Пяточная шпора — это заболевание ступни, характеризующееся разрастанием костной ткани на кости пятки. Другое название — плантарный фасциит. Со временем происходит травмирование прилегающих тканей, появляется выраженный болевой синдром. Больные часто обращаются за помощью, когда процесс уже далеко зашел и стало больно ходить.
Показания к блокаде при пяточной шпоре
Для лечения данной патологии используются такие способы:
- ортопедический;
- физиотерапевтический;
- медикаментозный.
Назначение инъекций происходит только после неудачной либо безрезультатной терапии консервативными способами. Продолжительное использование антивоспалительных мазей, в составе которых содержатся обезболивающие и антибактериальные средства, может вызвать привыкание. В результате не наступает желаемое улучшение. Также если причиной пяточной шпоры стали заболевания хронического типа, происходящие обострения будут частым признаком усугубления общего самочувствия.
Врожденное патологическое плоскостопие со временем ведет к увеличению нагрузки на пятку, в результате чего возникает шпора. Так как эта болезнь считается неизлечимой, действие местных медпрепаратов бесполезно. Такой же эффект могут вызвать приобретенные заболевания, такие как сахарный диабет и атеросклероз. Плантарный фасциит возникает как результат непроходимости кровеносных сосудов и затрудненного кровотока в районе стопы.
Если возникновение нароста произошло в ходе течения инфекционной болезни, то при медикаментозной терапии появится устойчивость к лечении медпрепаратами.
Пациенты обычно жалуются на резкую, стреляющую боль при опоре на больную ногу. Поэтому ступня при данной патологии во время ходьбы принимает вынужденные положения: опирается или только на носок, или на боковую поверхность.
Невозможность нормально ходить доставляет большой дискомфорт. Тогда принимается решение использовать гормональный препарат для купирования боли.
Суть и преимущества процедуры
При выполнении блокады пяточной шпоры вводится кортикостероид. С помощью иглы через мягкие ткани пятки препарат доставляется к очагу воспаления. Важно правильно выбрать место введения, поэтому процедура выполняется под контролем УЗИ.
Преимуществом данной процедуры служит быстрое начало действия препарата. Болевой синдром снимается практически сразу. Это происходит за счет купирования воспаления.
Блокада быстро обезболивает и снимает воспаление, но не лечит причину, поэтому не используется в самом начале лечения. Костный шип после проведения блокад никуда не исчезнет.
В этом видео вы увидите, как проходит процедура:
Какие уколы делают для блокады пяточной шпоры?
Лечение болевого синдрома при воспалении тканей вокруг пяточной шпоры производится гормональными препаратами. Они относятся к группе кортикостероидов. Эти лекарства обладают мощным противовоспалительным действием. Они представляют собой искусственный заменитель гормонов надпочечников. Используются препараты:
Гидрокортизон редко выбирают для блокады болевого синдрома при пяточной шпоре, потому что он короткого действия. Для достижения лечебного эффекта приходится делать несколько инъекций через короткий промежуток времени.
Кеналог довольно быстро справляется с болевым синдромом, хотя он тоже имеет кратковременное действие. Препарат хорошо снимает воспаление и отечность. После его применения наступает ремиссия. За курс обычно требуется сделать 2-3 блокады.
Дипроспан используется для блокады чаще остальных. Он более длительного действия, чем Кеналог и Гидрокортизон. В составе Дипроспана находятся бетаметазон натрия фосфат и бетаметазон дипропионат. Первый компонент обеспечивает быстрое снятие воспаления и отечности (за счет чего достигается лечебный эффект), и потом быстро выводится из организма. Второй компонент задерживается в месте введения дольше, чем обеспечивает непрерывное воздействие на воспаленную фасцию. За счет такого двойного действия достигается длительный период ремиссии (до полугода). Чаще хватает одного укола для избавления от боли, но при обширном воспалении может потребоваться еще пара процедур.
Как делать инъекции при пяточной шпоре?
От того, насколько точно будет введен кортикостероид, будет зависеть лечебный эффект. Процедуру должен проводить грамотный хирург или ортопед. Требуется правильно выбрать место инъекции, глубину, на которую вводить иглу, дозу лекарства. При ошибках в технике выполнения могут возникнуть осложнения, о чем пациент должен быть предупрежден.
