Heel Spur Research Articles

ASSESSMENT OF PLANTAR FASCIITIS AMONG ADULTS HAVING HIGHER BODY MASS INDEX AND GLUCOSE INTOLERANCE IN A MEDICAL INSTITUTE OF RAIPUR.

Introduction: Plantar fasciitis (PF) is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin on the calcaneus. PF is reported to be the most common cause of inferior heel pain in diabetic and non diabetic patient population. Calcaneal spurs (CS) have commonly been implicated as a risk factor for PF. To this purpose we have evaluated the frequency of Calcaneal spur (CS) in obese patients with Type-2 diabetes. Method: Study was designed as a cross sectional Analytical study . Male and female study subjects who were Obese (BMI ≥30 kg/m2), Having Diagnosed type 2 diabetes & above the age of 18 years, with a history of plantar heel tenderness and/or pain were included in the study Information was analysed by using the Microsoft Excel and SPSS . Chi square test was used for analysis. Results:Atotal of 65 obese diabetic patients were included into the study. The mean age of the patients was 54±5.8 years. There were 25 males and 40 females. The median duration of diabetes was 4.2 years (1-10 years). The mean HbA1c was 8.4±0.9. 78% were having plantar fasciitis. Conclusion: Poor diabetes control Peripheral Neuropathy seems to be the main reasons Existence seems to be in a relationship with diabetic complications; therefore, obese diabetic patients may be more prone to these complications. Therefore, weight reduction should be encouraged in these patients.

ASSESSMENT OF PLANTAR FASCIITIS AMONG ADULTS HAVING HIGHER BODY MASS INDEX AND GLUCOSE INTOLERANCE IN A MEDICAL INSTITUTE OF RAIPUR

Introduction: Plantar fasciitis (PF) is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin on the calcaneus. PF is reported to be the most common cause of inferior heel pain in diabetic and non diabetic patient population. Calcaneal spurs (CS) have commonly been implicated as a risk factor for PF. To this purpose we have evaluated the frequency of Calcaneal spur (CS) in obese patients with Type-2 diabetes. Method: Study was designed as a cross sectional Analytical study . Male and female study subjects who were Obese (BMI ≥30 kg/m2), Having Diagnosed type 2 diabetes & above the age of 18 years, with a history of plantar heel tenderness and/or pain were included in the study Information was analysed by using the Microsoft Excel and SPSS . Chi square test was used for analysis. Results:Atotal of 65 obese diabetic patients were included into the study. The mean age of the patients was 54±5.8 years. There were 25 males and 40 females. The median duration of diabetes was 4.2 years (1-10 years). The mean HbA1c was 8.4±0.9. 78% were having plantar fasciitis. Conclusion: Poor diabetes control Peripheral Neuropathy seems to be the main reasons Existence seems to be in a relationship with diabetic complications; therefore, obese diabetic patients may be more prone to these complications. Therefore, weight reduction should be encouraged in these patients.

The effect of high intensity laser therapy in the management of painful calcaneal spur: a double blind, placebo-controlled study.

To evaluate the effect of high-intensity laser therapy (HILT) in patients with calcaneal spur. The patients were randomized to receive either HILT + exercise (n = 21) (five times a week for a period of 3weeks) or placebo HILT + exercise (n = 21) (five times a week for a period of 3weeks). Pain severity (with visual analog scale (VAS) and with Roles and Maudsley score (RMS)), functionality (with Foot and Ankle Outcome Score (FAOS)), plantar pressure measurement, and quality of life (with short form-36 (SF-36)) of the patients were evaluated at baseline, at 4weeks, and 12weeks. A significant improvement in the VAS (p < 0.001), RMS (p < 0.001), and most of the SF-36 subgroup scores (p < 0.05) and most of the FAOS subgroup scores (p < 0.05) at 4 and 12weeks after treatment was achieved in both groups. Besides, there was no significant difference in VAS (p > 0.05) and RMS (p > 0.05) between the groups. FAOS symptoms (p = 0.022) and quality of life (p = 0.038) subgroups were higher in the placebo group at 12weeks. Significant improvements were observed in dynamic pedographic measurements in the HILT group (p < 0.05), and dynamic measurement values were significantly higher in the HILT group compared to placebo group (p < 0.05). Although the evaluation parameters, except dynamic pedographic measurements, have improved in both groups, our study results showed no superiority of HILT over placebo. To conclude, when the main complaint is pain in patients, only exercise therapy can be an economical, practical, and reliable treatment.

