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Хирургическое лечение пяточной шпоры

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17 августа 2019

Пяточная шпора – это разрастание кости, возникающее при нарушении в костной ткани обмена кальция, что появляется по причине ношения некачественной обуви или несвоевременного лечения заболеваний ног. Идентифицируется методом мануального осмотра и рентгена. Удаление пяточной шпоры хирургическим путем – крайняя мера, что проводится по назначению врача.

Методы удаления

В зависимости от объема, серьезности шпорового образования, назначаются методы лечения:

  • медикаментозные средства;
  • пластыри;
  • ортопедические стельки;
  • массаж;
  • операция;
  • косметологические методики.

Хирургическим путем

Хирургическое лечение пяточной шпоры назначается в тяжелых случаях, когда другие способы бессильны. Удаление шпор на ногах проходит под общей анестезией. В случае аллергии или противопоказаний — вводится местный анестетический препарат.

Существует три вида оперативного вмешательства:

  1. Открытый — травматичный и устаревший способ, используется редко. Разъединяются ткани пятки, открывается доступ к наросту, проводится удаление.
  2. Эндоскопический — делается 2 разреза. Первый для медицинских манипуляций. Второй – для хирургической камеры, через которую проводится наблюдение.
  3. Миниинвазивный. Делается надрез размером 2-3 мм и извлекается костное образование при помощи скальпеля. Ход операции отображается на рентгеновском аппарате.

Операция по удалению пяточной шпоры противопоказана детям и пожилым людям. Детские кости мягкие, способны заживать при консервативных методиках лечения. В пожилом возрасте процесс восстановления проходит с трудом, замедляется регенерация тканей и заживление ран. Результат – атрофические изменения в мышцах стопы, дегенерация суставов, хрящей.

Косметологические методы

Хорошо зарекомендовали себя современные методы лечебной косметологии. Они применяются при небольших образованиях, когда можно избежать оперативного вмешательства. Удаляется нарост следующими способами:

  • ударно-волновая терапия;
  • лазерное воздействие;
  • криодеструкция;
  • рентгенотерапия;
  • магнитотерапия;
  • электрофорез.

Лечение ударно-волновым методом – воздействие ультразвуком на очаг воспаления. Запускает процесс регенерации в костной ткани, размельчает отложения кальция, снимает воспалительный процесс. Нельзя проводить процедуру гипотоникам, беременным, кормящим, при нарушении свертываемости крови, злокачественных образованиях.

Воздействие жидким азотом подходит для пяточных шпор на начальной стадии формирования. Благодаря холодной температуре -198 градусов, предупреждается отечность и воспаление, останавливается рост костной ткани.

Лечение рентгеновскими лучами – эффективный способ убрать костное разрастание, купировать боль. Рекомендуется проводить до 10 сеансов. Воздействие идет в области ноги, поэтому риск нанесения вреда здоровью исключен.

Методика магнитотерапии заключается в силовом воздействие магнитных волн на ткани. Ускоряется метаболизм в поврежденной области, улучшается кровообращение. Курс состоит из 20 процедур. Запрещено использовать при аритмии, недавно перенесенном инфаркте миокарда и инсульте. При наличии аппарата, возможно самостоятельное применение в домашних условиях, после консультации доктора.

Удалить нарост электрофорезом можно за счет доставки лекарственных средств в очаг повреждения при помощи электрических импульсов. Препарат снимает болевые ощущение, воспаление, накапливается в зоне действия. Вводится Гидрокортизон и йодистый калий. Не допускаются к процедуре при онкологии, гипертонической болезни и астме.

В каких случаях необходимо удаление

Пяточная шпора – следствие ношения неудобной обуви, туфель на высоких каблуках, проблем с суставами и нагрузки на ступни. Может возникать сзади и сбоку пятки. Симптомы:

  • резкая острая боль при хождении;
  • болевые ощущения в спокойном состоянии;
  • болезненность при нажатии;
  • изменение походки;
  • выпуклое твердое образование (в развитой форме).