Пятку обрабатывают антисептическим раствором. Укол иглой выполняют под контролем УЗИ в самое болезненное место.
Пациент во время процедуры испытывает сильную боль. Чтобы облегчить это состояние, к раствору гормона добавляется 1% лидокаин. Сначала набирается кортикостероид, потом анестетик, перемешиваются встряхиванием.
Толстая кожа в месте введения и особенности строения пятки делают выполнение процедуры медленным. Опыт хирурга важен в этом вопросе: чем врач опытнее, тем быстрее он проведет инъекцию, соответственно — меньше мучений пациенту.
Обычно для достижения терапевтического эффекта хватает 2-3 блокад. В одну ногу они делаются с интервалом 60-90 дней, в разные можно через 2-3 недели.
Возможные осложнения
Большие дозы кортикостероидов и длительное использование блокад для купирования болей при пяточной шпоре могут пагубно сказаться на общем состоянии организма.
При использовании Кеналога возможны следующие побочные эффекты:
- инфицирование и абсцесс в месте введения;
- разрыв плантарной фасции (самое тяжелое из последствий);
- остеопороз в месте введения;
- отмирание тканей в месте использования.
Несмотря на то, что Кеналог используется местно, он оказывает негативное влияние на организм в целом. Стероиды подавляют действие гипофиза, из-за этого начинаются сбои в менструальном цикле. От переизбытка гормонов надпочечников появляется большой риск ожирения, развития гипертонии и повышения глюкозы крови. Если одновременно со стероидами принимать НПВС, то возникает большой риск желудочно-кишечных кровотечений.
У хорошего терапевтического эффекта от Дипроспана есть и обратная сторона. За счет его свойства накапливаться негативные эффекты будут более выражены. Даже при соблюдении дозировки и периодичности введения обменные функции организма страдают.
Нарушаются функции таких желез, как гипоталамус, надпочечники, гипофиз. Это приводит к сбоям во всех системах организма:
- снижение выработки половых гормонов со временем приводит к остеопорозу;
- увеличение гормонов надпочечников приводит к ожирению и развитию артериальной гипертензии;
- развивается скрытый сахарный диабет;
- падает иммунитет;
- увеличивается риск развития депрессии.
Самое грозное осложнение — разрыв подошвенной фасции. Оно приводит к инвалидности и невозможности наступать на больную ногу. Риск возникновения такого серьезного осложнения ставит блокаду на последнее место в выборе метода лечения пяточной шпоры.
Прежде чем воспользоваться гормональным способом лечения боли при пяточной шпоре, следует испробовать все другие способы.
Противопоказания к блокаде
Как любому медикаменту, к лечению кортикостероидами существует ряд противопоказаний:
- беременность и период кормления грудью;
- аллергия на компоненты препарата;
- туберкулез;
- псориаз и воспаления в месте введения;
- психиатрические заболевания;
- остеопороз;
- сахарный диабет;
- некоторые болезни сердечно-сосудистой системы.
Если было принято решение использовать этот метод лечения, то нужно обратиться к опытному хирургу. Полностью вылечить блокадами пяточную шпору не удастся, это больше метод обезболивания. Но период ремиссии может продолжаться довольно длительное время, и заранее его длительность предсказать не удастся, все индивидуально. Если делать специальную гимнастику, носить ортопедические стельки, продолжать лечение другими методами — можно добиться хороших результатов.
Пяточная шпора – заболевание, от которого не застрахован никто. Это образование нароста в пяточной зоне в виде шипа, который постоянно травмирует ткани, разрывая их. Таким образом, пострадавший испытывает сильные боли, особенно после состояния покоя. В медицине этот недуг носит название плантарный фасциит, и нужно помнить, что без соответствующего лечения избавиться от него нельзя.
Врачи обычно назначают консервативные методы лечения, однако если они не приносят желаемых результатов, делается укол в пятку при пяточной шпоре. Этот метод имеет много сторонников и противников, рассмотрим все за и против.
При каких условиях можно получить назначение на процедуру
Введение в зону поражения (пятку) инъекции назначается только после того, когда другие альтернативные способы оказались бездейственными.
