Heel Spur Research Articles

Conventional radiography and correlated factors of enthesopathies of the Achilles tendon and plantar fascia in patients with axial spondyloarthritis.

This study aimed to investigate the correlated risk factors and presence of radiological enthesopathies of the Achilles tendon and plantar fascia in patients with axial spondyloarthropathy (axSpA). 242 patients (121 female and 121 male) with axSpA were included in this study. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP), the Bath Ankylosing Spondylitis Radiology Index (BASRI), the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and CRP were evaluated in all patients. The lateral foot X-rays of the patients were assessed for enthesopathies of the Achilles tendon and plantar fascia attachments. Calcaneal spur and Achilles enthesopathies were present in 57.4% of the patients. 39.3% of patients had enthesopathies in both regions. The male and female groups differed statistically in terms of weight, height, body mass index (BMI), positive family history, and duration since diagnosis (p<0.05). The presence of calcaneal spur and Achilles enthesopathies was found to be significantly correlated with age, weight, BMI, symptom duration, and the score of BASDAI, BASFI, ASDAS-CRP, BASRI, and MASES (p<0.05). The presence of enthesopathies appears to be associated with age, weight, BMI, symptom duration, and disease activity. Conventional radiography can be used as an auxiliary tool in the evaluation of entheseal abnormalities in patients with SpA, especially in patients with advanced age, long symptom duration, and high BMI.

Investigation of The Effectiveness of Extracorporeal Shock Wave Therapy in Patients Diagnosed with Plantar Fasciitis: Comparison of Radial and Focus Applications

The aim of the study was to investigate the effectiveness of radial and focus (extracorporeal shock wave therapy) ESWT treatment on pain, function and size of the calcaneal spur in patients with clinical and radiological diagnosis of plantar fasciitis. A total of 112 patients aged between 18 and 95 years, were divided into 2 groups; group 1, rESWT (2.4 bar 12 hz 2000 beats), group 2 received fESWT (0.14 bar 14 hz 1000 beats) 3 times a week for 3 weeks. All patients were evaluated using the Visual Analog Scale (VAS)-pain and Foot Function Index before and after the treatment, at 4 week and 12 weeks. Calcaneal spur size was measured radiographically in the patients before and after the treatment at the 12th week follow-up. According to our records, VAS scores were found to be similar between the groups before treatment and at follow-ups (all p > .05). In both groups, a significant decrease in VAS scores was found in the follow-ups compared to before treatment (p < .001). FFI total, pain, activity and disability scores were found to be similar between the groups before treatment and at follow-up (all p > .05). In both groups, a significant decrease in Foot Function Index scores was found in the follow-ups compared to before treatment (p < .001). Both of rESWT and fESWT were effective in plantar fasciitis treatment there were no significant difference between 2 modalities in long term.

129 Low-Dose Radiotherapy for Heel Spurs: A 20-Year Safety and Efficacy Study

129 Low-Dose Radiotherapy for Heel Spurs: A 20-Year Safety and Efficacy Study

Calcaneal and dorsal spur morphological and morphometric measurements; 'A radiological study'

Aim: The foot is one of the most neglected parts of our body. One of the causes of foot pain is the plantar calcaneal spur (PCS), which is the bone protrusion formed under the calcaneal bone, and the dorsal spur (DS), which is seen dorsal to the calcaneus. Our study aimed to examine PCS and DS morphologically. Materials and Methods: 235 patients with PCS were included in this retrospective study. Plantar calcaneal spur length (PCSL), plantar calcaneal spur thickness (PCST), Fowler-Philip angle (FPA), and plantar calcaneal fat tissue thickness (PCFT) with radiology in patients with the calcaneal spur, and also to classify plantar calcaneal spur (PCS) and dorsal spur (DS). Results: Bilateral PCS was found in 57.4% of the patients. DS was found in 43.5% of the patients with right PCS and 40.3% of the patients with left PCS. Large DS types were found at a higher level in males than females. Right PCFT was found to be significantly higher in patients with PCS compared to the control group (p=0.034). Conclusion: It was concluded that the majority of PCS patients had bilateral PCS, DS could be seen and there was a strong correlation between PCSL and PCST.

