yogabook / pathologie / heel spur

heel spur (calcaneus spur, fasziitis plantaris)

Definition

Bony (exostosis) spur on the calcaneus: new bone formation, usually as a concomitant of plantar fasciitis; affects 10% of runners; more women overall; peak age 40-60 years; surrounding tendons may be calcified. The heel spur is a common overuse syndrome. 13-32% of people without plantar fasciitis and 50-89% of people with plantar fasciitis have an anterior heel sp ur. In particular, the occurrence without plantar fas ciitis is often an incidental finding. The calcification is usually located in the area of the insertion of the quadratus plantae, more rarely also in that of the abductor hallucis or the abductor digiti minimi.

1. Upper(cranial, posterior) heel spur in „Haglund’s exostosis“ or „Haglund’s heel“ (M77.3, M92.6): at the attachment of the Achilles tendon to the calcaneus
2. lower (plantar) heel spur (more common): Ossification in the area where the plantar aponeurosis attaches to the calcaneus

possibly associated with plantar fasciitis(inflammation of the plantar fascia). The term „Haglund’s exostosis“ does not exactly follow the description of the Swedish orthopaedist Patrick Haglung, who described a bone mass more profound than the Achilles tendon.

ICD M77.3

Cause

1. Overuse or inadequate training condition
2. Pre-existing insertional tendinopathy

Predisposing

– Behavior

1. Unsuitable footwear: too flat, insufficiently supportive soles, shoes that are too tight
2. Lots of activity on your feet
3. Technical deficiencies when running
4. Insufficient warm-up before sport, resulting in increased muscle tension
5. Occupations with standing or walking work
6. Inadequate increase in training workload, change in other important training parameters

– Health factors / illnesses

1. Older age (causes fat pads under the heel to shrink)
2. Large body length
3. Overweight (significantly increased risk), especially with rapid weight gain
4. Splayfoot

– Musculoskeletal system

1. Foot deformities, especially with a reduced longitudinal arch such as splayfoot, flatfoot, flatfoot; hollow foot
2. Muscle weakness, especially in the foot and calf muscles after/due to lack of exercise
3. Shortening of the toe flexors, especially if the toe extensors are weak
4. Lack of flexibility of the triceps surae
5. Leg length differences
6. Hyperpronation when running

Diagnosis

1. X-ray, ultrasound, MRI
2. Tests and signs: Windlass test for plantar fasciitis, manual pressure pain provocation
3. Root cause analysis during running through video analysis

Symptoms

1. from symptom-free to severe stabbing pain when rolling the foot or even when standing in the area of the front heel (lower) or mainly pain on exertion (posterior);
2. especially at the beginning: morning onset pain, worse after rest, later permanent pain on exertion
3. Pressure soreness
4. Painful toe position
5. Exercise-induced pain after prolonged exertion

Complications

1. Rupture

Therapy

Treatment is almost exclusively conservative:

1. Regular stretching (2-3/d)
2. Inlays, gel cushions
3. Shock wave therapy: does not shatter the heel spur itself but stimulates the metabolism in the surrounding tissue
4. KG
5. Irradiation
6. Trigger acupuncture
7. Analgesics if necessary
8. Botox infiltrations
9. local anti-inflammatory drugs
10. Kryotherapy
11. Local anesthetic with cortisone if necessary
12. Radiotherapy if necessary in cases of significant pain and resistance to treatment for 2-3 months, more commonly used in older patients
13. Surgical removal of the spur if necessary
14. Plantar fasciotomy if necessary
15. Recurrence prevention: stretching, fascia roll, foot massages. During sport: warming up

DD

1. RA
2. Ankylosing spondylitis
3. Gout
4. Ledderhose disease (lump formation in the plantar aponeurosis)
5. Dupuytren’s

Asana practice and movement therapy

In the case of a heel spur, plantar fasciitis is probably also present and it must be assumed that the plantar fascia is under too much tension. Therefore, in addition to the passive stretching of the plantar fascia muscles using the small fascia roll or foot massages, it is particularly important to stretch the toe flexors using postures that involve 90° dorsiflexion in the metatarsophalangeal joints fixed to the wall. At the same time, the triceps surae must be brought into a sufficiently strong but also well stretchable state. As both parts of the triceps surae are supinators of the ankle, the other supinators and the pronators of the ankle should also be stretched and strengthened to achieve a good balance of strength.

Asanas

1. Asanas in 851: Stretching the foot extensors / plantar flexors / calf muscles
2. Asanas in 852: Strengthening the foot extensors / plantar flexors / calf muscles
3. Asanas in 861: Stretching the supinators
4. Asanas in 862: Strengthening the supinators
5. Asanas in 871: Stretching the pronators
6. Asanas in 872: Strengthening the pronators
7. Asanas in 971: Stretching the toe flexors
8. virasana and baddha padasana for relaxed antagonists.