Heel Spur (epin calcanei)

A heel spur is a bony structure formed on the lower and back surfaces of the heel bone and is seen as the most common cause of foot pain. The ligament structure on the sole of the foot may deteriorate over time, and edema occurs at the attachment point to the heel. This deterioration is medically defined as plantar fasciitis. If this situation persists, over time, the edematous area hardens and becomes bony, forming a heel spur.

This pain causes serious discomfort, making it difficult to perform daily activities, and quality of life decreases. Patients with this disease typically describe pain when getting out of bed in the morning or when they first stand up after a long period of rest. The pain decreases as the day progresses and as they continue walking.

The incidence of heel spurs is higher in people who are overweight, have rheumatic diseases, and are in professions that require standing for long periods.

Non-surgical treatment is generally:

. Rest

. Anti-inflammatory drugs

. Use of personalized insoles

. Physical therapy agents (electrotherapy, cold pack, high-intensity laser, ESWT, and exercise)

. Local injections

Walking on a soft surface (pillow, etc.) at home, exercises to stretch the sole of the foot, and applying ice around the heel for 15 minutes are recommended practices to suppress pain.

In addition, using personalized insoles based on computerized foot analysis reduces the load on the person’s heel bone and relieves pain. In cases where these methods are not beneficial, surgery may be used. In general, surgery involves:

. Filing of the bone structure

. Loosening the ligament structure in the sole of the foot

. Muscle relaxation (in rare cases)

 

Flat feet (pes planus)

The foot is the only part of the body in contact with the ground. Consequently, it carries the entire body weight and transfers it to the ground. The foot also acts as a shock absorber through the muscles, bones, and ligament structures in the foot and the special arrangement of these structures. The bones in the foot form anatomical formations called arches in the shape of a roof in the inner-middle part of the foot.

Any deterioration in the structures that make up the foot disrupts the weight-bearing mechanism, and the problem we call pes planus (intoeing or flat feet) occurs. With this deterioration, the foot cannot fulfill its function of shock absorption and leverage. In addition, deterioration in the foot not only affects the foot but also causes chain deterioration to the knee, hip, and even the neck.

Flat feet occur in two ways. The first is termed flexible flat foot. This type is mostly seen in childhood and occurs due to loose ligament structure. The arc collapses with the load and recovers when the load is removed. Introversion may be considered normal in children in the first years of life. As the child grows, the ligament structures in the sole of the foot become stronger, and the arch begins to form. This is why children may experience pain in their early years. If the child does not complain, no treatment is required. Observation is recommended.

The second type is termed rigid flat foot. It is a disorder seen more frequently in young and adult people, with a prevalence rate of 20-25% in adults. In addition, some musculoskeletal system diseases can also cause pes planus through deterioration in the foot structure. In this distortion, the arc does not recover even when the load is removed.

Tests are performed to decide which type of flat feet is present. For example, if the arc rises when the person stands on his toes, it is classified as a flexible type; if it does not rise, it is classified as a rigid type.

The treatment methods of these two types are different. Exercise approaches and personalized insoles are used to treat flexible flat feet. While these treatments may be sufficient to eliminate the problem, orthopedic surgery may also be required.