436: Heel spur radiotherapy: prospective randomized clinical trial

436: Heel spur radiotherapy: prospective randomized clinical trial

Prevalence, causes, and treatment of plantar fasciitis in young females of a medical college

BackgroundPlantar fasciitis, a common musculoskeletal disorder, is characterized by inflammation of the plantar fascia, a thick band of tissue that connects the heel bone to the toes. The plantar fascia plays a crucial role in supporting the arch of the foot and absorbing shock during movement. Factors such as excessive physical activity, improper footwear, and biomechanical abnormalities are recognized contributors to the development of plantar fasciitis. However, the prevalence and underlying causes may vary across different demographic groups, necessitating targeted investigations.ObjectiveThis study aims to investigate the prevalence, causes and treatment of plantar fasciitis in young female students (18–30) of a medical college in Pakistan and explore potential associations with high-heel footwear.MethodologyIn this study, a cross-sectional survey was carried out, engaging 100 young females from a medical college. Employing a structured questionnaire, we assessed a spectrum of parameters, including heel pain symptoms, footwear habits, and available treatment options. The diagnostic precision of the Windlass test, specific to plantar fasciitis, was incorporated. Rigorous data analysis, utilizing SPSS, centered on discerning associations between the nuances of high-heel wear (considering types and duration) and the reported symptoms. This methodological framework ensures a comprehensive and precise exploration of the prevalence, causes, and treatment of plantar fasciitis in our targeted demographic.ResultsAll the participants were female, and the total number was 100, of which 66% felt pain in the heel when they wore high heels. Out of this 66%, only 6% are diagnosed with plantar fasciitis. The rest of the 60% have pain in the heel due to different causes such as heel spurs, stress fractures, etc. 2% of people receive treatment with steroid injections, and 12% are treated with ice.ConclusionWe conclude that the prevalence of plantar fasciitis is high in females wearing high heels. This study reveals that an increase in the total duration of wearing high heels with hard soles increases the symptoms of plantar fasciitis. Plantar fasciitis can be prevented by education and applying ergonomics and could be treated by steroids and the ice method, according to medical practitioners.

A RANDOMIZED COMPARATIVE CLINICAL STUDY TO EVALUATE THE AN-ALGESIC EFFECT OF JALOUKAVACHARANA AND SIRAVYADHA IN VA-TAKANTAKA WITH SPECIAL REFERENCE TO CALCANEAL SPUR

Vatakantaka (Calcaneal spur) is one among Vataja Nanatmaja Vyadhi. Kantavath Vedana (pricking pain) in Padatala Pradesha of Khudapradesha (Heel region) is a prominent characteristic feature, which is caused by Vishamampade (walking on irregular surfaces), Atishrama (excessive exertion over the heel) etc. This can be correlated to a Calcaneal Spur, which is a calcium deposit causing a bony protrusion on the underside of the heel bone, often frequently associated with plantar fasciitis; treatment includes Raktavasechana (bloodletting), Erandataila Pana, Agnikarma (cauterisation) and Samanya Vatavyadhi Chikitsha (general line of management). Jaloukavacharana (leech therapy) is a type of Ashastrakrita Raktamokshanopaya which is indicated in Avagadha Avastha (deeply situated), Grathita Avastha (complicated structures) of Doshas and by the word Sarvani Sarveva in all condition wherever Raktavasechana is indicated. At present, Jaloukavacharana (leech therapy) is taken. The study comprises 40 patients of Vatakantaka (Calcaneal spur). These patients were randomly selected based on inclusion and exclusion criteria. The duration of the study is 21 days. After evaluating therapy, it was observed that Jaloukavacharana provided better analgesic relief to the patients of vatakantaka (Calcaneal spur).

