A heel spur injection (called a blockade) is an effective way to treat inflammation of the heel fascia by injecting a drug based on artificial hormones directly into the heel spur.
The peculiarity of this method is that the active substance is injected into the affected fascia and begins to act instantly. Steroid injections have many contraindications; only a doctor can prescribe and administer them.
Attention: this article is for informational purposes only. Self-treatment of heel spurs with steroid injections is strictly prohibited!
What types of blockades are there?
Local
The doctor gives an injection exactly in the area where there is damage. The drug can be administered near or under it, hoping to get into the area of the inflammatory focus. When an injection is administered into the periarticular tissues, the blockade is called periarticular, and into the nerve trunks - perineural.
Segmental
The segmental method involves injecting an anesthetic into a specific spinal segment. This means that the medicine must enter the projection zone of this segment, corresponding to a specific nerve, vertebra or muscle.
Vertebral
The term "vertebral" means "vertebral, which refers to a vertebra" and is derived from the Latin vertebra - vertebra. The specialist inserts the needle subcutaneously into the space between the spinous processes of the vertebra (insertion depth - 2-4 cm) or into the vertebral body (depth - 8-10 cm).
Blockage in the spine for pain
A blockade in the spine for pain is carried out when nerve roots are pinched due to osteochondrosis, herniated intervertebral discs, neuralgia, spondyloarthrosis. Pain relief is achieved by temporarily “switching off” nerve conduction in a particular area. The introduction of anesthetics blocks the transmission of signals along the nerve fibers, and the pain recedes almost instantly. There is also a decrease in vascular spasm, swelling goes away, tissue self-healing processes are accelerated, and intracellular metabolism is normalized.
Symptoms of heel spurs
Symptoms of heel spurs
depend on the course of the disease, the availability of treatment and other limiting factors, the size and location of the growth on the heel tubercle. The determining role is played by the location of the spur in relation to the nerve fibers and endings - the closer it is, the more intense the signs of the disease appear. In rare cases, the thorn may be so “successfully” located that it can only be identified by the erased symptoms of inflammation and during an X-ray examination.
The most noticeable symptom of a heel spur for a patient is pain. In the early stages of the disease, they can be muffled, expressed in discomfort after prolonged standing or walking. The nature of the pain is usually pressing, as if a small pebble had hit the shoe. Sometimes patients notice increased fatigue and a general decrease in leg endurance.
Soon complaints of soft tissue injury appear when abruptly rising from a bed or from a chair (“got off on the wrong foot” - this is about a heel spur!), going up and down the stairs, jumping or running, or striding.
Subsequent stages of the disease are characterized by severe inflammatory symptoms of heel spurs:
- local increase in temperature, feeling of heat and tension in the heel area;
- swelling that causes discomfort when trying to take off or put on shoes (especially those that were previously comfortable for the patient);
- redness of the skin over the heel tubercle;
- a feeling of numbness in the foot, which can even rise above the ankle;
- the appearance of foci of coarsening - thickening of the stratum corneum on the skin of the heel;
- increased pain when walking and other activities associated with pressure on the heel (for example, sitting cross-legged);
- a noticeable protrusion under the skin;
- formation of painful calluses;
- tingling and burning sensation at the end of the day, while resting.
As the pain becomes continuous, the patient's gait begins to change - lameness appears
, an attempt to transfer weight to the toe or turn out the leg.
In advanced cases, a characteristic symptom of a heel spur is acquired transverse flatfoot
, which only complicates the situation and contributes to the growth of the heel spur.
With flat feet, the patient's foot lengthens, and the muscles of the lower leg of the affected leg grow unnaturally. The pain can radiate not only to the knee or hip, but also to the back. Complications can be expressed in postural curvatures
,
intervertebral hernias
.
