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Saturday, 23 December 2017

Calcaneal spurs (Calcium spurs)

                    Calcaneal spurs (Calcium spurs)




    A heel spur is a calcium deposit causing a bony protrusion on the underside of the heel bone. On an X-ray, a heel spur can extend forward by as much as a half-inch. Without visible X-ray evidence, the condition is sometimes known as  "heel spur syndrome". 

  The abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation, and swelling. If this process continues, the plantar fascia partially tears away from the heel. The body will fill this torn area with calcium, developing it as a bone, resulting in a heel spur. Constant abnormal pulling of the plantar fascia irritates the heel bone and the body lays down a bone spur as a protective mechanism. The projection or growth of bone may be called a spur and it grows where the muscles of the foot attach to the bone. While some heel spur is painless, others that are determined are the cause of chronic heel pain and any required treatment or surgical removal. 

 When small tears occur, a very amount of bleeding may occur. Pain experienced in the bottom of the heel is not produced by the presence of the spur. The pain is due to excessive tension of the plantar fascia as it tears from its attachment into the heel bone and not from the spur. Heel spur formation is secondary to the excessive pull of the plantar fascia. May people have heel spurs at the attachment of the plantar fascia without having any symptoms or pain. The Spurs may not appear on X-ray of patients with acute heel pain. Conversely, heel spurs of all sizes are often seen on X-rays of patients who do not have any heel pain. If a spur exists, it is only a shelf of bone rather than a small, sharp protrusion. Therefore, initial treatment is direst at decreasing the pulling and tightness of the plantar fascia and supporting the fascia during weight- bearing to decrease inflammation. If a nerve is initiated by the spur or inflamed due to swollen fascia the pain may radiate into the arch of the ankle. 

   Although heel spurs are often painless, they can cause heel pain. They are frequently associated with plantar fasciitis, a painful inflammation of the fibrous band of connective tissue (plantar fascia) that runs along the bottom of the foot and connects the heel bone to the ball of the foot. Treatment for heel spurs and associated conditions include exercise, custom-made orthotics, anti-inflammatory medications, and cortisone injections. If conservative treatments fail, surgery may be necessary. 

Causes of Heel Spurs

 Heel spurs occur when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping. 

Risk factors for Heel Spurs include

. Walking gait abnormalities, which place excessive stress on the heel bone. Ligaments, and nerves near the heel
. Running or jogging, especially on hard surfaces 
. Poorly fitted or badly worn shoes, especially those lacking appropriate arch support
. Excess weight and obesity

Other risk factors associated with plantar include: 

 . Increasing age, which decreases plantar fascia flexibility and thins the heel protective fat pad
. Diabetes
. Spending most of the day on one's feet
. Frequent short bursts of physical activity
. Having either flat feet or high arches

Pathophysiology

 The specialized soft tissue at the heel functions as a shock absorber. The subcutaneous structure consists of fibrous lamellae arranged in a complex whole containing adipose tissues that attach to vertical fibers of the dermis and the plantar aponeurosis. 

 The heel can absorb 100% of the body's weight during walking and 200% of the body's weight during running. The plantar fascia is a multilayered fibroaponeurotic structure that arises predominantly from the medical calcaneal tuberosity and inserts distally through several slips into the plantar plates of the metatarsophalangeal joints, the flexor tendon sheaths, and the bases of the proximal phalanges of the toes. 

 Dorsiflexion of the toes applies traction stress at the origin of the plantar fascia. A contracture in the triceps surae, a pes cavus, or a pes planus can increase the traction load at the origin of the plantar fascia during weight-bearing activities. 

 Other anatomic factors that can have similar effects are overpronation, the discrepancy in leg length, excessive lateral tibial torsion, and excessive femoral anteversion. However, overuse, not anatomy, is the most common cause of plantar fasciitis in athletes. The pain of plantar fasciitis is caused by collagen degeneration associated with repetitive microtrauma to the plantar fascia.  

