Calcaneal Spur Symptoms, Plantar Calcaneal Spur Treatment

The Role Of Calcarea Fluorica In Calcaneal Spur: A Case Study

ABSTRACT
The calcaneal spurs are the most common cause of pain in heel. Despite its high prevalence, the optimal treatment remains unclear. Homoeopathy with it’s holistic approach provides a better response in such condition by relieving patient symptomatically as well as by dissolving spur formed. One such case report is presented below. Patient attended Medicine OPD chiefly for complaints of pain in heel after detailed case taking and repertorisation, he was prescribed Calcarea fluorica medicine in 200 potency. Patient started to show improvement in form of reduction in pain in beginning followed by symptomatic relief for a long time.
KEY WORDS: Calcaneal spur, Calcarea fluorica, Homoeopathy, Case study

INTRODUCTION:
Heel pain is one of the most common disorders of foot that causes patients to seek medical care. A variety of soft tissue, osseous and systemic disorders can cause heel pain, of which calcaneal spur (CS) is the most common cause. CS formation occurs under the surface of the Calcaneus. It can also occur on the back of the heel at the insertion of the tendo-achilles. It commonly affects females than males1. Incidence of calcaneal spur in Indian population is about 59% and the most common age group affected was found to be 40-50 years. Pain in heel not only restricts movement, produces discomfort on walking or standing, affecting the daily activities but also disturbs the whole persona of a person. Management of calcaneal spur by conventional medical system includes, non-medical interventions like use of night splints, padding of foot, physiotherapy etc., and use of non-steroidal anti-inflammatory drugs, cortisone injections, botulinum toxins, endoscopic plantar fasciotomy, in step fasciotomy, minimal invasive surgical procedures extra corporeal shock wave therapy, bipolar radio frequency for micro tenotomy, etc.., which has got many side effects3. Homoeopathic medicine helps in relieving heel pain due to CS. Calcarea fluorica is one of the important remedy in treatment of CS and principally it is used for dispersing bony growth4.

CLINICAL PRESENTATION AND DIAGNOSIS:
Clinically it is presented as pain in heel, burning of sole, pricking sensation, pain appears when patient stands on the foot for walking and disappears when patient walks for some distance. It is diagnosed based on X ray finding of formation of spur in calcaneus bone1.

HOMOEOPATHIC APPROACH TO CALCANEAL SPUR:
Homoeopathic with its holistic approach is effective in treatment of Calcaneal spur, as it covers nature of the patient and underlying miasm which is responsible for formation of spur and its maintainance. There are even various other specific medicines to dissolve the spur formed like calcarea fluoricum4 and there are medicines to give symptomatic relief to patient like Rhus toxicodendron, Aranea diadema, Aurum met, Ruta, etc.1 In this case report effectiveness of calcarea fluoricum in treatment of calcaneal spur is discussed.

CASE REPORT:
A 59 year old female was brought by his son for the complaints of pain in the right heel associated with difficulty in walking since 1year and increased since 10 days. Pricking type of pain associated with difficulty while walking. Pain which is worsen at initial steps while walking and relived by continuous walking. Patient also complaints of generalised weakness. Based on x ray finding, it is diagnosed to be calcaneal spur.
She is a known case of hypertension and diabetes mellitus and on regular allopathic medication for the same.
PAST HISTORY: Apparently healthy. For the presenting complaints initially she was on allopathic medication presently they were advised surgery but they were not willing to do it and came for homoeopathic treatment. She is on allopathic medication for hypertension and diabetes mellitus.
FAMILY HISTORY: she does not remember about health status of her parents, her 2 elder sisters are diabetic. Her son and daughter are healthy.
GENERALS: Moderately built and nourished. She is having good appetite and thirst, no specific desires and aversions, bowel and bladder habit is regular, sleep is good, perspiration is profuse and offensive and thermally hot patient.
As a person she is introvert, does not express her feelings, she does all her work herself, does not want to depend on others, maintains good relation with all in family.
ANALYSIS OF THE CASE
After analyzing the case as mental and physicals were not characteristic, she was prescribed based on symptomatology and by referring to materia medica. Miasmatic evaluation for presenting symptom was done. Case showed the predominance of sycotic miasm. Considering symptomatology and underlying miasm she was prescribed Calcarea flourica 200, TID 1week, followed by PL 1week (21/2/2018).
Patient showed improvement in subsequent follow up. The details of the follow up are given below

DATE WITH FOLLOW UP & PRESCRIPTION
3/3/18
Pain reduced while walking
Pricking sensation same
Pain worsen on pressure same
Generalised weakness present.
Generals are good
Rx Calcarea Fluorica 200, TID for 1 weeks
Followed by PL TID 1 week

18/3/2018
Pain reduced.
Pricking sensation reduced.
Generalised weakness reduced.
Generals are good
Rx Calcarea Fluor 200 1dose
PL TID For 2 weeks

1/4/2018
Pain while walking reduced
Pricking sensation while walking decreased.
Generals good.
Rx Calcarea fluorica 6X TID
PL TID for 2 weeks

15/4/2018
Rarely she gets pain while walking
Occasionally gets pricking sensation
Generals are good
Rx PL TID For 2 weeks

1/5/2018
Pain in heel better
No pricking sensation
Generals are good
Rx PL TID For 2 weeks

30/5/2018
Pain in heel better
No pricking sensation
Generals are good
Rx PL TID For 2 weeks

Conclusion
The incidence of calcaneal spur has been increasing globally over years. Homoeopathy as a medical system contributed remedies for relief and preventing further complication of calcaneal spur without any side effects of medicine. Homoeopathy treats the person as a whole. calcaneal spur is a surgical condition, it require surgery but in some cases due to underlining strong miasm, when treated with homoeopathic medicine which helps in recovery. Calcarea fluorica helps dissolve the bony spur as mentioned in clarke’s material medica. There is need to conduct research to assess the efficacy of Calcarea flour and the extent to which it can resolve bony spur.

List of References
1. Suraia Paveen. A retrospective study of homoeopathic treatment in patients with heel pain with or without Calcaneal Spur. Indian Journal of Research in Homoeopathy. 2017; 11: 64-73. [Cited 2018 Feb 8]. DOI: 10.4103/0974-7168.200844.
available from: http://www.ijrh.org/temp/IndianJResHomoeopathy11164-9423814_023703.pdf
2. Kevin Lourdes R, Ganesan G Ram. Incidence of calcaneal spurs in Indian population with heel pain. Int J Res Orthop. 2016 Sep; 2 (3): 174-176. [Cited on 2018 Feb 12]. Available from: www.ijoro.org/index.php/ijoro/article/download/90/56
3. Konick De Caro, Calcaneal spur. Pysiopedia [cited 2018 March 1]. Available from https://www.physio-pedia.com>.
4. Clarke J H. A Dictionary of Practical Materia Medica. Volume 1. B Jain Publishers (Pvt) Ltd. New Delhi; 2006.

DR Deepak R Naik
Author: DR Deepak R Naik

PG SCHOLAR MD Part II Department of Practice of Medicine Government Homoeopathic Medical College and Hospital Bengaluru

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