In the later stages, patients complain as if there is a sharp thorn or nail stuck in the heel - during the exacerbation period, every step is like stepping on broken glass. The leg begins to hurt even without any load, the symptoms of heel spurs do not subside even at night. Early morning pain (sharp and throbbing) becomes an excruciating routine. Pain in the Achilles tendon area may also develop. In the later stages, a compensatory growth of dense connective tissue is also observed, in which calcium salts are deposited. They cause a strong reaction from the nerve endings and cause a complete loss of flexibility in the foot.
- to walk, patients have to actively use the hip joint.
When are blockades used?
Heel spurs
Blockades in traumatology and orthopedics are most often performed for heel spurs, using corticosteroid hormones. The maximum effect is provided by drugs such as Diprospan, Kenalog and Hydrocortisone.
Joints
The main indications for pain-relieving “blocking” of joints are exacerbations of arthritis and arthrosis. An anesthetic injection is given into the joint capsule, or less often into the muscle, after which relief quickly occurs.
Nerves
The medicine is injected directly into the area where the nerve trunk passes to quickly relieve inflammation and spasms. This type of pain relief is often the optimal solution for tunnel syndromes, neuralgia, neuritis, and oncological tumors.
Heel spur block: what is it?
A heel spur, medically called plantar fasciitis, causes severe pain in the heel that increases over time.
By blockade we mean an injection into the area of the most severe pain: the needle is inserted directly into the bone growth.
The medicine used is corticosteroid drugs, most often diprospan or kenalog, which have a prolonged (long-lasting) effect.
Sometimes doctors prescribe a blockade with a combination of diprospan with anesthetics (novocaine, lidocaine), which have a pronounced but short-term analgesic effect.
How does a spinal block block work?
First, the doctor examines the patient and, based on the examination and examination data, selects the optimal method. Then the injection site is disinfected, and local anesthesia is performed if necessary. Once the anesthesia has taken effect, the medicine itself is administered. Since the disease can affect any part, the injection is given in the lumbar region, shoulder blades or neck, that is, in the place where the pain is localized. At the end of the procedure, the injection site is once again treated with an antiseptic, and a sterile bandage is applied. To consolidate the effect, the patient remains lying on the couch for at least an hour.
Diagnostics
An orthopedic surgeon diagnoses and treats heel spurs. The main way to identify pathology and assess the degree of its development is radiography. The image clearly shows the bone growth, its shape, location and size.
Additional examination techniques include:
- general and biochemical blood test to identify the inflammatory process, assess the level of uric acid (important for diagnosing gout) and some other indicators;
- Analysis of urine;
- Ultrasound of the foot to assess the condition of soft tissues and identify a possible abscess;
- duplex examination of the vessels of the lower extremities (detects possible circulatory disorders);
- MRI of the foot to determine the condition of all anatomical structures of the foot, including nerve fibers.
If there are concomitant diseases, appropriate laboratory and instrumental studies and consultations with specialists are prescribed.
It is important to remember that heel pain does not necessarily indicate the development of a heel spur. Similar symptoms can be caused by:
- gout;
- rheumatoid arthritis;
- osteomyelitis (inflammation of bone tissue);
- Bekhterev's disease;
- bone tuberculosis;
- injuries, etc.
You should not self-medicate or take painkillers uncontrollably. Only a doctor can choose the appropriate regimen.
Advantages
- fast, complete and long-lasting pain relief;
- additional therapeutic effect due to the acceleration of recovery processes;
- possibility of repeated use;
- minimum of adverse reactions.
For tonic syndromes caused by muscle tension, blockades can relieve discomfort for several months or even years. For more serious diseases, anti-inflammatory and hormonal agents are added to the anesthetics, as well as chondroprotectors for cartilage regeneration. When introduced into a sore spot, they are much more active than droppers, tablets or ointments. Therefore, therapeutic blockades in neurology are much more effective than pharmaceutical drugs and physiotherapy.
How is shock wave therapy performed for heel spurs?