Лечение уколом пяточной шпоры уколом в пятку – это кардинальный шаг. Больные, которых поразил этот недуг, испытывают нестерпимую боль при ходьбе. Им уже не помогают выписанные ранее противовоспалительные мази, таблетки и физпроцедуры. Несмотря на это, не стоит забывать об ортопедических изделиях: стельках, подпяточниках. Они нужны и после проведенной терапии лечения уколом в пятку – блокаде.
Только после того, когда другие альтернативные способы оказались бездейственными, назначается инъекция в зону поражения
Процедура показана в первую очередь таким категориям пациентов:
- людям, у которых данный недуг – результат естественного возрастного изменения;
- страдающим врожденным плоскостопием;
- не обойтись без нее и тем, кто долго получал консервативную терапию и хочет быстрого противовоспалительного и обезболивающего эффекта, так как до этого ничего не помогало.
Чтобы была проведена блокада при пяточной шпоре, нужны два момента: согласие пациента и привлечение к манипуляции опытного ортопеда-хирурга.
Список пациентов, кому противопоказано введение кортикостероидов
Лечение плантарной фасции имеет внушительный список противопоказаний. Это связано с препаратами, которые вводятся – стероидами. Гормон может оказать влияние не только на желаемый участок, но и на организм в целом.
В группу риска входят следующие пациенты:
- женщины в период беременности на любом сроке;
- кормящие матери;
- лица, страдающие сахарным диабетом, заболеваниями сердца, нервной и сосудистой систем.
Женщинам, которые находятся в возрасте деторождения, обязательно нужно сдать перечень анализов на гормоны, и только после разрешения гинеколога возможен укол в пятку при пяточной шпоре.
Популярные препараты
Несмотря на то, что манипуляция проводится достаточно недолгое время современными медиками, есть препараты для лечения пяточной шпоры, которые используются активно специалистами. Чаще всего это кортикостероиды – гормоны, вырабатываемые надпочечниками.
- Дипроспан при пяточной шпоре. В случае введения этого вещества на основе бетаметазона можно говорить о быстром обезболивающем эффекте. Дополнительно он имеет противоаллергическое воздействие. Пациентами отмечается длительность действия около десяти суток, в целом достаточно двух уколов, чтобы нароста не стало. Дипроспан, наряду с положительными качествами, имеет много отрицательных моментов, о них обязательно нужно спросить у врача.
- Введение Гидрокортизона. В составе элементы, аналогичные гормонам, вырабатываемым надпочечниками. Чтобы костное образование было удалено, потребуется не менее 3-5 инъекций. По отзывам, укол в пятку при пяточной шпоре Гидрокортизоном менее эффективен по сравнению с Дипроспаном, но стоимость этого лекарства на порядок ниже.
- Кеналог является синтетическим аналогом гормона надпочечников. Его введение возможно только после тщательного обследования больного, включая оценку возраста, предрасположенности к аллергиям, пола, веса и прочего.
Уколы при пяточной шпоре – обезболивающие и противовоспалительные, применяются в случае острой боли, когда после других методов лечения (втирание крема, разнообразные гели) не был получен желаемый результат.
В случае острой боли применяются уколы при пяточной шпоре
Как правильно ввести инъекцию
Если вы решились на такой шаг, в первую очередь вам нужно найти опытного специалиста, который выполнял подобную процедуру не один раз, имеет ряд положительных отзывов от реальных людей.
Сложность заключена в сложности самого введения укола в пятку при шпоре.
Нужно точно рассчитать место, куда колоть гормональный препарат. От мастерства хирурга или ортопеда зависит то, как быстро будет вводиться лекарство, на какую глубину должна войти игла.
Хирурги предпочитают проводить процедуру с помощью УЗИ-аппарата. С ним можно наверняка увидеть место, где расположена пяточная шпора.
Самостоятельно вы не сможете выполнить действия по нескольким причинам:
- невозможно принять правильное положение и при этом точно попасть в область пяточной шпоры. Пальпация проводится только расслабленной стопы, а укол нужно ставить в прямом положении ноги, чтобы пятка была на весу;
- укол при пяточной шпоре проводится в условиях максимальной стерильности. Сделать это можно только в условиях больницы – в процедурном кабинете;
- колоть гормональный препарат может только квалифицированный специалист. Если вы не компетентны в этом вопросе, не рискуйте своим здоровьем.
