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achilles insertion spurs

Posted by Lori C on 1/22/01 at 15:11 (037086)

Dear Doctor,

I have been diagnosed with small achilles insertion spurs on both feet.
Calcaneal spur. Mineralization is normal. NO fractures, dislocations,joint space widening, mortise intact base of 5th metatarsal is intact.
I am in the process for the past few weeks of being correctly fitted for this condition. The orthotic that I am wearing has a metal arch support, and the heel portions have at this time about one half inch of cushioning, to raise me up past the swellings on my tendons.

My questions are: Is this the proper treatment for this condition?
What kind of excercises will help me? Since it is important that my foot be stable inside of my shoe ( which has a negative heel and rocker front--
New Balance brand), can I also add some kind of cushioning for my narrow heel so it doesn't ride up and down in my shoe and further inflame my tendons?If I tighten my laces on shoes to keep them from riding up and down than my ankles hurt. Thank you, Lori C.

Re: achilles insertion spurs

Dr. Zuckerman on 1/22/01 at 21:18 (037122)

What kind of response are you having with this treatment approach. ?

Re: achilles insertion spurs

Richard, C.Ped on 1/23/01 at 07:46 (037140)

Dr. Z,
I have never had someone with this DX come in my office, so please excuse my ignorance. I am curious, should she really be wearing a shoe with a negative heel? To me, this would seem to aggravate the condition more. It sounded like the orthosis has a slightly built up heel, why not the shoe?

I think that a shoe with a padded collar may help, or, an open heeled shoe or sandal.

Could another approach be to attach a donut pad to the inside counter to relieve pressure areas?

Again, please excuse my ignorance.
Richard, C.Ped

Re: achilles insertion spurs

Dr. Marlene Reid on 1/24/01 at 11:52 (037214)

Hi Lori, one of the important factors in insertional spurs is wheter or not you have an equinous. In most cases, that is what causes the spuring to occur. The achilles pulls excessively on the heel and spurs develope. It starts out as a symptom of equinous and then becomes painful and a problem on its own.

Then it becomes a catch 22 because it can further weaken the tendon. This is VERY important down the road because the tendon can fully or partially rupture. This is not that uncommon! We treat partial ruptures associated with spurs all the time. A heel pad or orthotic which raises the heel will help the pain associated with the spurs, but will not help the equinous.

I think its important to first quiet down the pain of the spurs and then address the equinous. Heep pads are great temporarily, or maybe a cast or crutches if the pad doesn't work. I would never inject the area.

Once the immediate pain is resolved, phase two in treatment takes place. Depending on your age and the amount of equinous, stretching may or may not work. Alternating shoes with different heel heights help to not allow the achilles tendon stay in one position all the time (even though heels may have been more comfortable, flatter shoes will let the achilles stretch out). If the pain never comes back, great. If it does, its time to start thinking about removing the spurs with or without lengthening the achilles tendon.

Re: achilles insertion spurs

Dr. Zuckerman on 1/24/01 at 12:29 (037221)

Hi, I agree and Richard the negative heel is something I haven't heard of in years . It use to be used in Earth Shoes. Just like strething on a stair steps in bad and it appears that this could be worse.

Never inject the achilles tendon.

When conservation treatment fails we have used ESWT for chronic tendonits without rupture and have seen some great results.

Surgery is a last resort and is very effective but does have a very long post-op recovery. The book that was written for shockwave talks about ESWT for achilles insertional tendonitis. Very effective and could be better then ESWT for pf and or heel spur pain.

Equinus is the the cause and must be addressed either with a heel lift or shoe lift and hopefully with stretching . Control of abnormal pronation. need to be look at . I love the deep heel cups that lift and control the turning in of the heel bone.

Re: achilles insertion spurs

Dr. Zuckerman on 1/22/01 at 21:18 (037122)

What kind of response are you having with this treatment approach. ?

Re: achilles insertion spurs

Richard, C.Ped on 1/23/01 at 07:46 (037140)

Dr. Z,
I have never had someone with this DX come in my office, so please excuse my ignorance. I am curious, should she really be wearing a shoe with a negative heel? To me, this would seem to aggravate the condition more. It sounded like the orthosis has a slightly built up heel, why not the shoe?

I think that a shoe with a padded collar may help, or, an open heeled shoe or sandal.

Could another approach be to attach a donut pad to the inside counter to relieve pressure areas?

Again, please excuse my ignorance.
Richard, C.Ped

Re: achilles insertion spurs

Dr. Marlene Reid on 1/24/01 at 11:52 (037214)

Hi Lori, one of the important factors in insertional spurs is wheter or not you have an equinous. In most cases, that is what causes the spuring to occur. The achilles pulls excessively on the heel and spurs develope. It starts out as a symptom of equinous and then becomes painful and a problem on its own.

Then it becomes a catch 22 because it can further weaken the tendon. This is VERY important down the road because the tendon can fully or partially rupture. This is not that uncommon! We treat partial ruptures associated with spurs all the time. A heel pad or orthotic which raises the heel will help the pain associated with the spurs, but will not help the equinous.

I think its important to first quiet down the pain of the spurs and then address the equinous. Heep pads are great temporarily, or maybe a cast or crutches if the pad doesn't work. I would never inject the area.

Once the immediate pain is resolved, phase two in treatment takes place. Depending on your age and the amount of equinous, stretching may or may not work. Alternating shoes with different heel heights help to not allow the achilles tendon stay in one position all the time (even though heels may have been more comfortable, flatter shoes will let the achilles stretch out). If the pain never comes back, great. If it does, its time to start thinking about removing the spurs with or without lengthening the achilles tendon.

Re: achilles insertion spurs

Dr. Zuckerman on 1/24/01 at 12:29 (037221)

Hi, I agree and Richard the negative heel is something I haven't heard of in years . It use to be used in Earth Shoes. Just like strething on a stair steps in bad and it appears that this could be worse.

Never inject the achilles tendon.

When conservation treatment fails we have used ESWT for chronic tendonits without rupture and have seen some great results.

Surgery is a last resort and is very effective but does have a very long post-op recovery. The book that was written for shockwave talks about ESWT for achilles insertional tendonitis. Very effective and could be better then ESWT for pf and or heel spur pain.

Equinus is the the cause and must be addressed either with a heel lift or shoe lift and hopefully with stretching . Control of abnormal pronation. need to be look at . I love the deep heel cups that lift and control the turning in of the heel bone.