Relationship of the Shape of Subacromial Spur and Rotator Cuff Partial Thickness Tear.

BackgroundThe present study was undertaken to evaluate the relationship between location of the rotator cuff tear and shape of the subacromial spur.MethodsTotally, 80 consecutive patients who underwent arthroscopic repair for partial thickness rotator cuff tear were enrolled for the study. Bigliani’s type of the acromion, type of subacromial spur, and location of partial thickness tear of the rotator cuff were evaluated using plain X-ray and magnetic resonance imaging. We then compared the groups of no spur with spur, and heel with traction spur.ResultsOf the 80 cases, 25 cases comprised the no spur group, and 55 cases comprised the spur group. There was a significant difference in type of tear (p=0.0004) between these two groups. Bursal side tears were significantly greater (odds ratio=6.000, p=0.0007) in the spur group. Subjects belonging to the spur group were further divided into heel (38 cases) and traction spur (17 cases). Comparing these two groups revealed significant differences only in the type of tear (p=0.0001). Furthermore, the heel spur had significantly greater bursal side tear (odds ratio=29.521, p=0.0005) as compared to traction spur.ConclusionsThe heel spur is more associated to bursal side tear than the traction spur, whereas the traction spur associates greater to the articular side tear.

A UNIQUE HERBAL COMBINATION WITH AGNIKARMA IN THE MANAGEMENT OF VATKANTAKA- A CASE STUDY

Vatkantak is one type of vat-vyadhi, which is most common form of articular disorder. Today’s era, continue standing work like conductor, heavy weight, labour work, travelling and injury etc leads to this disease. All the osteoarthritis diseases in Ayurveda have been described under the heading of ‘vatvyadhi’ vatkantak can be correlated with the calcaneal spur. Here in the case study a female patient of age 45 years presenting with clinical features of vatkantaka and was treated with Agnikarma got relief within 15 days.

Comparative analysis between platelet rich plasma and corticosteroid injection in plantar fasciitis

Introduction: Plantar fasciitis is a disorder resulting in pain in the heel and bottom of the foot. Risk factors include increased exercise, obesity, long periods of standing and heel spur. Non-operative treatment includes rest, contrast bath, sole inserts, stretching exercise, NSAIDS and steroidal medications. Invasive interventions are steroid injections, autologous blood, PRP application and open, endoscopic or percutaneous fascial surgical release of plantar fascia. Aims and Objectives: The aim of this study was to determine the effects on pain and function of PRP obtained manually as a cheap and easy method in the treatment of plantar fasciitis and to compare this data with that of steroid injection which is often used in clinical practice. The hypothesis was that a single dose of manually prepared PRP would reduce pain in plantar fasciitis and this effect is superior to the steroid injection. Materials and Methods: The present study was conduct at our institute during August 2016 to September 2018; 80 consecutive patients with chronic plantar fasciitis were enrolled and randomized in two groups: One group receives the Platelet rich plasma (PRP) therapy and another group receiving corticosteroid injection. The outcomes in both groups were observed and compared by The Foot and Ankle Disability Index (FADI) and Visual Analogue Scale (VAS) at 1st week, 4th week and 12th week post injection. The level of significance was set at p Results: Prospective data was collected of 40 patients. The average follow up duration was about 12 weeks. The score on VAS Scale and FADI improved from the baseline for both the groups but the patients who received PRP therapy had a statistically significant (p Conclusion: The application of PRP appears to be more effective than steroid injection in terms of pain and functional results in the treatment of chronic plantar fasciitis. Keywords: Steroid injection, PRP, Plantar fasciitis, FADI score, VAS scale.