 An inflammatory response and reparative process can double the thickness of the plantar fascia, which is normally approximately 3mm. Biopsy specimens reveal collagen necrosis, angio- fibroblastic hyperplasia, chondroid metaplasia, and calcification. The heel pain can also have a neurologic basis. The tibial nerve, with nerve roots from L4-5 and S2-4, courses in the medial aspect of the hindfoot, through the tarsal tunnel, under the flexor retinaculum, and over the medial surface of the calcaneus. The calcaneal branch, arising directly from the tibial nerve, carries sensation from the medial and plantar heel dermis. 

The tibial nerve divides into lateral plantar nerves, which proceed into the plantar aspect of the foot through a foramen within the origin of the abductor hallucis muscles, which forms the distal tarsal tunnel. The first branch of the lateral plantar nerve changes courses from a vertical to a horizontal direction around the medial plantar heel. It passes deep to the abductor hallucis muscle fascia and the plantar fascia and is the nerve supply ot the abductor digit minimi. The tibial nerve and its branches in the hindfoot can be involved with compressive neuropathies. A valgus heel can stretch the tibial nerve. 

Symptoms of Heel Spurs

 Heel spurs often cause no symptoms, but heel spurs can be associated with intermittent or chronic pain, especially while walking, jogging, or running if inflammation develops at the points of the spur formation. In general, the cause of the pain is not the heel spur itself but the soft-tissue injury associated with it. 

 Many people describe the pain of heel spurs and plantar fasciitis as a knife or pin sticking into the bottom of their feet when they first stand up in the morning, a pain that later turns into a dull ache. They often complain that the sharp pain returns after they ants up after sitting for a prolonged period of time. 

Non-surgical Treatments of heel spurs

 The heel pain associated with heel spurs and plantar fasciitis may not respond well to rest. If you walk after a night's sleep, the pain may feel worse as the plantar fascia suddenly elongates, which stretches and pulls on the heel. The pain often decreases the more you walk, but you may feel a recurrence of pain after either prolonged rest or extensive walking. If you have heel pain that persists for more than one month, consult a healthcare provider. He or she may recommend conservative treatments such as: 
. Stretching exercises
. Shoe recommendations
. Taping or strapping to rest stressed muscles and tendons. 
. Shoe inserts or orthotic devices
. Physical therapy
. Night Splints 

 Heel pain may respond to treatment with over-the-counter medications such. as acetaminophen (Tylenol), ibuprofen(Advil), or naproxen(Aleve).In many cases, a functional orthotic device can correct the causes of heel and arch pain such as biomechanical imbalances. In some cases, injection with a corticosteroid may be done to relieve inflammation in the area. 

Surgery for Heel Spurs

 More than 90 % of people get better with nonsurgical treatments. If conservation treatment fails to treat symptoms of heel spurs after a period of 9 to 12 months, surgery may be necessary to relieve pain and restore mobility. 

 Surgical techniques include:

. Release of the plantar fascia
. Removal of a spur

Pre-surgical tests or exam are required to identify optimal candidates, and it's important to observe post-surgical recommendations concerning rest, ice, compression, elevation of the foot, and when to place weight on the operated foot. In some cases, it may be necessary for patients to use bandages, splints, casts, surgical shoes, crutches, or canes after surgery. Possible complications of heel surgery include nerve pain, recurrent heel pain, permanent numbness of the area, infection, and scarring. In addition, with plantar fascia release, there is a risk of instability, foot cramps, stress fracture, and tendinitis.

Prevention of heel spurs

  You can prevent heel spurs by wearing well-fitting shoes with shock-absorbent soles, rigid shanks, and supportive heel counters, choosing appropriate shoes for each physical activity, warming up and doing stretching exercises before each activity, and pacing yourself during the activities. 

 Avoid wearing shoes with excessive wear on the heels and soles. If you are overweight, losing weight may also help prevent heel spurs.