Способствуют формированию шпор – хронический артрит, подагра, атеросклероз, сахарный диабет, ревматизм. Чаще страдают люди с избыточным весом, спортсмены (футболисты, бегуны) и девушки, предпочитающие обувь на каблуках.

Операции по удалению шпор на пятке назначается в следующих случаях:

  • сильные боли;
  • прогрессирующий рост;
  • нарушение привычного образа жизни (невозможность двигаться);
  • неэффективность других лечебных методик.

Уход после удаления и профилактика рецидива

Восстановительный период при хирургическом вмешательстве занимает от 10 до 15 дней. После удаления шпор на ногах открытым способом восстановление займет 1-2 месяца. На этот срок нужно ограничить подвижность прооперированной области.

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Несколько дней может сочиться кровь из раны, необходимо ежедневно менять повязки. В первые две недели после операции хирурги прописывают носить гипс или бандаж. После снятия рекомендуется одевать ортопедическую обувь и стельки. Нужно исключить физические нагрузки, посещать сеансы физиотерапии.

После реабилитации следует заняться укреплением связок и мышц. Подойдет лечебная гимнастика, массажные коврики (аппликатор Кузнецова), массаж. Рекомендуется проконсультироваться с врачом для разработки комплексной терапии.

Для профилактики формирования наростов следует:

  • вовремя лечить заболевания позвоночника;
  • укреплять мышцы стопы;
  • следить за весом;
  • проводить профилактику суставных заболеваний;
  • носить качественную удобную обувь;
  • вести активный образ жизни.

Возможно образование постоперационных рубцов. Предупредить их помогут мази, крема (Контрактубекс, Имофераза, Дерматикс Ультра) и народные средства.

От того, насколько корректно работает опорно-двигательный аппарат, зависит комфортное состояние человека, физические возможности, походка. В медицине есть консервативные методы, позволяющие быстро, безболезненно убирать образовавшуюся шпору. Соблюдая меры профилактики и не запуская болезнь, можно избежать хирургического вмешательства.

Плантарный фасциит или пяточная шпора является одной из причин боли в пятке. Самый высокий риск развития заболевания у пациентов с избыточным весом и нарушениями обмена веществ. Чаще пяточная шпора образуется у женщин.

При нагрузке подошвенный апоневроз надрывается в области прикрепления к надкостнице пяточной кости. Во время сна стопа находится в сокращенном состоянии, поэтому сращение происходит с небольшим укорачиванием апоневроза. Как только утром пациент становится на пол, снова образуются разрывы. Поэтому при плантарном фасциите наблюдается усиление боли по утрам. Повторяющиеся травмы приводят к хроническому воспалению и образованию костного нароста – пяточной шпоре. Пациентам кажется, что удаление пяточной шпоры является единственным способом избавиться от сильной боли в пятке. Но грамотный подолог или ортопед обязательно ознакомит больного не только с хирургическими методами, но и с альтернативными способами лечения.

Хирургические способы лечения пяточной шпоры

Виды операций

Возможно проведение хирургического вмешательства открытым доступом (через разрез) и эндоскопическим способом. В первом случае процесс послеоперационной реабилитации дольше, чем во втором. Но, при эндоскопическом варианте выше риск повреждения нервных окончаний.В процессе операции производится удаление пяточной шпоры с иссечением части апоневроза.

Эффективность оперативного лечения

Полное выздоровление после хирургического вмешательства наблюдается в 70-75% случаев. У остальных пациентов может сохраняться боль в ногах или наблюдаться нежелательные послеоперационные последствия.

Наиболее частые осложнения:

  • рецидив – возвращение боли в пятке после реабилитации;
  • тарзальный туннельный синдром – нарушение чувствительности и движений ноги в результате
  • сдавления ветвей большеберцового нерва;
  • неврома – разрастание поврежденных в ходе операции нервных волокон;
  • инфекционные осложнения – чаще возникают у пациентов с сахарным диабетом;
  • длительное заживление послеоперационной области;
  • осложнения, связанные с наркозом;
  • усиление болевого синдрома.

