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A bone spur is a boney prominence. On the heel there are several different types of spurs or prominences that can present clinically. The different conditions include:
- Plantar heel spur
- Posterior heel spur
- Haglunds deformity
- Pump bump
- Prominent peroneal tubercle
Plantar Heel Spur
This is the most common of the bone conditions affecting the heel. The plantar spur, a ridge of bone that develops over years, is often an incidental finding on x-ray. Patients who needlessly worry about their heel spurs shouldn't because the condition rarely is the source of heel pain. The orientation of the spur is usually parallel to the ground and it forms next to the plantar fascia (the most common source of heel pain). Plantar heel pain, with or without the presence of a spur, is treated by the same by focusing on the plantar fascia and ignoring the spur. Even if there is with a heel spur, plantar heel pain is successfully treated 95% of the time with conservative treatment.
Posterior Heel Spur
This also is a ridge of bone at the back of the heel and produces a visible enlargement that can be painful and prone to rubbing with enclosed shoes. The process is much more difficult to treat than plantar heel spurs and involves calcification of portions of the Achilles tendon. Which will also thicken and degenerate in the process of spur formation. The most challenging aspect of this condition is being able to wear normal shoes with the condition. The heel shape is altered and the bone prominence can press into the heel counter.
Non-surgical treatments include: use of backless shoes, heel cups, heel lifts, anti-inflammatory medication and physical therapy. If backless shoes can be worn for an extended period of time, the symptoms can often be controlled.
Surgical treatment involves detaching the majority of the Achilles tendon and removing the bony prominence that had built up. The thickened Achilles is trimmed to make it less thick and reattached to the heel bone by using a special bone anchoring devices. The foot needs to be casted for several weeks, rehabiliation with formal physical therapy is usually necessary; finally returning to supportive shoes is due gradually. Recovery can take 4-6 months before the patient can return to full activities.
The posterior heel spur is, at times, mistakenly called a Haglunds deformity. However, a true Haglunds does not involve the insertion of the Achilles tendon. It is an abnormal development of the Heel bone which forms a bone prominence above the point where the Achilles attaches to the heel. Although the Haglund's can rub on the Achilles, and similarly cause a posterior prominence to the heel, x-rays will not show any calcific changes at the Achilles insertion and will confirm the abnormal shape of the back of the heel bone.
Treatments are similar to those involving the posterior heel spur, but in the case of surgery, the recovery is less involved since the bone can be removed without detaching the Achilles tendon.
The pump bump is an incomplete Haglunds condition and usually is a posterior lateral prominence that is smaller and can involve a localized skin thickening overlying the prominence. Heel cups and backless shoes can help, but often a minor surgery is necessary to trim and smooth the bone over the outside aspect of the back of the heel. By rounding the bone, the bump will often disappear.
Prominent Peroneal Tubercle
This is a bone prominence that can be seen on the outside of the heel bone. If the bone grows large enough, it can begin to rub on one or both of the peroneal tendons that pass by this bone. If this process becomes painful and debilitating, it will necessitate partial removal of the bone. Fortunately, this condition is rare, and in many cases the prominent tubercle causes little pain and is something that can be left alone until it becomes more bothersome.
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