Fw: Calc Spurs
Richard Ziegeler
Description
Collection
Title:
Fw: Calc Spurs
Creator:
Richard Ziegeler
Date:
12/14/2000
Text:
----- Original Message -----
From: Richard Ziegeler
To: <Email Address Redacted>
Sent: Thursday, December 14, 2000 2:51 PM
Subject: Calc Spurs
Thankyou to all who responded to my call for assistance with a recalcitrant medico. All replies have served to reinforce my own ideas and in fact we have educated the Doc.! He is now referring all of his patients with plantar fasciitisThankyou again to all for the support. I wish you all a safe and happy Christmas. Richard Ziegeler (Australia)
I have fitted in the last month a pair of medium density EVA foot orthoses to a patient who had calcaneal spurs and who had had one steroid injection with no pain relief. He has also been stretching 5+ times a day, calf stretching, over a step. Since wearing the foot orthoses he has had no pain and doesn't even have pain on weightbearing in the morning.Hope this helps. Kaisha Gurry
What I found to help also, is to cut out the affected area on the plantar surface of the heel, and replace the cut-out plastic with PPT, or Poron and the entire length of the orthosis with a foam cover. I have great success with this technique in onjunction to agressive calf stretching.
> It has been my experience that most patients don't suffer necessarily from a calcaneal spur but rather plantar fasciitis or calcaneal nerve entrapment.
> There are many patients with heel spurs who are pain free. Often the spur develops secondary to inflammation in the tendon at the insertion into the calcaneous due to a calcium deposit released as part of
> the inflammatory process. There are a lot of papers on the podiatry sites on the internet and medscape which support conservative treatment of these
> conditions. In fact it has been thought that a good stretching program can reduce pain by up to eighty percent. Many patients reinjure constantly because they go from a rest situation like sleep where the tendons contract, immediately into a full stretch situation. ie walking. I give all my patients advice on stretching as well as fitting them with good foot orthoses. Often my patient's report improvement even in the short time between casting and fitting of the orthosis. I would expect about a fifty percent improvement within two weeks and then a slower improvement to recovery. In some patients steroid may work. In many it doesn't. This may be due to the fact that steroid reportedly does not work with everyone, may be due to the accuracy of the delivery or the fact that the person's biomechanics are such that it is only taking care of symtoms not the cause. Occasionally with some of the more chronic cases it is necessary to utilise a night splint to maintain a stretch on the plantar fascia in addition to the other treatments. I hope this is of some use. Feel free to contact me to discuss further. Michael Gurry
..........
i too have been using hard inserts to treat calcaneal spurs (usually w/ a horseshoe pad and spenco covering) for me this has been the most effective treatment. the key is keeping the plantar fascia stretched out. also a night splint is helpful in keeping the foot in dorsi-flexion so that the tell-tale morning pain is kept in check. some of the local pt's here are also using athletic tape to tape the arch, and have found this to be very succesful. john mckinley,
..........
One of the most efficaous uses of orthotics is to solve the problem of heel pain. The orthotics act to minimise the extension of the Plantar Fascia and
thereby reduce the tension at the calcaneal insertion point. True clinical studies are difficult to find but you may be able to locate references through the articles of some magazines. Podiatry Today featured heel pain in the October issue www.podiatrytoday.com).Seamus Kennedy ..........
Try contacting Dr. Edward Glaser...I'm sure someone on the list has his E-mail. He has a very unique approach to a myriad of foot problems which includes calcaneal spurring. I am wearing his custom orthotics and have been helped by their design. The company which fabricates these devices is Sole Supports 1-888-650-7653. Joel Kempfer ........
HI; In response to the heel spur problem, have your patient try Bauer-Find blue dot heel supports. I have had good sucess with them. They retail for about $65. Also a 90 degree heel stretch splint will help. Good luck, Ron Cahill CPO...........
UCBL is the best choice. If the force at heel
strike is painfull, you can add some type of padding. Mechanically, it makes the most sense because of what it is designed to do. Short of FO intervention, it has been my expierence this is the way to go. Good luck with your new Doc.Aaron Kent C.Ped.
..........
You are right, I'm practicing Orthopedic Surgery for the last 20 years Local Injection for treatment of Planter Fasciitis is a common practice.
Since 3 years I'm working in the field of podiatric medicine, where I'm using functional orthosis and stretching ex. as a very succesful treatment
for such common disorder. I'm advising my patients not to let any body give them injections. Not only the patients needs education, also the doctors.
Best regards Amr Aboulmaged, MD, .......
