What is Heel Spur and how does it occur?
Contrary to popular belief, heel spurs are not actually a bone disease, but a condition that occurs as a result of chronic damage to the plantar fascia membrane on the sole of the foot. Thanks to the dimple called the long arch of the foot, which is located on the inside of each person’s foot, the loads on the foot are distributed in a stable form, preventing too much load on the soft tissues and bones. As a result of the collapse of the arch of the foot, standing for a long time, long walks and bad shoe habits, the plantar fascia, which supports this arch, is very stretched. Due to chronic injury, thickening of the plantar fascia and soft tissue edema occur, especially where it attaches to the heel bone. This rheumatic event on the sole of the foot is called plantar fasciitis. As the disease progresses, this membrane begins to thicken and chronic injuries occur at the point where it attaches to the heel bone. The body tries to reduce the tension by creating new bone in this area. When this bone structure is pointed, it is called heel spur.
What complaints does a heel spur cause?
The most valuable symptom is pain. This pain is especially bothersome in the morning. When the patient gets up in the morning, he cannot step on his heel for a while. As the disease progresses, morning pains begin to spread throughout the day. Hard-soled shoes and high-heeled shoes can be uncomfortable. In severe cases, standing up becomes uncomfortable at any time, and the pain may even continue at rest.
How to diagnose heel spur?
It can be diagnosed with a good examination during the plantar fasciitis period, where the heel spur is no longer formed. In this step, edema and thickening of the basement membrane can be detected only with MRI and sometimes ultrasound imaging. When a heel spur occurs where the membrane adheres to the heel bone, an easy x-ray is sufficient to make the diagnosis. An important point to remember is that foot pain and heel spur may be the first sign of inflammatory spinal rheumatism. Especially if there is pain behind the heel and is resistant to treatment, this disease should definitely be investigated.
What treatments are used for heel spurs?
Heel spurs are usually treated with conservative formulas. Surgery has no place except in very special cases. Antirheumatic drugs, activity restriction, shoe modification may be sufficient in mild cases. Special insoles, perforated heel reinforcements may work. In stubborn cases, cortisone injections in the heel work well. Although the short cycle results are good, there is a repetition tendency approaching 40-50%. The fact that the injection cannot be made to the real place also has a role in this. Therefore, this type of needle should be made with ultrasound imaging. Although the shock wave called ESWT has been used frequently in recent years, its results are worse than the cortisone injection and it is not preferred because the patient may feel pain during the process.
PRP in the treatment of heel spurs
PRP is the abbreviation of the initials of the English word “Platelet Rich Plasma” and means “strong plasma from platelet”. In this method, it is a natural treatment method as the drug is prepared from the patient’s own blood. The high rate of growth factors contained in the PRP fluid stimulates the cells of the structures in the plantar fascia and heel spur region, where the injury occurs, thereby accelerating the beautification in that region.
In recent studies, satisfactory results have been reported, especially in cases of heel spurs that could not be achieved with other treatments. It is generally applied once, sometimes twice in the middle of a month. PRP treatment is actually a proven way to be effective in joint rheumatism such as knee hip and tendon rheumatism such as tennis elbow. Now we can say that heel spurs and plantar fasciitis are also in the field of use of PRP treatment.
Of course, all treatments and PRP treatment should be supported with activity modification and an appropriate training program. PRP therapy remains a new hope for many persistent musculoskeletal diseases.