Calcaneal Spurs: Difference between revisions
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== Physical Therapy Management <br> == | == Physical Therapy Management <br> == | ||
Calcaneal spurs, both upper and lower spurs, are treated with conventional physiotherapy. Conventional therapy includes ultrasound, passive and active stretching and strengthening of the muscles of the legs and cold and warmth applications. The aim is to eliminate the inflammation surrounding the spur. This kind of treatment may take 6 to 12 months. <ref>1</ref> | Calcaneal spurs, both upper and lower spurs, are treated with conventional physiotherapy. Conventional therapy includes ultrasound, passive and active stretching and strengthening of the muscles of the legs and cold and warmth applications. The aim is to eliminate the inflammation surrounding the spur. This kind of treatment may take 6 to 12 months. <ref>1</ref> | ||
Another proven therapy is radial shockwave therapy. This method consists of very high-energy mechanical waves, pointed at the calcaneal spur. By the growth of blood vessels the inflammation shall be taken away. <ref>2</ref> | Another proven therapy is radial shockwave therapy. This method consists of very high-energy mechanical waves, pointed at the calcaneal spur. By the growth of blood vessels the inflammation shall be taken away. <ref>2</ref> | ||
Some claim that their is no difference between both methods of treatment. <ref>2</ref> However there are different studies who claim ESWT is not effective in the treatment of plantar fasciitis. <ref>3</ref> <ref>4</ref> Because of this discrepancy between studies, further support for an effective treatment with ESWT is needed. | Some claim that their is no difference between both methods of treatment. <ref>2</ref> However there are different studies who claim ESWT is not effective in the treatment of plantar fasciitis. <ref>3</ref> <ref>4</ref> Because of this discrepancy between studies, further support for an effective treatment with ESWT is needed. | ||
Revision as of 01:12, 2 February 2011
Original Editors - Caro De Koninck
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
key-words:
calcaneal spur, heel spur, bone spur, plantar fasciitis
Definition/Description[edit | edit source]
A calcaneal spur occurs when there is a bone spur, a small bony outgrowth, formed on the heel bone. A more common name for calcaneal spur is heel spur. Calcaneal spurs can be located at the back of the heel or under the sole. Spurs at the back are often associated with Achilles tendonitis, while spurs under the sole are associated with plantar fasciitis.
Clinically Relevant Anatomy[edit | edit source]
add text here
Epidemiology /Etiology[edit | edit source]
The etiology of the spur have been debated. At the beginning of the twentieth century, gonorrhea was considered a prime ethiological factor. Heredity, metabolic disorders, tuberculosis, systemic inflammatory diseases and many other disorders have also been implicated. Now abnormal biomechanics (excessive pronation) enjoys wide support as the prime etiological factor for the painful plantar heel and the inferior calcaneal spur. The spur is thought to be a result of the biomechanical fault and an incidental finding when associated with the painful plantar heel. [1]
Characteristics/Clinical Presentation[edit | edit source]
The painful heel is a relatively common foot problem but calcaneal spurs are not considered a primary cause of heel pain. Most heel pain patients are middle-aged adults. Many of them are obese, so obesity can be considered a risk factor.
Not all heel spurs cause symptoms but when they to people often experience more pain during weight-bearing activities, in the morning or after a period of rest. The pain however is not the result of pressure of weight on the top of the spur but the experienced pain is coming from an inflammation around tendons where they attach to the bone.
Differential Diagnosis[edit | edit source]
calcaneal stress fracture
nerve entrapment
fat pad atrophy
Diagnostic Procedures[edit | edit source]
The diagnose is based on the patient's history and on results of the physical examination. The suspicion diagnose is confirmed mostly in the X-ray on the calcaneus.
Outcome Measures[edit | edit source]
add links to outcome measures here (also see Outcome Measures Database)
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
add text here
Physical Therapy Management
[edit | edit source]
Calcaneal spurs, both upper and lower spurs, are treated with conventional physiotherapy. Conventional therapy includes ultrasound, passive and active stretching and strengthening of the muscles of the legs and cold and warmth applications. The aim is to eliminate the inflammation surrounding the spur. This kind of treatment may take 6 to 12 months. [2]
Another proven therapy is radial shockwave therapy. This method consists of very high-energy mechanical waves, pointed at the calcaneal spur. By the growth of blood vessels the inflammation shall be taken away. [3]
Some claim that their is no difference between both methods of treatment. [4] However there are different studies who claim ESWT is not effective in the treatment of plantar fasciitis. [5] [6] Because of this discrepancy between studies, further support for an effective treatment with ESWT is needed.
Night splints, massage, taping, acupuncture, walking casts, laser therapy and cryotherapy are more means to help the patient. [7]
When neither of these treatments take away the problem, more aggressive techniques like surgery can be employed.
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
Buzzle.com, Intelligent Life on the web. Calcaneal spur. http://www.buzzle.com/articles/calcaneal-spur.html (accessed 15 november 2010)
MedicineNet.com. Definition of calcaneal spur. http://www.medterms.com/script/main/art.asp?articlekey=7095 (accessed 15 november 2010)
Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
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References[edit | edit source]
- Edmund M, Kosmahl PT, MS, Herbert E, Kosmahl DPM. Painful Plantar Heel, Plantar Fasciitis, and Calcaneal Spur: Etiology and treatment. J Orthop Sports Phys Ther 1987; 9(1) [8]
- D'andrea Greve JM, Grecco MV, Santos-Silva PR. Comparison of radial shockwaves and conventional physiotherapy for treating plantar fasciitis. Clinics 2009; 64(2) http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322009000200006&lng=en&nrm=iso&tlng=en (accessed 20 november 2010)
- De Vera Barredo R, Menna D, Farris JW. An evaluation of research evidence for selected physical therapy interventions for plantar fasciitis. J Phy The Sci 2007; 19: 41-56 http://www.jstage.jst.go.jp/article/jpts/19/1/41/_pdf (accessed 20 november 2010)
- Buchanan J, Buchbinder R, Forbes A, Gordon J, Prabaharan V, Ptatsnik R. Ultrasound-guided extracorporeal shockwave therapy for plantar fasciitis. JAMA 2002; 288: 1364-1372
http://jama.ama-assn.org/content/288/11/1364.full.pdf+html (accessed 27 december 2010)
- Buch M, Haake M, Schoellner C, Goebel F, Vogel M, Mueller I, Hausdorf J, Zamzow K, Schade-Brittinger C, Mueller H-H. Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial. BMJ 2003; 327 http://www.bmj.com/content/327/7406/75.full.pdf (accessed 27 december 2010)