I have had many professional as well as personal experiences over the years with Plantar Faciitis (PF)and have learned that there is more than one
way to skin a cat. The use of anti-inflammatories in conjunction with orthotic management and stretching exercises seems to be the answer. It is
important to remember that this problem takes time to resolve. I have been successful with plantar surface FO's incorporating strong longitudinal
support and medial wedges with 90% of my patients. The remaining 10% (recalcitrant) have not responded to these protocols. I was referred to and
I'm referring you to an article The Influence of Medial and Lateral Placement of Orthotic Wedges on Loading of the Plantar Aponeurosis in the
October 1999 issue of Journal of Bone and Joint Surgery (Vol 81-A, No 10) by Geza Kogler, PH.D, C.P.O.. IT CHANGES EVERYTHING !!! Dr. Kogler uses the usual orthotic approach (plantar surface FO's) for PF patients. When presented with recalcitrant PF, he will utilize the protocols presented in the paper referenced above. This paper identifies the use of lateral wedges in the study. DR Kogler use 5mm - 7mm lateral elevation under the 5th - 3rd metheads with a transition from full thickness to zero under the 2nd methead. A lateral heel wedge is described accurately. To fully appreciate this approach to the biomechanics of the plantar aponeurosis (PA), palpate the PA while you supinate the forefoot. This supination approximates the use of a medial forefoot wedge. You should notice that the PA becomes taut and quite prominent. Now pronate the forefoot (to pproximate a lateral forefoot wedge/elevation) and notice the relaxation of the PA. IT CHANGES
EVERYTHING!!! For those patients with the statistically rare bony exotosis (heel Spur) I will utilize a silicone plug in the FO immediately inferior to that location to provide an extra measure of comfort/protection. Jim.............
I am a podiatrist in the US and have treated sucessfully heel pain with physical therapy e.g. ultra sound, parafin baths and whirlpool along with plantar foot strapings (Cambels Rest Dressings) three/two times a week with a prescription for a mild anti-inflamatory. A follow-up therapy is a foot orthotic in a partial pronated attitude, aprox, 3-5degrees pronated. Try the treatment with the MD it works.Frank Ferrari D.P.M............
UCBL is my choice as well. The problem is, with a UCBL, we are essentially just supporting the arch and adding a heel cup to incorporate a heel spur.
Since a heel spur is basically a calcium build up, the only way I know to get rid of them for good is Cortizone shots. I think its important to put the
patient in a UCBL before, during, and after the cortizone treatments with emphasis on after the treatment to keep the spur from re-occurring. The
problem with heel spurs is that most of them are plantar fasciitis mis-diagnosed. Sincerely,
Dawn Hill, ..........
Here there is a regular practice of surgeons injecting steroids for calc. apurs. We at HOPE are the largest
providers of insoles, soft do-nut / scooped out cushions and silicon or gel heel cushions. Results are very good but still a number of pts. require
injection or minor surgery. Sometimes a soft heel shoe, enclosing the heel mass properly, serves the purpose of pain relief. Sometimes steroids provide complete cure. Dr. Khalid
From: Richard Ziegeler
To: <Email Address Redacted>
Sent: Thursday, December 14, 2000 2:51 PM
Subject: Calc Spurs
Thankyou to all who responded to my call for assistance with a recalcitrant medico. All replies have served to reinforce my own ideas and in fact we have educated the Doc.! He is now referring all of his patients with plantar fasciitisThankyou again to all for the support. I wish you all a safe and happy Christmas. Richard Ziegeler (Australia)
I have fitted in the last month a pair of medium density EVA foot orthoses to a patient who had calcaneal spurs and who had had one steroid injection with no pain relief. He has also been stretching 5+ times a day, calf stretching, over a step. Since wearing the foot orthoses he has had no pain and doesn't even have pain on weightbearing in the morning.Hope this helps. Kaisha Gurry
What I found to help also, is to cut out the affected area on the plantar surface of the heel, and replace the cut-out plastic with PPT, or Poron and the entire length of the orthosis with a foam cover. I have great success with this technique in onjunction to agressive calf stretching.
> It has been my experience that most patients don't suffer necessarily from a calcaneal spur but rather plantar fasciitis or calcaneal nerve entrapment.
> There are many patients with heel spurs who are pain free. Often the spur develops secondary to inflammation in the tendon at the insertion into the calcaneous due to a calcium deposit released as part of
> the inflammatory process. There are a lot of papers on the podiatry sites on the internet and medscape which support conservative treatment of these
> conditions. In fact it has been thought that a good stretching program can reduce pain by up to eighty percent. Many patients reinjure constantly because they go from a rest situation like sleep where the tendons contract, immediately into a full stretch situation. ie walking. I give all my patients advice on stretching as well as fitting them with good foot orthoses. Often my patient's report improvement even in the short time between casting and fitting of the orthosis. I would expect about a fifty percent improvement within two weeks and then a slower improvement to recovery. In some patients steroid may work. In many it doesn't. This may be due to the fact that steroid reportedly does not work with everyone, may be due to the accuracy of the delivery or the fact that the person's biomechanics are such that it is only taking care of symtoms not the cause. Occasionally with some of the more chronic cases it is necessary to utilise a night splint to maintain a stretch on the plantar fascia in addition to the other treatments. I hope this is of some use. Feel free to contact me to discuss further. Michael Gurry
..........
i too have been using hard inserts to treat calcaneal spurs (usually w/ a horseshoe pad and spenco covering) for me this has been the most effective treatment. the key is keeping the plantar fascia stretched out. also a night splint is helpful in keeping the foot in dorsi-flexion so that the tell-tale morning pain is kept in check. some of the local pt's here are also using athletic tape to tape the arch, and have found this to be very succesful. john mckinley,
..........