Несмотря на достаточно высокий процент излечения, к оперативному вмешательству прибегают в 5-10 случаях из 100.

Показания к операции:

  • Отсутствие клинического эффекта от комбинированного лечения, проводимого в течение полугода.
  • Работа, при которой невозможно снизить нагрузку на ноги и обеспечивать регулярный отдых.
  • Сильная и постоянная боль, ограничивающая привычную физическую активность.

Останавливая выбор на операции, принимают во внимание риск использования анестезии и тяжесть сопутствующих заболеваний. Особенно осторожно следует быть пациентам с сердечно-сосудистыми проблемами и сахарным диабетом. К хирургическому лечению не прибегают, если с начала консервативной терапии прошло меньше 6 месяцев.

Консервативное лечение пяточной шпоры

Комплексное консервативное лечение зарекомендовало себя как отличная альтернатива операции. Положительный эффект или полное выздоровление наблюдается у 90% пациентов.

Соблюдение режима труда

Обязательно строго придерживаться режима труда и отдыха, снизить физическую нагрузку, особенно работу стоя. Важно исключить вредные физические факторы – неудобную обувь, бег и ходьбу босиком по твердым поверхностям.

Рекомендуется постоянно носить ортопедическую обувь. Желательно обувать ее сразу же после пробуждения. Это уменьшит количество микроразрывов фасции после ночного отдыха.

Физиотерапевтические методы

Наиболее благотворное влияние на пациентов с пяточной шпорой оказывает ударно-волновая терапия. Акустическое воздействие различной интенсивности действует сразу на несколько звеньев патологического процесса в стопе. Блокируя импульсы, волны уменьшают боль в ногах. Также доказано, что акустические волны снимают воспаление, повышая в тканях уровень противовоспалительных веществ. Волны хорошо проникают сквозь мягкие ткани к костному наросту, постепенно «размягчая» его. Так же такое глубокое физиотерапевтическое воздействие способствует образованию новых сосудов и нормальной хрящевой ткани.

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Реже применяется электрофорез, ультразвуковая и рентгенотерапия.

Медикаментозная терапия

Сильную боль при ходьбе купируют нестероидными противовоспалительными препаратами. Назначают внутрь в виде таблеток и местно (мази, гели, пластыри).

Пациентам с выраженным воспалением иногда применяют стероидные блокады. Кортикостероидный препарат при этом врач-ортопед вводит непосредственно в очаг воспаления. Процедура болезненна, поэтому прибегают к ней в крайних случаях.

Физические упражнения

Самое главное для больных с пяточной шпорой – привести свой вес в норму. Разгрузке сводов стопы так же способствует укрепление мышц ног. Специалистами по лечебной физкультуре разработаны комплексы упражнений, позволяющие предотвратить прогрессирование фасциита. Все они направлены на постепенное растяжение подошвенного апоневроза, что уменьшает вероятность разрывов. Чтобы не допустить рецидив, выполнять упражнения нужно постоянно, а не только в период лечения.

Массаж

Постоянное мышечное напряжение приводит к натяжению подошвенного апоневроза и его разрывам. Курс мануального и аппаратного массажа отлично справится с этой проблемой.

Ортопедические изделия

Всем пациентам необходимо носить индивидуальные (сделанные на заказ) или готовые ортопедические стельки. Их конструкция позволяет перераспределить вес и обеспечить максимальную разгрузку сводов стопы.

Так же применяют ночную иммобилизацию. Для этого подходят брейсы, ночные ортезы и страсбургские носки. Они фиксируют стопу под прямым углом по отношению к голени, максимально удлиняя подошвенный апоневроз. Благодаря этому, сращивающиеся за ночь разрывы не укорачивают фасцию.