The Effect of High Intensity Laser Therapy in the Management of Painful Calcaneal Spur

The Effect of High Intensity Laser Therapy in the Management of Painful Calcaneal Spur

Relationship between leg-length discrepancy and plantar fasciitis

Objective: This study evaluated the relationship between leg-length discrepancy (LLD) and plantar fasciitis (PF). Methods: A cross-sectional study was performed that measured the length of the lower limbs via a scanometry of patients with PF. Other risk factors such as body mass index (BMI), foot posture, and the presence of a plantar heel spur on foot X-ray were also evaluated. Results: Of the 54 participating patients, 44.4% were male with a mean age of 50.38 (23-73 years), 81.5% had pain in one foot, and 53.7% had plantigrade feet. We observed LLD in 88.9% of the sample, with a mean discrepancy of 0.749 cm (SD +/-0.63); 46.3% of the painful feet presented with spurs on X-ray. Conclusions: Approximately 90% of the patients presented with LLD, and the shorter limb was the affected side in most cases. Level of Evidence II; Prognostic Studies.

A pilot study to evaluate the efficacy of a selected treatment module for Vaatkantak with special reference to Agnikarma

Vaatkantak, vis a vis calcaneal spur/ plantar fasciitis, is a common problem affecting the quality of life of people. A specific treatment plan was adopted for its treatment in the present study and the results were evaluated. Agnikarma, an external application of lepa guti and internal usage of guggulu and kupilu were selected for the pacification of Vata Dosha. The duration of treatment was kept for one and a half month. Agnikarma was done on weekly basis. A total of 10 subjects were selected for the present study. The treatment protocol-module of the present study was found highly effective in curing Vaatkantak as marked improvement was seen in all patients.

Plantar fasciitis treated with endoscopic partial plantar fasciotomy—One-year clinical and ultrasonographic follow-up

BackgroundEndoscopic operations for plantar fasciitis generally have good clinical outcome. The aim of this study was to record the effect of endoscopic partial fasciotomy and heel spur removal and evaluate by ultrasonography whether the fascia regenerates and the heel spur reforms. MethodsEleven consecutive patients were evaluated before and 3, 6 and 12 months after surgery. Operations were performed endoscopically using a deep fascial approach with a medial and a lateral portal. Bony spurs were removed and the medial half of the plantar fascia was transected. All patients followed a standardized rehabilitation program. ResultsMedian Foot Function Index values decreased from 119 pre-surgery to 69 and 12 (p=0.004), at 3 months and 1year post-operatively respectively. Median VAS-score for first step pain was likewise reduced from median 71mm to 29mm and 7mm (p=0.004), respectively. Median fascial thickness at the medial insertion was 6.0mm (range 4.6–6.8mm) pre-operatively. A heel spur was present in 9 cases. One year postoperatively a well-defined fascia in the area of resection was demonstrated in 8 cases. In the rest of the cases scar tissue made it impossible to clearly outline the fascia. Nine of the feet showed good medial fascial tensioning. There was no evidence of recurrence of the bony spur. ConclusionsEndoscopic partial plantar fascia resection reduced pain symptoms and increased function significantly 3 months after operation, with additional effect achieved 12 months after surgery. Based on ultrasonography the resected fascia regenerated/healed, and a calcaneal spur did not recur.

Effect of In-Shoe Foot Orthosis Contours on Heel Pain Due to Calcaneal Spurs

The objective of this study is to investigate the effect of contouring the shoe insole on calcaneal pressure and heel pain in calcaneal spur patients. Calcaneal pressure was measured using three force sensors from 13 patients including three males and 10 females. These patients have plantar heel pain due to calcaneal spurs, and we examined five customized contour insole foot areas (0–100%). Sensors were attached at the central heel (CH), lateral heel (LH) and medial heel (MH) of the foot. The pain was measured using an algometer and evaluated by the pain minimum compressive pressure (PMCP). In this study, it was observed that the calcaneal pressure decreased with increasing insole foot area. In addition, increasing the insole foot area from 25% to 50% can reduce the calcaneal pressure approximately 17.4% at the LH and 30.9% at the MH, which are smaller than the PMCP, while at the MH, pressure reduced 6.9%, which is greater than the PMCP. Therefore, to reduce pain, one can use 50% insole foot area, even though at MH it is still 19.3% greater than the PMCP. Excellent pain relief was observed when using 100% insole foot area, as the pressures in those three areas are lower than the PMCPs, but it is not recommended because it requires large production costs.

