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Development of posterior and plantar heel spurs

Discussion in 'Biomechanics, Sports and Foot orthoses' started by JaY, Jun 6, 2014.

  1. JaY

    JaY Active Member


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    Dear Biomechanic geniuses

    I have a patient coming to see me tomorrow. The chiropractor referred him to me having diagnosed him with posterior and plantar calc spurs of both feet. He is a serious runner and has recently participated in another Comrades Marathon here in Durban, SA.

    Obviously I am going to do a biomech assessment on him. I will also rule out any degenerative and inflammatory joint diseases, as well as trauma. What else should I look out for??

    I am also assuming that I will be sending him for shockwave therapy to try break down the spurs and to re-start the inflammatory reaction so that it hopefully ends in complete healing.

    What about surgical opinion? (I will first try orthotics for him though...)

    Thank you!
     
  2. docbourke

    docbourke Active Member

    Re: DEVELOMENT OF POSTERIOR AND PLANTAR HEEL SPURS

    If there is an insertional calcific spur where the Achilles inserts onto the calcaneaum in my experience the only permanent solution is surgery with excision of the spur and Haglund prominence and reattachment of the Achilles. Excellent results but need to watch wound healing. Full running at high levels takes 12 months or more.
    Obviously it will depend on the symptoms and conservative treatment should be sought initially but unfortunately it tends to treat the symptoms not the cause. There are advocates for the lesser procedure done arthroscopically but I have not had much experience with it and can't see it solving the problem which appears to be degeneration at the Achilles Insertion.
     
  3. drsarbes

    drsarbes Well-Known Member

    I think we are getting a bit ahead of ourselves here.

    You would need to assess his symptoms and underlying etiology then come up with a treatment plan. Not just his biomechanics but his running schedule, routine, pace, terrain, shoes, other activities, general health, occupation, etc......

    Surgical debridement of insertional achilles enthesopathy is no small matter, especially for an athlete.
    Plantar heel spurs/fasciitis more often than not can be controlled non surgically, but if surgery is indicated these are much easier to correct than posterior pathology. I have never had a runner return to normal running after Posterior os calcis debridement in less than 6 months.

    For his initial visit I would not even mention a surgical approach. Runners want to keep running. Try everything you can think of prior to referring him out.

    Steve
     
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