Comparison between the effect of Steroid Injection, Prolotherapy Local Injection and Extracorporal Shock Wave Therapy in Treatment of Symptomatic Calcaneal Spur

Abstract Background Calcaneal spurs are common cause of heel pain occurring anywhere along the calcaneal tuberosity and most frequently found at the insertion of the plantar fascia. They are usually asymptomatic, but when they are painful, the condition is generally the result of inflammation of the insertional fibers of the plantar fascia at the medial tuberosity. Symptomatic calcaneal spurs are often found in association with plantar fasciitis. Like plantar fasciitis, calcaneal spurs can occur alone or may be part of a systemic inflammatory condition such as rheumatoid arthritis or gout. In some patients, the cause seems to be entirely mechanical, and such patients often exhibit an abnormal gait with excessive heel strike. Objective To compare the effectiveness of dextrose prolotherapy injection, corticosteroid injection and extracorporal shockwave in symptomatic calcaneal spur, based on clinical and functional outcome measures. Patients and Methods This study was conducted on forty-five patients diagnosed with symptomatic calcaneal spur (plantar fasciitis) for more than 6 months. The patients were recruited from Physical Medicine, Rheumatology and Rehabilitation department at Ain Shams University Hospitals. Diagnosis was based on detailed history taking, full clinical examination, pain and functional assessments of the foot using visual analogue scale (VAS score) and foot function index (FFI). Results Eight weeks after treatment, the pain score by VAS was significantly improved at ESWT group mostly, less extent at prolotherapy group and least at corticosteroid group. Also the percentage of improvement in ESWT group was found higher than the other groups indicating the long term analgesic effect of ESWT. Eight weeks after treatment, the FFI subscales (pain, disability and activity limitation)and total FFI score significantly improved mostly at ESWT group, less extent at prolotherapy group and least at corticosteroid group indicating the long term beneficial effect of ESWT on the function in patients with chronic PF. Conclusion Although ESWT, dextrose prolotherapy injection, and local corticosteroid injection were all effective in the treatment of symptomatic calcaneal spur during 8weeks of follow-up but, ESWT was superior to all other modalities in its effect on pain intensity and function during daily life activities at long term follow up.

MedCapsNet: A modified Densenet201 model integrated with capsule network for heel disease detection and classification

Conditions affecting the heel bone, such as heel spurs and sever's disease, pose significant challenges to patients' daily activities. While orthopedic and traumatology doctors rely on foot X-rays for diagnosis, there is a need for more AI-based detection and classification of these conditions. Therefore, this study addresses this need by proposing MedcapsNet, a novel hybrid capsule model combining modified DenseNet201 with a capsule network, designed to accurately detect and classify heel bone diseases utilizing lateral heel x-ray foot images. We conducted a comprehensive series of experiments on the proposed hybrid architecture with several datasets, including the Heel dataset, Breast BreaKHis v1, HAM10000 skin cancer dataset, and Jun Cheng Brain MRI dataset. The first experiment evaluates the proposed model for heel diseases, while the other experiments evaluate the model on a range of medical datasets to demonstrate its performance over existing studies. On the heel dataset, MedCapsNet achieves an accuracy of 96.38%, AUC of 98.35% without data augmentation, cross-validation accuracy of 95.69%, and AUC of 98.87%. The proposed model, despite employing a fixed architecture and hyperparameters, outperformed other models across four distinct datasets, including MRI, X-ray, and microscopic images with various diseases. This is notable because different types of medical image datasets typically require different architectures and hyperparameters to achieve optimal performance.

Physicians’ experiences with indications and prescriptions of foot orthoses–A cross-sectional study in northern Germany

