is less than normal (flat feet) or more than normal (combed feet) causes differences in these stretching movements. These differences constitute the main cause of the disease we call heel spur. In other words, those with such structural differences are more prone to the disease.
Symptoms of heel spurs show themselves with heel pains, especially with pressing on the ground. Severe pain that occurs with the first step on the ground after getting out of bed in the morning is typical. This severe pain decreases after the first 1-2 steps, but continues throughout the day. In the advanced stages of the disease, heel pain from stepping on may also occur. As long as the heel spur is not treated, it progresses, so there is no concept of self-healing. The longer the process, the greater the resistance of the disease to treatment.
The diagnosis of the disease is usually made with a simple examination. The patient’s complaints and living conditions are important in the diagnosis. Imaging methods are used to plan the treatment of the patient diagnosed after the examination. Most of the time, a simple X-ray is sufficient. Thanks to the x-ray, the size of the bone protrusion (thorn) is determined and a treatment plan is made.
In the treatment of early-stage heel spur, there is no obvious finding on X-ray. The patient’s complaints have just started (maximum 1-2 months). At this stage, the number of applications to the doctor is low, as the pain does not bother much and does not cause restrictions in daily work. On the other hand, this is the period when we are most successful in the treatment of heel spurs. Simple pain relief drugs provide significant improvement after 1-2 days of rest and the patient recovers. The causative factors are being reviewed, changing shoes or evaluating work conditions stops the progression of the disease.
In the middle stage heel spur, the complaints are long-lasting and there is pain that starts with morning pain and continues throughout the day. Bone protrusion is formed on the radiograph, but it is less than 1 cm in measurement. Patients who have been diagnosed before but experience disruptions during the treatment process are in this group. In this group, a gradual treatment is applied. First of all, 1-2 weeks of drug therapy is given to correct the acute picture. Rest is recommended during this period. If the complaints are resolved, they are followed up with protective measures. (such as reducing standing time, choosing shoes) . If there is no response to drug treatment, other treatment methods are used. The most well-known of these is to make a needle from the heel. Cortisone injection provides improvement in the edematous area of the sole and provides a temporary improvement in the patient’s complaints. In these patients, the use of insoles is recommended to increase the effectiveness of the treatment. A maximum of 2-3 injections can be made in the same area. More regional side effects occur. If the complaint still persists after the injection and there is no significant regression, the patient is classified as advanced stage heel spur.
Advanced-stage heel spurs are the patient group whose pain has become chronic and whose results could not be obtained with other treatment methods. The patients lost hope, reduced their daily activities and accepted the unhealed disease. Multiple injections were applied and no results were obtained. The size of the bony prominence on the X-ray is greater than 1 cm. In this group, surgical treatment methods were tried, that is, the bony prominence was removed, but surgical treatments were decreased because clinical improvement could not be achieved.
In recent years, a ray of hope has emerged for these helpless patients whose complaints continue. A high rate of clinical improvement is achieved with thermotherapy (colloquially, laser treatment), which is based on the principle of destruction of the nerves that cause pain in the problem area. The treatment is carried out under local anesthesia in operating room conditions. It takes about half an hour and the patient does not feel pain during the procedure. 1-2 hours after the procedure, the patient is sent to his home and is told not to give full weight to the treated area for 3-4 days. During the procedure, the nerves around the bony prominence are destroyed and the patient’s complaints are relieved.