One of the most efficaous uses of orthotics is to solve the problem of heel pain. The orthotics act to minimise the extension of the Plantar Fascia and
thereby reduce the tension at the calcaneal insertion point. True clinical studies are difficult to find but you may be able to locate references through the articles of some magazines. Podiatry Today featured heel pain in the October issue www.podiatrytoday.com).Seamus Kennedy ..........
Try contacting Dr. Edward Glaser...I'm sure someone on the list has his E-mail. He has a very unique approach to a myriad of foot problems which includes calcaneal spurring. I am wearing his custom orthotics and have been helped by their design. The company which fabricates these devices is Sole Supports 1-888-650-7653. Joel Kempfer ........
HI; In response to the heel spur problem, have your patient try Bauer-Find blue dot heel supports. I have had good sucess with them. They retail for about $65. Also a 90 degree heel stretch splint will help. Good luck, Ron Cahill CPO...........
UCBL is the best choice. If the force at heel
strike is painfull, you can add some type of padding. Mechanically, it makes the most sense because of what it is designed to do. Short of FO intervention, it has been my expierence this is the way to go. Good luck with your new Doc.Aaron Kent C.Ped.
..........
You are right, I'm practicing Orthopedic Surgery for the last 20 years Local Injection for treatment of Planter Fasciitis is a common practice.
Since 3 years I'm working in the field of podiatric medicine, where I'm using functional orthosis and stretching ex. as a very succesful treatment
for such common disorder. I'm advising my patients not to let any body give them injections. Not only the patients needs education, also the doctors.
Best regards Amr Aboulmaged, MD, .......
I have had many professional as well as personal experiences over the years with Plantar Faciitis (PF)and have learned that there is more than one
way to skin a cat. The use of anti-inflammatories in conjunction with orthotic management and stretching exercises seems to be the answer. It is
important to remember that this problem takes time to resolve. I have been successful with plantar surface FO's incorporating strong longitudinal
support and medial wedges with 90% of my patients. The remaining 10% (recalcitrant) have not responded to these protocols. I was referred to and
I'm referring you to an article The Influence of Medial and Lateral Placement of Orthotic Wedges on Loading of the Plantar Aponeurosis in the
October 1999 issue of Journal of Bone and Joint Surgery (Vol 81-A, No 10) by Geza Kogler, PH.D, C.P.O.. IT CHANGES EVERYTHING !!! Dr. Kogler uses the usual orthotic approach (plantar surface FO's) for PF patients. When presented with recalcitrant PF, he will utilize the protocols presented in the paper referenced above. This paper identifies the use of lateral wedges in the study. DR Kogler use 5mm - 7mm lateral elevation under the 5th - 3rd metheads with a transition from full thickness to zero under the 2nd methead. A lateral heel wedge is described accurately. To fully appreciate this approach to the biomechanics of the plantar aponeurosis (PA), palpate the PA while you supinate the forefoot. This supination approximates the use of a medial forefoot wedge. You should notice that the PA becomes taut and quite prominent. Now pronate the forefoot (to pproximate a lateral forefoot wedge/elevation) and notice the relaxation of the PA. IT CHANGES
EVERYTHING!!! For those patients with the statistically rare bony exotosis (heel Spur) I will utilize a silicone plug in the FO immediately inferior to that location to provide an extra measure of comfort/protection. Jim.............
I am a podiatrist in the US and have treated sucessfully heel pain with physical therapy e.g. ultra sound, parafin baths and whirlpool along with plantar foot strapings (Cambels Rest Dressings) three/two times a week with a prescription for a mild anti-inflamatory. A follow-up therapy is a foot orthotic in a partial pronated attitude, aprox, 3-5degrees pronated. Try the treatment with the MD it works.Frank Ferrari D.P.M............
UCBL is my choice as well. The problem is, with a UCBL, we are essentially just supporting the arch and adding a heel cup to incorporate a heel spur.
Since a heel spur is basically a calcium build up, the only way I know to get rid of them for good is Cortizone shots. I think its important to put the
patient in a UCBL before, during, and after the cortizone treatments with emphasis on after the treatment to keep the spur from re-occurring. The
problem with heel spurs is that most of them are plantar fasciitis mis-diagnosed. Sincerely,
Dawn Hill, ..........
Here there is a regular practice of surgeons injecting steroids for calc. apurs. We at HOPE are the largest
providers of insoles, soft do-nut / scooped out cushions and silicon or gel heel cushions. Results are very good but still a number of pts. require
injection or minor surgery. Sometimes a soft heel shoe, enclosing the heel mass properly, serves the purpose of pain relief. Sometimes steroids provide complete cure. Dr. Khalid
Citation
Richard Ziegeler, “Fw: Calc Spurs,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/215473.