The Application of Shock Wave in the Therapy of Patients with Calcaneal Spur

Introduction: Calcaneal spur is a common condition associated with pain in the foot area. The disease enables proper foot load which leads to pain in other areas of the osteoarticular system. Among the proposed methods of conservative treatment, shock wave therapy is applied. Aim: The aim of the study was to assess the clinical effectiveness of focussed shock wave therapy in patients with calcaneal spur. What is more, the impact of therapy on patients quality of life has been assessed. Material and Methods: The study included 25subjects treated in outpatient conditions at the Department of Rehabilitation, University Hospital in Bialystok. To perform the procedures, a PiezoWave² byRichard Wolf Elevation Medical has been used. Patients underwent four shock wave procedures. Clinical assessment based on the physical and subjective examination has been conducted before and after the treatment. Pain has been assessed according to the VAS, Laitinen scale and the Foot Function Index has been used in order to measure pain, disability, activity limitation as well as Role and Maudsley scores. Results: After the application of shock wave procedures, pain relief assessed by VAS and Laitinenscale has been observed. Analysis of the effectiveness of therapy with Foot Function Index and the Role and Maudsley scale revealed significant improvements in examined subscales (pain, disability and limited activity). Conclusions: Focussed shock wave therapy reduces pain in patients with calcaneal spur. The proposed treatment improves the functional status of patients, contributing to the enhancement of their quality of life.

Autologous Platelet Rich Plasma-A Biological Therapeutic Option for Retrocalcaneal Bursitis and its Associations

Background: Retrocalcaneal bursitis is the inflammation of the bursa between the anterior aspect of the Achilles and posterior aspect of the calcaneum which is associated with achilles tendinitis, plantar fasciitis, calcaneal spurs, fibromyalgia and rheumatoid arthritis.

Foot baropodometry regarding on body weight

While standing, we used baropodomerty to measure pressure on foot area. Human foot cause force reaction while making contact with the base. We also used plantogram and a special foam to measure foot size pressure and force as well as pressure and force that is appearing between the foot and the surface. In this work, we compared pressure between normal and deformed men and female foot against their body weight. With this analysis, we found that deformed foot makes bigger pressure on heel spur. In this research, we had 10 male and 10 female candidates. We were measuring weight, height and foot area as well as pressure and force that foot produce while walking. At the end, we concluded that the candidates with bigger body weight, made more pressure and force on their feet. We are hoping that this research will contribute in shoe factory to decrease weight on feet.

The use of intralesional and posterior tibial nerve pulsed radiofrequency in the treatment of calcaneal spur

The use of intralesional and posterior tibial nerve pulsed radiofrequency in the treatment of calcaneal spur

Chosen Conservative Treatments on the Symptoms of Calcaneal Spur: A Short Review

Chosen Conservative Treatments on the Symptoms of Calcaneal Spur: A Short Review

HIGH HEEL SHOES

Object: Outcome of wearing high heel shoes in young generation: A CrossSectional Study. Introduction/ Background: High heels increase the heel height, thusincreasing the pressure under the metatarsal head in forefoot, they push the center of mass of thebody forward taking the hips and spine out of alignment moreover the altered posture of walking1-5 in high heels places excessive forces on the inside of the knee joint . All these factors contributein causing deleterious pathologic deformities. The studies carried out previously were morefocused on the adult population furthermore there isn’t much work done to investigate the effectof heels in Pakistan therefore, this was a non-invasive study the purpose of which was to evaluatethese complications particularly targeting the medical students of medical colleges, Karachi.Methods: A total of 220 respondents aged between 15 to 25 years were selected as potentialrespondents meeting the criteria for selection. A convenience based randomized samplingmethod was adopted, where the participants were required to fill questionnaires and give theirdemographic details. They were inquired about the presence of any co morbidities which was anessential part of the exclusion criteria. They were also inquired about their usage of high heelshoes, their size, duration and frequency of usage, and if they had been causing anycomplications such as bunions, heel spur, callosities or pain in soles, calf or back. The dataobtained was analyzed through SPSS and the graphs of frequency for all the complications werecomputed. Results: After analyzing the 220 participants it was found that 7.7% were males while92.3% were females, and 61.8% were found to be within 21 to 23 years of age. After the analysesof data for the complications it was found that out of the total participants 18.8% experience footswelling, 19.4% blisters, 16.4% foot numbness, 12.3% foot callosities, 2.8% heel spur, and 3.7%experience bunions. Conclusions: From this study conducted on the students of medicalcollege it was found that wearing high heel shoes is not associated with any significantcomplications among most of the students

Results of Reinsertion of the Distal Achilles Tendon.