Как видите, на результат в корне влияет опыт врача и ваше общее состояние здоровья.
Каких последствий следует опасаться
Как было сказано выше, блокада – довольно серьезная и опасная процедура. Она имеет ряд осложнений, и ваш врач обязательно должен предупредить о последствиях.
- Используются гормональные лекарства. Значит, предполагаются соответствующие реакции организма и аллергии.
- Не исключается попадание инфекции с иглой (при несоблюдении правил стерильности). В этом случае вам грозит нагноение, в некоторых случаях даже отмирание тканей.
- Может разорваться подошвенная фасция. Как результат – инвалидность, потеря возможности нормально передвигаться.
Если вы заметили, что после укола вам стало больнее наступать, или наоборот появилось онемение, покраснение, странный черный оттенок, гнойные выделения, воспаление тканей, немедленно обращайтесь к врачу.
Как сохранить лечебный эффект после блокады
Чтобы блокада была эффективной, от больного требуется выполнить ряд простых рекомендаций:
- перейти в щадящий режим относительно ступни. Обязательным приобретением должна стать пара подпяточников. Они ускорят процесс выздоровления, лекарство будет дольше действовать;
- постоянно делать массаж пораженного места, запомнить упражнения против шпоры;
- делать профилактику с кремами и гелями направленного действия;
- использовать специальные ортезы, чтобы зафиксировать больное место.
Такие простые действия помогут вам продлить эффект после укола.
Отзывы
Для многих людей укол в пятку при шпоре стал спасением, по отзывам можно оценить, насколько эффективен данный метод терапии.
После сорока лет начала замечать боль в ноге после отдыха. Иногда не могла возобновить движение в течение продолжительного времени. Пробовала лечиться самостоятельно, ничего не помогло. Запустила болезнь до той степени, что только блокада могла меня спасти. После введения препарата сразу почувствовала облегчение, хотя колоть было больно. После нужна была еще одна инъекция. Я делаю гимнастику и использую крем, о шпоре не вспоминаю больше года.
Начала лечить шпору при первых проявлениях. Испробовала все кремы и гели, предложенные в аптеке. Уже ничего не помогало, и блокада была единственной надеждой. Я прошла все анализы, меня осмотрел хирург, сделали УЗИ. Только после этого назначили день процедуры.
Я боялась боли и осложнения от лечебных уколов. Долго выбирается место, куда будет вводиться игла. Мне нужно было пройти четыре процедуры для полного выздоровления. Я справилась. Могу сказать, что это того стоило – о боли не вспоминаю.
Заключение
Инъекции при пяточной шпоре показаны далеко не всем пациентам, нужно пройти определенную подготовку, чтобы получить разрешение на блокаду. Перед тем, как решиться на это, важно проконсультироваться со специалистом, узнать обо всех последствиях и рисках и только после этого принимать решение.
Прописывают укол в пятку при пяточной шпоре довольно часто. С помощью инъекций удается добиться купирования болевого синдрома и воспалительного процесса, снятия отечности. Чаще всего для этих целей прибегают к помощи стероидных медпрепаратов. Уколы, в отличие от лекарств в таблетированной форме, обладают быстрым эффектом. Существует ряд противопоказаний, которые важно учитывать перед началом терапии.
Когда инъекции делают при пяточной шпоре?
Укол от пяточной шпоры назначают пациентам в следующих ситуациях:
- неэффективность прочих методов терапии,
- мощный болевой синдром, ухудшающий качество жизни,
- наличие противопоказаний к другим способам лечения.
Когда не назначают процедуру?
К помощи уколов при пяточной шпоре не прибегают, когда у пациента наблюдается гиперчувствительность к компонентам, которые входят в состав медпрепаратов. Кроме этого, с осторожностью прописывают инъекционное введение, если у человека диагностированы следующие состояния:
- туберкулез,
- остеопороз,
- инфицирование клапанов сердца стрептококками,
- диабет,
- чрезмерная масса тела.
Какие медикаменты используют?
