Abstract
BackgroundPlantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people.MethodsWeightbearing lateral foot radiographs of 216 people (140 women and 76 men) aged 62 to 94 years (mean age 75.9, SD 6.6) were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored.ResultsOf the 216 participants, 119 (55%) had at least one plantar calcaneal spur and 103 (48%) had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5). Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0), report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8) and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4). No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture.ConclusionCalcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.
Highlights
Plantar calcaneal spurs are common, their pathophysiology is poorly understood
The validity of this hypothesis has been questioned by studies which have shown that: (i) most spurs are located deep to the plantar fascia; (ii) histological analysis of surgically excised plantar fascia does not reveal signs of inflammation [24]; (iii) the bony trabeculae of spurs are not aligned in the direction of soft tissue traction [23]; and (iv) excised spurs can reform after surgical release of the plantar fascia [25]
Achilles tendon spurs were significantly more common in those with plantar calcaneal spurs (OR = 2.0, 95% CI 1.2 to 3.5)
Summary
Plantar calcaneal spurs are common, their pathophysiology is poorly understood. The traditional explanation, which could be termed the longitudinal traction hypothesis, suggests that repetitive traction of the insertion of the plantar fascia into the calcaneus leads to inflammation and reactive ossification of the enthesis [15]. Evidence to support this hypothesis can be derived from studies which have shown that plantar fascial tension increases with lowering of the medial longitudinal arch [16], and that people with heel pain are more likely to be flatfooted [6,17]. The validity of this hypothesis has been questioned by studies which have shown that: (i) most spurs are located deep to the plantar fascia (typically in the flexor digitorum brevis, quadratus plantae and abductor hallucis muscle insertions [18,19,20,21,22], and within fibrocartilage and loose connective tissue [23]); (ii) histological analysis of surgically excised plantar fascia does not reveal signs of inflammation [24]; (iii) the bony trabeculae of spurs are not aligned in the direction of soft tissue traction [23]; and (iv) excised spurs can reform after surgical release of the plantar fascia [25]
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