Комплексное консервативное лечение в большинстве случаев позволяет не только избежать хирургического вмешательства, но и полностью избавиться от боли при плантарном фасциите.

Хирургическое удаление костного нароста позволяет очень быстро и эффективно решить проблему. Однако, использование инвазивного метода оправдано только при безуспешности консервативной терапии.

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Давно борюсь с пяточной шпорой, народные рецепты и физиотерапия не помогает, не могу найти грамотного врача в Москве. Уже настроилась на ее удаление, только боюсь, что она может образоваться снова. Что посоветуете?

Здравствуйте, Татьяна! Уж где где, а в Москве полно врачей-ортопедов. Советуем вам обратиться к одному из них.

Пяточная шпора – распространенное заболевание. Чаще всего его лечат с помощью физиотерапии, массажа и народных методов. Но в тяжелых, запущенных случаях, ортопед может порекомендовать удаление пяточной шпоры хирургическим путем.

Что такое шпора на пятке и когда назначают операцию

По некоторым данным, от плантарного фасциита страдает до 10% взрослого населения. В зоне риска люди, ведущие активный образ жизни, женщины старше 40 лет, а также пациенты с нарушениями обмена веществ, лишним весом и плоскостопием.

Шпора представляет собой костное разрастание в районе пятки, которое приносит острые болевые ощущения, травмируя окружающие нарост ткани. На рентгеновском снимке хорошо заметна патология, обычно размер шипа составляет от 0,5 до 1 см.

Лечение плантарного фасциита проводится в основном в домашних условиях с помощью народных рецептов и ортопедических приспособлений. Но, если через 5 – 6 месяцев терапия не дала положительного результата, назначается хирургическое лечение костного нароста.

Виды операций, их различия, преимущества и недостатки

Хирургическое удаление пяточной шпоры используется только тогда, когда остальные средства не привели к желаемому результату. Существует несколько видов операционного вмешательства, у каждого из которых есть свои преимущества и недостатки.

Операция по удалению пяточной шпоры достаточно простая, обычно пациенты уезжают из больницы на 2 – 3 день после процедуры. Но, чтобы предупредить рецидивы, необходимо установить причину появления шипа и устранить их.

Если появилась пяточная шпора, операция по ее устранению назначается не сразу, рекомендуется сначала испробовать домашние методы лечения.

Хирургическое вмешательство имеет ряд показаний к применению:

  • Отсутствие эффекта от лечения, проводимого в течение полугода;
  • Невозможность снизить нагрузку на нижние конечности;
  • Продолжительные болезненные ощущения, мешающие нормальной физической активности.

Открытая операция

Традиционная процедура, которая все реже встречается в больницах. Открытую операцию считают устаревшим и травматичным способом лечения, выполняют в учреждениях, где нет современного оборудования. Период реабилитации растягивается на 1,5 – 2 месяца, как минимум 2 недели из которых пациенту придется ходить с гипсом.

Преимуществами этого метода вмешательства являются доступность и простота операции. Оперативное удаление пяточной шпоры открытым способом имеет ряд недостатков:

  • Использование местной анестезии;
  • Продолжительный операционный период, который может растянуться на 2 месяца;
  • Нарушение целостности кожного покрова.
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Эндоскопическое рассечение

Хирургия развивается, а вместе с этим появляются новые способы проведения лечения. Эндоскопическая операция при пяточной шпоре – современный и доступный способ удалить костный нарост. При проведении процедуры выполняются два разреза на коже ступни, глубина которых около 0,5 см. Один нужен для хирургической камеры, при помощи которой врач, а второй – для рассечения подошвенной фасции в месте ее крепления к костному образованию. Рассечение снижает напряжение в пятке, в результате чего проходят боль и воспаление. Через 15 дней после вмешательства разрезы заживают.

Недостатками этого способа вмешательства являются: нарушение кожного покрова, из-за чего высок риск инфекции, повреждение нервных волокон, которое может нарушить чувствительность и подвижность ступни.