 Pain in the heel not only restricts movement but the general discomfort of walking or standing also disturbs the whole persona of a person. The pain can be attributed to a medical condition knows as Calcaneal Spur. It refers to a sharp, pointed, horny outgrowth on the calcaneal bone present in the heel. The outgrowth is the build-up of calcium deposit on the heel bone. The reason behind calcaneal spur formation is repeated stress on the heels. When the heels are exposed to repeated stress, it leads to damage to muscle, ligaments, and fascia that covers the heel bone. As a result, the heels are exposed and become prone to trauma and formation of the calcaneal spur. People who are obese and athletes are prone to develop calcaneal spurs. Wearing of high heels and ill-fitting shoes also spur the formation of calcium deposits on the heel bone. 

 The main symptoms of the calcaneal spur is a pain in heel around the spur. The pain gets worse when a person steps on the ground after a period of inactivity especially in morning following a long rest. The pain increases while walking, running and standing. The character of pain may be described as sharp pain, dull pain or pain from pin-pricking. Homeopathic medicines offer a very safe and complete treatment of calcaneal Spur. The homeopathic medicines for calcaneal spur are made of natural substance and have no side effects. 

Homeopathic treatment for Calcaneal Spur

 Natural Homeopathic medicines for Calcaneal spur are very strong and powerful in treating the condition. Homeopathic medicines, which are completely safe to use, help in both relieving the pain in heels due to spurs and also in dissolving the spurs, thus providing treatment for calcaneal spurs. 

 Calcarea Flour: 

 One of the best homeopathic remedies for calcaneal flour treatment is Calcarea flour. It is the most effective natural Homeopathic medicines with the best healing power to dissolve the calcaneal spur. This homeopathic remedy is of great help in all cases of calcaneal spur whether painful or not. Calcarea flour acts as the best resolving agent for calcaneal spur and is considered the first choice of homeopathic remedy in every case of the calcaneal spur. 

Ammonium Mur

 Ammonium Mur is a very beneficial natural Homeopathic medicine for the Calcaneal spur. This homeopathic remedy is of great help in decreasing the pain as well as dissolving the spur. Apart from specific worsening of pain on walking, the person also complains of pain in morning. A few people needing Ammonium Mur may get relief by slight rubbing of the heel. The pain can be stitching or tearing in nature for using Ammonium Mur. 

Rhus-tox:

 Homeopathic medicine Rhus-tox is the top natural remedy for pain in the heel on standing due to calcaneal spur. Homeopathic medicine Rhus-tox also helps in repairing the muscles and ligaments covering the heel bone, thus preventing further heel damage. Its next action is to dissolve the spur. Rhus-tox thus acts in three spheres for Calcaneal Spur patients- pain relief, strengthening the muscles or ligaments, and dissolving the spur. The pain narrated by the person on standing is ost of the times stitching in character. The person may feel the pain as being similar to that caused by a splint. Another expression used may be a pain as from a nail under the skin. 

Aranea Diadema

 Aranea Diadema is considered among the top natural homeopathic medicines for Calcaneal Spur treatment. This Homeopathic remedy is best for getting rid if digging and boring type of pains in the heel. The pain may alternate with a numb feeling in the heel. An extreme sensitivity to cold air can also be predominantly present. 

Aurum Met

 The pain in the heel at night due to Calcaneal Spur is best relieved by natural Homeopathic remedy Aurum Met. It is very appropriate and efficient Homeopathic medicine to get rid of night pain in heel arising because of the spur. 

Mezereum

 For patients complaining of pain in the heel spur when touched, natural homeopathic medicine Mezereum is the best remedy. Mezereum is of great help in treating the heel spur pain that worsens by touching. The patient may show an increased sensitivity to cold air. 

Ruta

 The tendon that connects the calf muscle the calf present in the back of the leg to heel is known as Tendo Achilles. For patients who have pain in heel due to Calcaneal Spur with the extension of pain in tendon Achilles, the best homeopathic remedy for relief is Ruta. Ruta is of great help in bony and tendon complaints. 


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