BackgroundFoot orthoses (FOs) are prescribed by general practitioners (GPs) and orthopedic surgeons for various complaints. As there are very limited medical guidelines and checklists, the prescription of FOs is often inconsistent. Therefore, our study to evaluate the general prescription behavior and indication experiences with FOs from the perspective of GPs and orthopedists. MethodsA survey was carried out using a questionnaire from October to December 2021. GPs and orthopedic surgeons in northern Germany were included. The focus of the survey was to examine which foot problems would lead GPs and orthopedic surgeons to prescribe FOs and to evaluate what factors these physicians included in their diagnostic analysis. Apart from descriptive analyses, a stepwise linear regression analysis was performed to explore potential associations of the primary outcome variable ‘specific effect on the prescription of FOs’, which was introduced to shed light upon the estimated added value of the prescription of FOs. ResultsOut of the 790 questionnaires distributed, 184 questionnaires were returned by GPs (n = 95) and orthopedic surgeons (n = 74) (response rate 23 %). FOs were most frequently prescribed for talipes valgus (96 %) and heel spur (54 %). Diagnostic analysis was mainly carried out clinically. Custom-made FOs (82 %) were prescribed more frequently than prefabricated FOs (6 %). Regular interaction within the prescription process was most commonly with orthopedic technicians (61 %). The estimation of the specific effect on FO prescription was assessed by a mean of 66 % of the participants, 82 % recommended self-exercises as an additional therapy. ConclusionsFOs are a specific and well-established aid prescribed by many GPs and orthopedic surgeons for a variety of foot complaints. Despite being one of the most frequently prescribed orthopedic devices, the utilization of FOs is predominantly explorative due to a growing but nevertheless still deficient body of well-researched evidence. There is a clear need for a uniform approach to the indication and prescription of FOs among physicians.

Views about the clinical, diagnostic and comprehensive treatment of plantar fasciitis: a review

INTRODUCTION. One of the problems in modern podiatry is plantar fasciitis. According to population studies, more than two million patients are treated for plantar fasciitis each year in the United States, 1 in 10 people will develop heel pain during their lifetime, and 1 % of visits to podiatrists are related to heel pain. Plantar fasciitis occurs in approximately 10 % of the general population, with 83 % of these patients being active working adults between the ages of 25 and 65. The high prevalence of plantar fasciitis in the population necessitates the search and development of new and effective methods for its recognition and treatment. AIM. Generalization of literature data on the mechanisms of development of plantar fasciitis, methods of diagnosis and treatment. MATERIALS AND METHODS. The databases PubMed, Scopus and the electronic scientific library eLIBRARY were searched for articles using the keywords: “plantar fasciitis”, “plantar fasciosis”, “heel pain”, “heel spur”. Search depth — 10 years. Publications related to the diagnosis and treatment of PF were selected. During the study, 40 publications were selected, the content of which, to one degree or another, corresponded to the purpose of this study. RESULTS AND DISCUSSION. Pain syndrome in the area of the heel bone is the main reason for seeking medical care in patients with plantar fasciitis. Currently, there are several approaches to the treatment of plantar fasciitis: conservative and surgical treatment. Conservative treatment is represented by methods of manual therapy, physical therapy, and physical therapy. Surgical methods include various variants of resection of the bony outgrowth of the calcaneal region and other interventions. CONCLUSION. Treatment of plantar fasciitis requires a multidisciplinary approach to treatment, as no single treatment method is universal. Conservative treatment of patients with plantar fasciitis should be comprehensive. Due to the high prevalence of plantar fasciitis in the population, the introduction of new treatment techniques and the development and use of a unified patient management tactic can improve patient outcomes and quality of life. Among other surgical methods, the use of RFD has a positive effect in patients with PF refractory to conservative therapy and is the least invasive method among surgical methods.

Clinical Study of a Four-Step Program for the Treatment of Plantar Fasciitis with Bone Spurs.

The most common causes of plantar and heel pain are plantar fasciitis and calcaneal spurs, and they often co-exist. Surgery is a recognized treatment for refractory plantar fasciitis. However, few studies have proposed treatment options for patients with metatarsophalangeal fasciitis with bone spurs. Accordingly, this study's purpose was to propose a four-step surgical regimen, and to improve the surgical outcome of plantar fasciitis with osteophytes and to establish a procedure for surgical treatment. Retrospective analysis of 45 patients suffering from plantar fasciitis with bone spurs from 2020 to 2023. All patients underwent a four-step procedure, including plantar fascia release, calcaneal spur grinding, inflammatory tissue removal, and calcaneal burr decompression. The imaging parameters and functional scores were recorded before and after the operation. The objective evaluation included the measurement of calcaneal spur length on radiographs. Clinical evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS), the Visual Analog Scale (VAS), and the Foot and Ankle Outcome Scale (FAOS). Measurement data that conformed to normal distribution were expressed as (x2 ± s), and pre-and postoperative AOFAS, FAOS, and VAS scores were compared using repeated-measures ANOVA, and preoperative and postoperative spur lengths were compared using paired t-tests. The 45 patients were followed up for 3 to 30 months, (17.72 ± 8.53) months, at final follow-up, the patient's AOFAS score improved from preoperative (74.93 ± 5.56) to (94.78 ± 3.98), FAOS score increased from preoperative (76.42 ± 3.37) to (96.16 ± 2.74), the VAS score decreased from (3.18 ± 0.54) to (1.07 ± 1.20) (p < 0.05), the length of spur decreased from (0.72 ± 1.81) cm to (0.23 ± 1.19) cm, and there were significant differences before and after operation (p < 0.05). The four-step surgical regimen is an appropriate and effective surgical procedure to treat plantar fasciitis with bone spurs.