Reattachment of the distal Achilles tendon to the posterior calcaneus following distal Achilles tendon tears/avulsions or after excision of large posterior heel spurs is a challenging task for the orthopaedic surgeon. Between 2005 and the end of 2015, 22 patients who underwent repair/reconstruction of a lesion of the distal Achilles tendon were identified from our electronic records. Calcaneal reinsertions were performed following distal Achilles tendon tears/avulsions (n = 15) or following excision of a large symptomatic posterior heel spur (n = 7). The respective outcome was evaluated comparatively using the VISA-A - G (Victorian Institute of Sports Assessment-Achilles tendon, German version) questionnaire (100 = maximum). Data were collected preoperatively (n = 11/22), and prospectively at three, six, and 12 months postoperatively (n = 5 - 11/22). Two further retrospective follow-ups were performed 12 - 114 and 21 - 149 months postoperatively (n = 17/22 and 22/22, respectively). All data were analysed retrospectively. Complications were searched from the electronic files. Transosseous sutures and different anchor techniques (Panalok®, Corkscrew®, SpeedBridge®) were generally performed. Preoperatively, the VISA-A - G score was 27.3 ± 13.5 (6 - 45) following distal Achilles tendon reinsertions for avulsions and 45.3 ± 49.0 (0 - 100) when reattachment was performed after resection of a large posterior heel spur (p = 0.831). At the final follow-up, VISA-A - G values were 89.4 ± 13.9 (54 - 100) following distal Achilles tendon tear/avulsion and 82.5 ± 24.5 (51 - 100), when Achilles tendons were reattached after posterior heel spur excisions (p = 0.969). There were no complications in the "heel spur group". In the Achilles tendon tear/avulsion group, four out of seven patients with Panalok® repairs developed a fistula. One patient suffered a thromboembolism. None of these complications affected the long-term outcome. This study demonstrates good long-term outcomes after distal Achilles tendon reinsertion. Knotless double row anchor repair provides a greater area of compression, simplifies and standardises the repair/reconstruction, and provides safety against fistula. These implants are therefore recommended for safe and effective reattachment of the distal Achilles tendon.

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There is no general consensus among experts regarding terminology, pathogenesis and treatment of heel spurs. Surgical treatment of heel spur is considered for patients who have not responded adequately after 6-12 months of conservative therapy. Although there is no evident association between the presence of osteophyte in the heel and plantar heel pain removal of exostosis is still viewed by many experts as the main purpose of surgical management. Another option includes plantar fascia release surgery aimed to relieve tension of plantar aponeurosis and improve pain. Surgical treatment of the proximal plantar fasciosis is reserved for degenerative, non-inflammatory cases to increase collagen regeneration and plantar fascia vascularity.

Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment

ObjectiveThe aim of this study was to define a quantitative parameter to indicate which cases of plantar fasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of two different treatment modalities. MethodsSeventy patients (mean age: 49.10; range: 41–58) with chronic plantar fasciitis unresponsive to conservative treatment for 3 months were treated with either betamethasone injection or extracorporeal shock wave therapy (ESWT). Correlation between AOFAS scores, fascia thickness, duration of symptoms, age and calcaneal spur length were assessed. ResultsDegree of fascial thickening (mean 4.6 mm for all patients) did not influence baseline AOFAS scores (r = −0.054). Plantar fascia thickness significantly decreased in both groups after treatment (1.2 mm for steroid, 1.2 mm for ESWT) (p < 0.01 for both groups). Percentage of change in AOFAS scores (68% for steroid and 79% for ESWT, p = 0.069) and fascial thickness (24% for steroid and 26% for ESWT, p = 0.344) were similar between two groups. Functional recovery was not correlated with baseline fascial thickness (r = 0.047) or degree of fascial thinning after treatment (r = −0.099). Percentage of change in AOFAS scores was correlated only with baseline AOFAS scores (r = −0.943). ConclusionsPlantar fascia thickness increases significantly in plantar fasciitis and responds to treatment. Both ESWT and betamethasone injection are effective in alleviating symptoms and reducing plantar fascia thickness in chronic plantar fasciitis. However, the only predictive factor for functional recovery in terms of AOFAS scores is patients' functional status prior to treatment. Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis. Level of evidenceLevel III, Therapeutic study.