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The heel bone, the calcaneus (formerly called the calcaneum), is the largest bone in the foot. It is a heel bone formed of spongy tissue where numerous tendons and ligaments are inserted. The most notable of these are the Achilles tendon, which is inserted at the back of the heel, and the plantar fascia, a fibrous membrane that runs along the sole of the foot.
Static disorders, valgus associated with a flat foot for example, are the main causes of talalgia. But other factors should also be considered, such as obesity, which increases the pressure on the feet, which carry the entire weight of the body, venous insufficiency, a short Achilles tendon, prolonged walking or the wearing of ill-fitting shoes. A flat or hollow foot can also cause talalgia. To avoid the appearance of a heel spur, it is of course necessary to be attentive to these favourable factors.
Symptoms of heel spur or Lenoir spur
It is also called plantar insertional fasciitis or plantar fasciitis. It is also known as plantar fasciitis. Indeed, fascia and aponeurosis are related terms. In the case of inflammation, the suffix -ite is added, hence the term plantar fasciitis.
The pain is mechanical, comparable to a prick or a nail piercing the sole, of progressively increasing intensity, which can lead to limping and an inability to climb stairs.
There is usually a morning derailment of a few steps. If the derailing lasts more than fifteen minutes, this should suggest a spondylopathy or psoriatic rheumatism.
On X-ray, a thickening of the bone at the insertion of the plantar fascia can be seen. This is the famous "spine" of radiologists, which is only a bony growth that is the consequence of excess traction and inflammation, but never the cause of pain.
Ultrasound is necessary to identify the origin of the pain: oedema or inflammation of the aponeurosis one or two centimetres in front of the insertion, partial rupture, tumour or cyst.
X-ray of a heel spur
If you experience symptoms such as those listed above, you should consult a doctor or other health professional who will be able to make an accurate diagnosis and suggest the appropriate therapy to relieve you.
The treatment of plantar fasciitis involves resting for a few days while you get a pair of orthopaedic insoles that will correct any static problems that have led to your heel pain. Stopping physical exercise often helps to reduce the pain.
If there are no associated static problems, a simple pair of heel pads should be sufficient.
This so-called heel pad must be made of a firm material (plastic, agglomerated cork) to avoid instability, which is a source of reflex contractures, stabilising tensions and therefore of accentuation of the pain. Cushioning heels should be avoided, especially as talalgia is not caused by excess pressure but by traction on the insertions.
During the treatment, it is absolutely necessary to avoid walking, running and any painful physical activity, walking barefoot or in flat shoes. Wearing orthopaedic insoles with high arches that tend to increase the tension in the plantar fascia should also be avoided.
A physiotherapist is almost obligatory as part of your treatment follow-up. The physiotherapist will combine massage, local physiotherapy such as shock waves or ultrasound and, above all, exercises combining contraction, relaxation and passive stretching.
Physiotherapy sessions are a recognised treatment for pain relief and always precede any surgery.
In the case of intense pain, corticosteroid infiltration is justified. These infiltrations should be done through the plantar region and preferably under imaging control to avoid blind infiltrations which can lead to micro ruptures of the aponeurosis or a cyst inside the aponeurosis.
Non-steroidal anti-inflammatory drugs can provide occasional pain relief, for example after physical activity, in addition to the indirect application of an ice pack to calm the inflammation.
It is advisable to wear rubber-soled shoes with a wide, medium-height heel. This will really help to relieve your foot of heel spur pain.
If you wear orthotics or heels, you should choose a pair of shoes with removable insoles to accommodate your orthotics.
You will find this type of shoe in our selection of comfortable trainers. We recommend Dr Comfort shoes which have a removable insole and a midsole. This will allow you to adjust the volume and depth of the shoe depending on whether you have orthotics, heels or nothing at all.
The most common surgery performed for the treatment of heel spurs is endoscopic plantar fasciotomy (EPF). This is an outpatient procedure that takes 15-20 minutes and can be performed under general or local anaesthetic. The operation consists of a small incision (about one centimetre) on each side of the heel. A small camera is placed in one incision and a small surgical hook is placed in the other incision. While fully visualising the plantar fascia with the camera, the hook is used to cut through part of the fascia. The hook and camera are removed, and the incisions are closed with one or two stitches. There is no implanted material during this procedure.
The purpose of this surgery is to release a tight or contracted plantar fascia. The cut area is extended by about 2 cm and heals in this position.
Preventing heel spurs requires increased attention to the overall health of your foot. Be aware of the daily demands you place on your feet. Make sure you give your feet a break at the end of the day.
As a general rule, you should never insist on a developing heel pain.
If you continue to walk, exercise or wear shoes that hurt your heel, you risk long-term problems such as heel spurs. If you experience heel pain after any activity, apply ice to the affected area and rest your foot until it improves.
Taking care of your foot health will help reduce your risk of developing this condition.
Author : Philippe Vesin - Pedorthist