Calcaneal spurs and plantar heel pad pain

Abstract

Objectives: Calcaneal spurs may cause plantar heel pad pain. Their excision does not, however, abolish this pain. A number of co-morbid factors, such as increase in weight, advancing age, diabetes, elevated uric acid levels, and heel pad compressibility index, have been identified. This study evaluates 123 patients with calcaneal spurs and plantar heel pad pain in association with these factors. Methods: A prospective evaluation of 123 patients with calcaneal spurs in 136 heels and plantar heel pad pain in association with diabetes mellitus, body mass index >27, elevated uric acid and heel pad compressibility index, were matched with a control group of 141 patients (136 heels) without heel pad pain or co-morbid factors. This study was carried out between February 1997 and September 1999 in three hospitals. There were 91 females and 32 males in the study group, while the control group had 86 females and 55 males. Results: All patients in the study cohort presented with calcaneal spurs and plantar heel pad pain. The mean age for the males was 38.1±2.4 and females 43.3±0.8. 78.04% (96 patients) had body mass index (BMI) of over 27, in 48 patients (39.02%) uric acid levels were elevated above two standard deviations from the mean and 59 patients (47.96%) were diabetic, some with more than a single factor. The heel pad compressibility index of 0.54±1.06 in males and 0.62±0.02 in females of the study population was significantly greater than in the control population (males: 0.49±0.4, females: 0.56±1.8). The study and control groups were comparable with respect to age. Conclusion: Calcaneal spurs cause plantar heel pad pain, but the roles of other co-morbid factors are significant. The excision of these spurs does not necessarily abolish pain. It is evident that heel pad compressibility increases with advancing age, weight gain, and diabetes mellitus, and contributes to the pathogenesis of plantar heel pain. This has an impact on the management of these patients, by de-emphasizing the role of surgical excision of these spurs.