A heel spur is a bony growth that forms on the heel bone (calcaneus). Heel spurs are common and often do not cause pain, but can cause pain when contacting soft tissue. They may be caused by pressure on the heel and associated with plantar fasciitis or Achilles tendinopathy. Treatment options include medications like NSAIDs, corticosteroid injections, physiotherapy including stretching, ultrasound, shockwave therapy, and night splints or orthotics.

1. calcaneus spur
BY RAFI AL-SHAMRANI

2. outline
 Anatomy
 Disorder
 Treatment

3. Anatomy

5. Disorder

6. Definition
 A heel spur is a bony growth that forms on the heel bone (calcaneus).
 Heel spurs are common and do not always cause pain, Pain caused by contact of the spur
with the surrounding soft tissue.
 It can be located at the back of the heel (dorsal heel spur) or under the sole
(plantar heel spur).
 The dorsal spurs are often associated with Achilles Tendinopathy, while spurs
under the sole are associated with Plantar fasciitis.

8. Causes
 The cause of heel spurs is not completely understood.
 They may be caused by pressure on the heel.
 In general, the cause of the pain is not the heel spur itself but the soft-tissue injury
associated with it.

9. Sings and symptoms
 Pain in the bottom of your heel.
 Pain that is worse when you first get out of bed.
 Pain that gets worse after walking or standing.

10. RISK FACTORS
 older than 40.
 overweight.
 Have wear and tear arthritis (osteoarthritis).
 Have plantar fascia inflammation.
 Walking gait abnormalities, which place excessive stress on the heel bone, ligaments,
and nerves near the heel.
 Running or jogging, especially on hard surfaces.

11. DIAGNOSIS
 Sharp pain localized to the heel.
 X-rays.

12. Examination
 ROM
 Observation
 Palpation
 Compare bilaterally
 Test Sensation

13. TREATMENT

14. Medical treatment
Medication such as:
 NSAID(e.g. ibuprofen )
 Cortisone injections
 Botulinum toxin
Surgery:
 Endoscopic plantar fasciotomy
 In-step fasciotomy

16. Physiotherapy
Modalities:
 Cryo-ultrasound therapy
It promises an effective and long-lasting clinical improvement in patients with chronic plantar fasciitis.
 Ultrasound
 Ice massage
 Thermotherapy
useful for reduction of pain during exercises.
 Low level laser therapy
laser therapy with 850nm wavelength was applied for 9 sessions 3 times a week
 Extracorporeal Shock Wave Therapy
 Iontophoresis

17. Extracorporeal Shock Wave Therapy
 ECSWT is recommended to be the first choice in treating calcaneal spur.
 ESWT appeared effective in relieving heel pain among patients with calcaneal spur
especially when given within the first 4 months after the start of patient complaint.
 ESWT should be useful when the treatment is given with an amount of at least
3x500 impulses weekly.

18. Extracorporeal Shock Wave Therapy

19. Iontophoresis
Using acetic acid followed by 8 minutes of
pulsed ultrasound at 1.5W/cm2 and
exercises.

20. Physiotherapy
 K-tape( if planter faciates present)
 plantar fascia stretching
 Calf muscle stretch

21. Orthotics
 Night Splints
 Heel inserts
 Foot wear Modification

23. References
1. https://www.clinicalkey.com/#!/content/patient_handout/5-s2.0-pe_ExitCare_DI_Heel_Spur_en
2. http://www.webmd.com/pain-management/heel-spurs-pain-causes-symptoms-treatments#1
3. http://www.physio-pedia.com/Calcaneal_Spurs
4. https://www.epainassist.com/sports-injuries/foot-and-heel-injuries/heel-or-calcaneal-spur
5. http://ard.bmj.com/content/71/Suppl_3/757.13
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753417/pdf/v060p01064.pdf
7. https://www.clinicalkey.com/#!/content/journal/1-s2.0-S1067251614005742
8. http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/heel-spur
9. http://www.shockwavetherapy.education/index.php/tutorials/ankle/heel-spurs
10. https://www.clinicalkey.com/#!/content/medline/2-s2.0-24172641
11. www.revrokineto.com/viewart/111/en
12. https://www.clinicalkey.com/#!/content/medline/2-s2.0-28214811