HeCapsNet: An enhanced capsule network for automated heel disease diagnosis using lateral foot X‐Ray images

AbstractFoot pain, particularly caused by heel spurs and Sever's disease, significantly impacts mobility and daily activities for many people. These diseases are traditionally diagnosed by orthopedic specialists using X‐ray images of the lateral foot. In certain situations, the absence of specialists requires the adoption of AI‐based methods; however, the lack of a dataset hinders the use of AI for the preliminary diagnosis of these diseases. Therefore, this study first presents a novel dataset consisting of 3956 annotated lateral foot X‐ray images and uses the original capsule network (CapsNet) to automatically detect and classify heel bone diseases. The low accuracy of 73.99% of CapsNet due to the low extraction feature layers led us to search for a new model. For this reason, this paper also proposes a new enhanced capsule network (HeCapsNet) by adjusting the features extraction layers, adding extra convolutional layers, using “he normal” kernel initializer instead of “normal” and utilizing the “same” padding scheme to perform better with medical images. Evaluating the performance of the proposed model, higher accuracy rates are achieved, including 97.29% for balanced data, 94.19% for imbalanced data, area under the curve (AUC) of 98.69%, and a fivefold cross‐validation accuracy of 95.77%. We then compared our proposed model with state‐of‐the‐art modified CapsNet models using various datasets (MNIST, Fashion‐MNIST, CIFAR10, and brain tumor). HeCapsNet performed similarly to modified CapsNets on relatively simple non‐medical datasets such as MNIST and Fashion‐MNIST, but performed better on more complex medical datasets.

Comparison of tibial nerve pulsed radiofrequency and intralesional radiofrequency thermocoagulation in the treatment of painful calcaneal spur and plantar fasciitis: a randomized clinical trial.

Ultrasound-guided tibial nerve pulsed radiofrequency (US-guided TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-guided intralesional RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur and plantar fasciitis. This study aimed to compare the effectiveness of the two procedures. A prospective, randomized, single-blind study. Single-center pain clinic. Forty-nine patients who met the inclusion criteria were randomized into two groups. Group U (25 patients) received US-guided TN PRF at 42°C for 240 s, whereas Group F (24 patients) received FL-guided intralesional RFT at 80°C for 90 s. The most severe numeric rating scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness via the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. NRS and AOFAS scores significantly improved in Groups U and F at 1 and 3 months compared with baseline (P < .05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in Group U and 75% of patients in Group F. No significant difference was observed in the incidence of mild adverse events between the groups. US-guided TN PRF and FL-guided intralesional RFT have shown significant effectiveness in the treatment of painful calcaneal spur and plantar fasciitis. Larger randomized controlled trials are needed. NCT06240507.

