Esporão de calcâneo

PLANTAR FASCIITIS AND HEEL SPURS

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Calcaneal spurs — Calcaneal spurs can develop on the plantar tuberosity and can extend across the entire width of the calcaneus. The apex of the spur is embedded in the plantar fascia. Heel spurs are typically asymptomatic, and surgery is rarely, if ever, necessary.

Every year, as many as 2 million persons present with plantar heel pain, with men and women affected equally.

Plantar fasciitis is the most common cause of plantar heel pain. Historically, plantar fasciitis was considered an inflammatory syndrome; however, recent studies have demonstrated a noninflammatory, degenerative process, leading some to use the term plantar fasciosis. Regardless, the condition usually stems from multiple causes and can be debilitating for the patient.

Plantar fasciitis causes throbbing medial plantar heel pain that is worse with the first few steps in the morning or after long periods of rest. The pain usually decreases after further ambulation, but can return throughout the day with continued weight bearing. Tenderness is noted on the medial calcaneal tuberosity and along the plantar fascia. Pain often increases with stretching of the plantar fascia, which is achieved by passive dorsiflexion of the foot and toes. Radiography is usually not necessary, although weight-bearing radiography can help rule out other causes of heel pain.

Approximately 50 percent of patients with plantar fasciitis have heel spurs, but they are most often an incidental finding and do not correlate well with the patient’s symptoms.

Ultrasonography can demonstrate a thicker heel aponeurosis of greater than 5 mm.

Treatment of plantar fasciitis is typically conservative, although resolution can take months to years.

First-line therapies include relative rest, stretching before initial weight bearing, strengthening exercises, anti-inflammatory or analgesic medications, and ice. Arch taping, over-the-counter shoe inserts, custom orthotics, or supportive shoes may be helpful.

Night splints, corticosteroid injections, and formal physical therapy have been used for more recalcitrant cases.
Extracorporeal shock wave therapy may also be of benefit.

Surgery to transect the plantar aponeurosis is used only when other treatments have been ineffective.

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Tratamento:

 Rest — Give your foot a chance to heal by resting. But don't completely stop being active. Doing that can lead to more pain and stiffness in the long run.
 Take pain medicines — If your pain is severe, you can try taking pain medicines that you can get without a prescription. Examples include ibuprofen (sold as Advil® or Motrin®) and naproxen (sold as Aleve®). But if you have other medical conditions or already take other medicines, ask your doctor or nurse before taking new pain medicines.
 Wear sturdy shoes — Sneakers with a lot of cushion and good arch and heel support are best. Shoes with rigid soles can also help. Adding padded or gel heel inserts to your shoes might help, too.

Resumindo então pessoal:

Esporão de calcâneo – DIAGNÓSTICO: anamnese, exame físico e exame de imagem (Raio-X); importante diferenciar de outras afecções do calcanhar. TRATAMENTO: Descansar os pés, usar calcanheira de silicone o dia todo (colocá-la embaixo do calcanhar por dentro do sapato), instruir o paciente para usar um sapato com pequeno salto para que o peso do corpo seja distribuído mais para a parte anterior dos pés aliviando mais o calcanhar. Medicamentos (analgésico) podem ser usados para alívio sintomático (Paracetamol, 500 mg).

Referências:

UpToDate: Plantar fasciitis and other causes of heel pain. 2013.
TU P; BYTOMSKI JR. Diagnosis of Heel Pain. American Family Physician. Volume 84, Number 8 October 15, 2011