SPURS BONE — a thorn visible growths of a bone tissue on the surface of bones.
Highway to. usually are located on a back or lower surface of a calcaneus in this connection there was a name «spur». It is extremely rare III. to. are localized on an epiphysis of other bones (e.g., on an elbow shoot) where they, as a rule, are an accidental find (clinically are not shown and do not demand treatment). Therefore in a wedge, practice only calcaneal spurs are of interest. According to L. E. Kevesh (1957), they are found in 26,4% of persons at the age of 40 — 44 years and in 88,5% of persons at the age of 70 years and are more senior.
The calcaneal spur can be located in the field of a medial shoot of a hillock of a calcaneus - a bottom spur (fig., a) or back department of a hillock of a calcaneus a back spur (fig., b).
Sh.'s etiology to. finally it is not found out. One of the most frequent reasons of their education consider hron. traumatization. So, e.g., bottom spurs arise at the persons having flat-footedness (see). At flat-footedness the raised tension of a bottom aponeurosis in this connection at a rift of foot during walking there is a continuous traumatizing the place of its attachment at a hillock of a calcaneus is noted, and proliferative inflammatory process with gradual formation of a bone ledge develops further; The Reason of formation of a calcaneal spur can become the excessive load of legs connected with a profession or increase in body weight at obesity, wearing inconvenient, close footwear. Emergence of bone growths at the place of an attachment of an Achilles tendon to a hillock of a calcaneus is possible at athletes at frequent traumatization of this area and development of a recurrent bursitis (see). The bruise of a calcaneus, regional changes in the field of a hillock of a calcaneus can also promote development of a spur.
At gistol. a research Sh. to. consists of again formed bone tissue which is continuation of a bone of a calcaneal hillock. In it note a new growth of bone beams and signs hron. osteoperiosteums that (see). In soft tissues, on -
Fig. Roentgenograms of calcaneuses (a side projection) of patients with bottom and back bone spurs (are specified by shooters).
kryvayushchy a spur, the mucous bag often forms.
Patients with a bottom spur complain on acute, thermalgias at a support of a heel (feeling «nailing in a heel» — a kalkanodiniya). Often pains extend on all calcaneal area — a so-called talalgia.
In some cases they appear suddenly and have acuity, and sometimes develop gradually.
Intensity of pain does not depend on the size of a spur. Spurs of the big sizes, the pointed form sometimes find accidentally at rentgenol. research. Pains are caused first of all by changes in soft tissues — an inflammation of deep synovial bags (under - a calcaneal bursitis, an achillobursitis) and the phenomena of a periostitis (see) in this area. An important role in their emergence is played by involvement in inflammatory process of dense network of medial calcaneal branches of a tibial nerve and the lateral calcaneal branches of a sural nerve located close to a periosteum. Because of severe pains patients involuntarily try to unload a heel, go on fingers or on the outer edge of foot. At bilateral defeat gait becomes sliding, patients are forced to use a stick or even crutches. At a back spur of pain arise during the walking and pressure a back of footwear at the place of an attachment of an Achilles tendon; patients are forced to wear shoes without back.
There are no visible inflammatory changes at a calcaneal spur usually. The spur is not probed under a thick coat of soft tissues, only morbidity during the pressing is defined on a hillock of a calcaneus from a sole. At a back spur hypostasis and callosity of skin in the field of an attachment of an Achilles tendon are possible.
The diagnosis of a calcaneal spur is based on a wedge, yielded and results rentgenol. researches. Dif
the ferentsialny diagnosis is carried out with an osteochondropathy of a calcaneus, osteomyelitis, an acute injury. The osteochondropathy of a hillock of a calcaneus (see Haglund — Shin-tsa a disease) meets at children's and teenage age and is characterized typical rentgenol. changes of a calcaneus. At osteomyelitis (see) pains are not connected with loading; radiological in a calcaneus define a sclerosis, focal destruction, sequesters.
Treatment of a calcaneal spur of hl. obr. conservative is also directed to elimination of inflammatory changes in surrounding fabrics. It includes unloading of calcaneal area by means of individual orthopedic insoles with deepening and soft laying in a heel, and also special orthopedic footwear with deepening in a heel at a bottom spur or in a back — at back (see Footwear). As a temporary measure recommend carrying a soft porolonovy thrust bearing with deepening or an opening in the center. Appoint heat baths with sea salt, to lay down. gymnastics and massage of muscles of feet and shins, ozo-keritovy or paraffin applications, electrophoresis of novocaine, fo-noforez hydrocortisone. In the presence of the expressed inflammatory phenomena appoint a bed rest, imposing of a plaster splint to 10 — 14 days, antibiotics. In case of lack of effect of the specified treatment resort to alcohol - new kainovym to blockade, magnetotherapy (cm), roentgenotherapies. At a roentgenotherapy the exposure dose usually makes 50 — 200 r on a course (depending on observed effect); sessions spend bucketed 2 — 4 days. In the absence of effect or at a recurrence of a disease in 2 — 3 months the course of a roentgenotherapy can be repeated. In the absence of effect of conservative treatment resort to surgery — removal
of a spur together with the subject site of a bone. Operation is carried out under intra bone anesthesia. At a bottom spur on bottom edge of a calcaneus make a horseshoe section, throw back a piece of leather together with hypodermic cellulose towards fingers; cut muscles and the bottom aponeurosis which is attached to a hillock of a calcaneus delete a spur together with the subject bone plate, excise a hypodermic calcaneal bag if that is available, and a part of a fatty tissue. On a wound put layer-by-layer stitches, a compressing bandage and a plaster splint for a period of 4 weeks. After removal of a splint appoint foot baths, massage, carrying orthopedic insoles.
The forecast at rational and timely treatment favorable.
For prevention of a calcaneal spur it is necessary to avoid overloads of feet, especially to the people inclined to development of flat-footedness.
Bibliography: Blochin V. N. and Vinogradova T. P. Spurs of calcaneuses, Ortop. and travmat., No. 1, page 96, 1937; Dolchuk N. 3., etc. About radiation therapy of so-called calcaneal spurs, in the same place, No. 3, page 68, 1975; On d-rushnyak E. P. Age changes of joints of the person, Kiev, 1972; Reynberg S.A. Radiodiagnosis of diseases of bones and joints, book 1 — 2, M., 1964; H and to l and V. D's N. Fundamentals of operational orthopedics and traumatology, M., 1964; Buller M. R. Conduite and tenir devant une «ruff» sa1sapyoeppe, Bordeaux of m£d., t. 11, p. 889, 1978; R o t liba r t B. A. Heel spur and heel spur syndrome, J. Amer. Podiat. Ass., v. 61, p. 186, 1971. I. S. Istomina.