Операция с миниинвазивным рассечением под рентгеновским контролем

Современный способ устранения пяточной шпоры, который используется не во всех клиниках. Суть метода состоит в том, что делается всего один надрез глубиной 3 мм, именно через него и проводится рассечение фасции с помощью скальпеля. После этого вводят фрезу для удаления шпоры.

Главным преимуществом такого вида хирургического вмешательства является его минимальное травмирование пятки. Благодаря чему реабилитация длится 2 дня, гипс после манипуляций не носят.

Цена операции по удалению подошвенного фасциита составляет 5 – 10 тысяч рублей на одну ногу. Существенным недостатком является то, что хирург не может увидеть того, что происходит под кожей, из-за чего существует вероятность слишком глубокого или, наоборот, недостаточного рассечения фасции.

Квантовая терапия

Лазерная терапия для лечения пяточных шпор используется с недавнего времени. Ее действие основано на улучшении кровообращения в районе патологии, которое стимулирует клеточный обмен, выводит токсины и ускоряет заживление пораженных участков. Курс разбивается на 2 части. Первый этап длится 10 дней, используется частота – 50 Гц, второй этап проводится только при необходимости, через две недели после окончания первого курса, мощность лазерного облучения составляет 80 Гц.

В среднем, для лечения пяточной шпоры лазером требуется провести 8 – 10 процедур. Стоимость одного сеанса в среднем составляет 900 рублей. Но у этого дорогостоящего вида терапии имеются свои преимущества: безболезненность, быстрый курс лечения, противоотечное, противовоспалительное действие, обезболивание.

Противопоказаниями для этого вида терапии являются: беременность, лактационный период, онкологические заболевания, нарушения свертываемости крови, сердечнососудистые болезни и инфекции.

Противопоказания

Оперативное лечение пяточной шпоры не рекомендуется пожилым людям из-за сложности заживления. Не подходит хирургическое вмешательство и тем, у кого есть противопоказания к применению анестезии, а также при наличии инфекционных заболеваний. Для пациентов с сахарным диабетом рекомендуется проводить операцию с особой осторожностью.

Осложнения

Удаление шпоры на пятке хирургическим способом используется редко, только 5 – 10% больных попадают на операционный стол. Среди этих пациентов у 70 – 75% болезнь отступает после проведения лечения. У остальных же, может сохраниться болевой синдром, а также присутствовать нежелательные последствия. В интернете можно прочитать отзывы об оперативном лечении, и они не всегда являются положительными из-за возможного возникновения осложнений.

Самыми распространенными осложнениями являются:

  • Рецидив – возвращение дискомфорта и болей после операции;
  • Нарушение чувствительности и подвижности ноги;
  • Появление невром – разросшихся нервных волокон, задетых в ходе операции;
  • Деформация свода стопы;
  • Инфицирование открытой раны;
  • Продолжительное заживление после операции;
  • Осложнения, вызванные применением наркоза.

Реабилитация после операции

Операция по удалению пяточной шпоры имеет реабилитационный период, в течение которого желательно не нагружать нижние конечности, лучше дождаться полного заживления ран. Реабилитация может длиться от 2 дней до 2 недель, в зависимости от вида проведенного вмешательства. Через 7 – 10 дней снимаются швы, рекомендуется приобрести индивидуальные ортопедические стельки, которые снизят нагрузку на пятку. Желательно носить их не только в послеоперационный период, но и в повседневной жизни, для предупреждения развития различных патологий, связанных с деформацией стопы.

Удаление пяточной шпоры хирургическим путем помогает решить проблему заболевания. Однако, чтобы уберечься от появления рецидивов, необходимо устранить первоначальные причины разрастания костной ткани, иначе к терапии придется возвращаться много раз. Лучше лечить плантарный фасциит консервативными методами, но если все же пришлось прибегнуть к операции, то выбирайте подходящий для себя способ и обязательно действуйте согласно рекомендациям врача.

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