The role of Radiotherapy in relieving pain caused by calcaneal spur

The pain caused by the calcaneal spur and the decreased quality of life are the hallmark features of this condition. Radiotherapy has been the subject of increasing evolution in recent decades for pain relief in both benign and malignant pathologies. The aim is to evaluate the efficacy in pain relief and the toxicity associated with the treatment. A retrospective review of a group of patients with painful complaints due to calcaneal spur who underwent Radiotherapy. Between 2012 and 2023, twelve patients, seven men, and five women, with a median age of 61 years (40-82) underwent palliative radiotherapy for calcaneal spur. Five patients had calcaneal spur on the right, five on the left, and two with bilateral spurs. All had complaints of pain in the calcaneus. One patient had undergone previous surgery and one radiofrequency and corticosteroid infiltration without resolution of the painful condition. The treatment regimens varied, with the majority (n=7) receiving 15Gy in 3 fractions of 5Gy on alternate days. 100% of the patients reported complete pain relief after treatment. One patient required re-irradiation after 4 months, with a complete response in pain control. No patient experienced toxicity related to radiotherapy. Radiotherapy plays an important role in pain control for this pathological condition, as demonstrated in this analysis. Classical studies have shown that a minimum total dose of 5Gy would be necessary for better pain control. There is a need to raise awareness among healthcare professionals about the important role of radiotherapy in pain management in this pathology.

Are enlarged peroneal tubercle and accessory anterolateral talar facet associated with calcaneal spur?

BackgroundAs the anatomical variations of the foot, enlarged peroneal tubercle (EPT) and accessory anterolateral talar facet (AALTF) have attracted the attention of foot surgeons in recent years. However, EPT and AALTF have not been examined for a relationship with calcaneus spur (CS) as a common osteophyte.MethodsThe subjects were 369 individuals who died in northeastern Thailand and were preserved as skeletal specimens. The authors examined for the presence of left and right EPT, AALTF, and calcaneus spur (CS). We divided the EPT (+) group with EPT and the EPT (-) group without it and also divided the AALTF (+) group with AALTF and the AALTF (-) group without it. The age at death and the presence of CS were compared statistically between the EPT (+) and EPT (-) groups and between the AATLF (+) and AALTF (-) groups.ResultsOut of the total 369 cases, EPT was found in 117 cases (31.7%), AALTF was positive in 91 cases (24.7%), and CS was found in 194 cases (52.3%). In comparison between EPT (+) and EPT (-) groups, CS was significantly higher (p < 0.0001) in the EPT (+) group, but there was no significant difference in age at death. In comparison between AALTF (+) and AALTF (-) groups, there was no significant difference in age at death or CS.ConclusionThis study showed a strong relationship between EPT and CS, and the prevalence of EPT and AALTF by age in Thailand was first reported. We believe it helps to know the pathogenesis and biomechanism of EPT and AALTF.Trial registrationNot applicable.

Paleoanthropological Analysis of Osteological Material from the Myntobe Burial Ground

The article deals with the paleoanthropological analysis of the skeletons unearthed from the Myntobe necropolis and dated to the II – IV centuries AD. Myntobe necropolis is located 2 km south of Gani Muratbayev village in the Keles district of Turkestan province. The burial ground consists of more than 600 randomly located mounds of various sizes. All mounds have a dirt embankment. Archaeological excavations were carried out at the burial ground in 2017 and 2022, as a result of which burials in the catacombs and naus were unearthed. An analysis of the burial tradition and recovered material allows researchers to speak about the belonging of these burials to the Kangli tribes. Since the burials date back to the Kangli period, the theoretical part reveals the issues of the location and political structure of the tribes and, most importantly, the determination of the paleopathology of the Myntobints by conducting a macroscopic analysis of the discovered skeletons. The results of the analysis allowed for drawing preliminary conclusions about lifestyle, social life, and nutritional status. When writing the theoretical part of the article, electronic textbooks and resources from the book fund of the National Library of Kazakhstan and the library of the International Kazakh-Turkish University named after Kozh Ahmet Yasawi were used. In total, 9 skeletons were selected for paleoanthropological and paleopathological analysis, from mounds No. 3, No. 6, and No. 7. Paleoanthropological reasoning in the main section is written on the basis of materials in Turkish and English from the collections of Turkish libraries. The skeletons found were analyzed macroscopically and many diseases were identified, such as osteoarthritis (joint deformity), osteopathy, ankylosing spondylitis, heel spurs, thickening of the cranial bone, and deformity of the mandibular joint. Preliminary conclusions about the paleopathology of the discovered skeletons are made.

How to perform Baxter's nerve blockage easily by ultrasound in chronic heel pain: Four simple steps.

