How do you remove this thorn in your side?

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A heel spur appears as a small bump on the heel bone. Where does it come from?

“So, first of all, this is not an eyesore at all. This is what we call plantar aponeurosis. It is a form of plantar aponeurosis tendinitis. Patients experience pain in the heel when they prop up. They experience constant pain for weeks or months before they see a doctor. When they first see a doctor, they are usually asked to get an X-ray. And, we often see what is called a heel spur (ossification of the tendon’s attachment point to the heel bone). However, contrary to popular belief, it is not the heel spur that causes the pain, but rather a reflection of chronic overexertion of the plantar aponeurosis. »

So are heel spurs the result of plantar fasciopathy? Can you define what it is?

“The plantar aponeurosis forms the arch of the foot. It is a fibrous layer that wraps around muscles and tendons. And it is this plantar aponeurosis that can cause plantar aponeurosis, which is inflammation. »

So are we talking about arch disease?

“This is a pathology of microtrauma overload at the calcaneal insertion of the plantar aponeurosis. Contributing factors include being overweight, standing and walking for long periods of time, and sometimes walking in flat shoes. The pathology generally appears after the age of 45. We also often find a shortening of the muscle chain in the posterior part of the leg. Anatomically, there is continuity between the calf and the plantar aponeurosis. So, if the calf muscles are slightly retracted, there is too much tension on the bony insertion of the heel bone, and that is why we get this small spur. »

How do you treat this pathology? Do you remove the thorns in your side?

“First, the diagnosis is made by means of X-rays and ultrasound examinations. Then, the treatment is essentially medical. We will seek to reduce all the factors that trigger the plantar aponeurosis: reduced walking, prolonged standing, mechanical stress in the heel support area, etc. We usually prescribe cushioning gel heel pads. Another important factor is physical therapy. We will work on stretching the calf muscles and the plantar aponeurosis. In addition to this, there is treatment based on anti-inflammatory and analgesic drugs. For rebellious, disabling forms, corticosteroid infiltration may be recommended. This allows the patient to get relief very quickly. »

Then no surgery?

“Medical treatment can take several months. Surgery is considered only in case of failure. But this is only as a last resort, and not before a year of medical treatment. Very few patients end up having surgery. If a case is difficult to treat, then we offer surgery. It involves removing the aponeurosis by detaching it from the heel area, where there are small spines. We make a cut so that there is no more traction. In principle, this intervention can provide people with lasting relief. »

Is this operation fast?

“The operation is performed on an outpatient basis. We open the inner part of the heel by two to three centimeters. The patient then walks quickly on crutches again for two to three weeks while recovering. »