«Дипроспан»
Лекарство относится к группе глюкокортикостероидов. В его составе находится активный компонент — бетаметазон. Лечение пяточной шпоры осуществляется при помощи раствора для инъекций или суспензии, в составе которой находятся дополнительные компоненты. Эффект от введения лекарства наблюдается на протяжении 10 суток. Пациенты отмечают уменьшение болевых ощущений или полное их исчезновение. Продолжительность и эффективности терапии напрямую связана с правильным введением фармпрепарата. Некоторым больным достаточно однократного приема, однако в исключительных ситуациях требуется сделать 3 укола.
«Гидрокортизон»
Этот фармпрепарат представляет собой гормон коры надпочечников. Чтобы достичь максимального эффекта, пациенту прописывают 2 или 3 укола, которые делают через небольшие промежутки. Такой механизм проведения позволяет накопить в очаге воспалительного процесса активный компонент. «Гидрокортизон» может вызывать ряд побочных эффектов, при возникновении которых важно обратиться в медицинское учреждение.
«Кеналог» от пяточной шпоры
С помощью этого медикамента удается добиться быстрого эффекта. Люди отмечают купирование болевого синдрома на продолжительное время. Невзирая на свою результативность, описываемое лекарство может спровоцировать возникновение серьезных последствий для организма. Не исключено отмирание мышечной ткани и атрофия определенных областей кожного покрова.
Использование блокады
Эффективное фармсредство
Наиболее результативным лекарством для проведения манипуляции является глюкокортикостероид, который имеет название «Дипроспан». Инъекция этим медпрепаратом дает возможность быстро купировать болевой синдром и воспалительный процесс. Помимо этого, лекарство обладает противошоковым и десенсибилизирующим свойством. Уколы проводят в тех ситуациях, когда лекарства в форме таблеток не приносят требуемого терапевтического эффекта. В процессе выполнения блокады пациенты жалуются на мощные болевые ощущения, которые более интенсивны, нежели боль, вызываемая пяточной шпорой. Именно поэтому перед проведением манипуляций человеку важно настроиться, поскольку не каждый может вытерпеть процедуру.
Чтобы в процессе лечения снизить неприятные ощущения, прибегают к помощи «Лидокаина», которым предварительно обрабатывают пораженную область пятки.
Другие медпрепараты
Меньшей популярностью среди пациентов пользуются уколы в пятку при шпоре с использованием «Гидрокортизона». Это обусловлено тем, что преимущественно требуется не один укол. Именно это в значительной мере и пугает больных. «Кеналог» используют еще реже. Медикамент обладает массой побочных эффектов и может привести к серьезным осложнениям. К примеру, нередко у пациентов наблюдается усиленное появление язвенных дефектов желудочно-кишечного тракта. Может случиться аритмия или подняться артериальное давление. Помимо этого, иногда «Кеналог» приводит к параноидальным синдромам, развитию судорог и дрожи в конечностях. Именно поэтому инъекционное введение триамцинолона назначается исключительно в тех ситуациях, когда другие медпрепараты оказались неэффективными.
Техника выполнения
Блокада пяточной шпоры должна осуществляться исключительно опытным медиком, что позволит не допустить развития последствий и приведет к быстрому наступлению требуемого терапевтического эффекта. В первую очередь доктор выбирает лекарство. От этого зависит продолжительность и результативность терапии. Затем определяют дозировку. Преимущественно пациенту прописывают 0,5 мл лекарства для укола и такой же объем анестетика для местной обработки кожного покрова. После этого врач приступает непосредственно к инъекции. Техника выполнения:
- Обезболивание.
- Определение места укола. Доктор ощупывает пятку и определяет область, где локализуется болевой синдром.
- Выполнение инъекции. Иглу вводят медленно и аккуратно, чтобы ее не сломать.
Благодаря такому способу введения медпрепарат доставляется непосредственно в пораженную зону и сразу начинает действовать, обезболивая и снимая воспалительный процесс. После проведения нескольких уколов наступает период ремиссии, боли не беспокоят пациента около полугода. Человек может отказаться от употребления лекарств для снятия болевых ощущений в таблетированной форме. Однако невзирая на достаточное количество преимуществ, существуют у уколов и недостатки, которые выражаются в виде большой вероятности возникновения аллергических реакций и сильных болей при проведении укола.
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