Baxter's neuropathy is one of the overlooked causes of chronic heel pain. Diagnosing neuropathy in Baxter's can be challenging due to its potential occurrence as a secondary condition to other common syndromes that cause heel pain, such as plantar fasciitis, calcaneal spur, hypertrophic muscle, tenosynovitis, space-occupying lesions or trauma. Ultrasound is a reliable and easily accessible device that guides injections for the treatment of Baxter's neuropathy. We have written this letter as a guide, especially for beginner and professional pain specialists.

Ayurvedic management of acute calcaneal spur with Viddhakarma and Siravedha: A case report

The feet are a highly dependent yet most neglected part of the body. The negligence may result in various levels of discomforts and associated heel pain. Abnormal pressure over foot muscles and ligaments may lead to chronic plantar heel pain and further development of calcaneal spur, which are the most encountered orthopedic problems. Various modern treatment options are available for the management of calcaneal spur, but either they involve longer duration or are expensive. Hence, there is a need to opt treatment approaches that may provide satisfactory results with minimum adversities. Viddhakarma (~therapeutic needle-piercing) and Siravedha (~therapeutic bloodletting) are the therapies of Ayurveda origin, with proven efficacy in pain management and can be used in conditions such as calcaneal spur. A 42-year-old female patient presented to the outdoor patient department in the hospital on August 17, 2022, complaining of sharp pricking pain with heat sensation in the right heel, morning stiffness in bilateral heels, and difficulty in walking for four days. On assessment, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and Foot Function Index Scale for the right foot of the patient were scored 47, 9 and 127, respectively. The X-ray of the bilateral foot (anterio-posterior and lateral view) showed an inferior bony spur projecting forward from calcaneal tuberosity more on the right side than on the left. The patient was treated with Viddhakarma, Siravedha of the right foot, along with oral Ayurvedic medicines. On completion of the treatment, the WOMAC and VAS scores were reduced significantly to 37 and 6, respectively. Further, there was a significant reduction in the Foot Function Index scale score to 96 within ten days of the treatment. Based on the clinical observations, it may be inferred that a combination of Viddhakarma, Siravedha, and oral Ayurvedic medicines can be safe, convenient, and effective in managing patients suffering from calcaneal spur. Both of these procedures can be performed by trained health-care professionals on an outpatient basis, thus convenient to the sufferers too.

Plantar calcaneal spurs and their connection with lumbar herniating discs

Introduction: Calcaneal spurs are bony triangular projections of varying sizes that are found on the calcaneum. By analyzing the incidence of plantar spurs and lumbar herniated disks, the current research aims to provide a reliable baseline for determining the pathological significance of spurs with herniated disks. Methods: Consecutive patients who had visited a local physiotherapy clinic for plantar calcaneal spurs between October 2022 and February 2023 with no self-reported comorbidities such as diabetes or vascular diseases were qualified for the study. Of the eligible subjects, a total of 84 patients were randomly selected from the clinic’s database. All 84 patients were subjected to weight-bearing lateral foot radiographs and magnetic resonance imaging scans. A Visual Analog Scale (VAS) was used to measure heel pain. Associations between the presence of spurs, herniated disks, sex, body mass index (BMI), and heel pain were then explored. Results: Of the 84 patients, 40 were males (48%) and 44 females (52%), with a mean age of 64.2 ± 5.6 years. The mean BMI was 28.5 ± 5.2 kg/m2. From the analysis of the imaging examination results, of the 84 patients with calcaneal spurs, 40 (48%) had lumbar disk herniation at L5-S1, 38 (45%) at L4-L5, 1 (1%) high lumbar herniations, and 5 (6%) no hernia. Women accounted for 45% of L5-S1 herniations and 41% of L4-L5 herniations. Pearson correlation between the variables speaks for a positive weak (r = 0.33) and significant relationship between VAS and weight and between VAS and BMI (r = 0.436, p &lt; 0.001). Conclusion: Given the high percentage of patients suffering concomitantly from plantar calcaneal spurs and discal hernias (94%), we assume that there might be a probable link between the two disorders.