The UVT procedure is carried out using a special device that creates ultrasonic waves of the required frequency. The number of procedures is prescribed individually and depends on the severity of the disease and the intensity of the pain syndrome. Typically, 3 to 5 visits to the doctor are required. During the procedure, a special gel is applied to ensure closer contact of the UVT device emitter with the skin. Next, the doctor acts on the pathological source of pain.
Ultrasound waves differentially penetrate soft tissues, reach bone growths, relieving inflammation and relieving pain. In addition, the therapeutic effect of shock wave therapy for heel spurs is achieved due to:
- strengthening by waves of blood microcirculation and metabolic processes in the pathological focus;
- ultrasonic blocking of the transmission of pain impulses to the brain;
- resorption of the formed secondary scar tissue of the plantar fascia of the foot with restoration of its elasticity.
note
An important feature of UVT is that ultrasonic waves do not have a negative effect on healthy cells and tissues.
Drugs
Anesthetics
Injections with Novocaine are given into nerves and soft tissues. After administration, nerve innervation is blocked, nutrition and cell resistance to allergens are improved. Novocaine has a bacteriostatic effect and has a high safety profile, rarely causing adverse reactions. Lidocaine provides a longer and more pronounced effect compared to Novocaine. It is based on the inhibition of voltage-gated sodium channels, due to which nerve signals cease to be generated and their transmission to the brain stops. Lidocaine dilates blood vessels and relaxes muscles. The pain disappears a few minutes after it enters the tissue.
Important! Lidocaine is less toxic than Novocaine.
Hormones
Dexamethasone is a fast-acting anti-inflammatory drug with prolonged action. It suppresses the activity of the immune system and has an antihistamine effect. Dexamethasone is one of the drugs of choice for diseases of the musculoskeletal system. Eliminates unwanted reactions to local anesthetics and is ten times more effective than hydrocortisone. Diprospan is used for joint diseases and heel spurs. Quickly relieves pain and discomfort, relieves allergic manifestations. Bone growths on the heel disappear after 1-2 procedures. The product can be used for epidural and perineural blockades. The only drawback is the possible side effects common to all corticosteroids. However, compared to analogues, the risk is lower.
Vitamin B12
The use of cyanocobalamin is justified by its ability to have a ganglion-blocking effect, that is, to inhibit nerve conduction. Vitamin B12 is usually administered in combination with B1 and Novocaine. The main indications are neuritis and polyneuropathy.
Causes of pain and heel spur formation
The human foot has a complex anatomical structure and bears the load of the human body while walking, running and jumping. The foot is also responsible for the spatial position of the body during movement, regardless of surface unevenness. A large load on the foot can lead to damage to the elastic tissues of the tendon-ligamentous apparatus, in particular the plantar (plantar) fascia. This ligament supports the arch of the foot and is fixed to the heel tubercle, with the latter growing, which leads to the formation of a heel spur.
The risk group includes people whose profession or lifestyle involves constantly being on their feet, as well as athletes who experience excessive regular stress on their feet.
The following factors can provoke these changes:
- excess weight and everyday overload of the foot;
- diabetes mellitus, gout;
- progressive flat feet;
- circulatory disorders in the lower extremities;
- joint diseases (arthritis, arthrosis);
- long-term wearing of incorrectly selected shoes (tight, high heels or thin hard soles).
Blockade in the spine: consequences and their prevention
Complications occur only in 0.5% of cases. These may include unexpected reactions to medications such as dizziness, vomiting, or increased heart rate. Damage to blood vessels at the injection point with the formation of a hematoma, infection and bleeding is also possible. Allergic reactions are possible. For preventive purposes, additional injections are given, and a test test is performed to prevent allergies. Our center has all the conditions for safely performing therapeutic blockades that will relieve you of debilitating pain for a long time. You don't have to worry about possible consequences or poor quality pain relief.
We employ high-level specialists with extensive experience, making patients feel comfortable and confident. If necessary, you will be prescribed one or more intra-articular injection procedures and a drug will be selected based on the indications.
