Why heel spurs are traction spurs after all

Johann Zwirner,Francesca Templer,Aqeeda Singh,Benjamin Ondruschka,Niels Hammer

doi:10.1038/s41598-021-92664-4

Abstract

It is unclear whether plantar and posterior heel spurs are truly pathological findings and whether they are stimulated by traction or compression forces. Previous histological investigations focused on either one of the two spur locations, thereby potentially overlooking common features that refer to a uniform developmental mechanism. In this study, 19 feet from 16 cadavers were X-ray scanned to preselect calcanei with either plantar or posterior spurs. Subsequently, seven plantar and posterior spurs were histologically assessed. Five spur-free Achilles tendon and three plantar fascia entheses served as controls. Plantar spurs were located either intra- or supra-fascial whereas all Achilles spurs were intra-fascial. Both spur types consistently presented a trabecular architecture without a particular pattern, fibrocartilage at the tendinous entheses and the orientation of the spur tips was in line with the course of the attached soft tissues. Spurs of both entities revealed tapered areas close to their bases with bulky tips. Achilles and plantar heel spurs seem to be non-pathological calcaneal exostoses, which are likely results of traction forces. Both spur types revealed commonalities such as their trabecular architecture or the tip direction in relation to the attached soft tissues. Morphologically, heel spurs seem poorly adapted to compressive loads.

Highlights

It is unclear whether plantar and posterior heel spurs are truly pathological findings and whether they are stimulated by traction or compression forces
Trabeculae that are oriented in line with the Achilles tendon and plantar fascia and/or spur growth in the direction of load application of the two soft tissues indicates that the spur results from traction forces
The Achilles tendon inserts into the middle facet of the calcaneal tuberosity that is covered with fibrocartilage (Fig. 3)

Summary

Introduction

It is unclear whether plantar and posterior heel spurs are truly pathological findings and whether they are stimulated by traction or compression forces. Plantar spurs were located either intra- or supra-fascial whereas all Achilles spurs were intra-fascial Both spur types consistently presented a trabecular architecture without a particular pattern, fibrocartilage at the tendinous entheses and the orientation of the spur tips was in line with the course of the attached soft tissues. Achilles and plantar heel spurs seem to be non-pathological calcaneal exostoses, which are likely results of traction forces Both spur types revealed commonalities such as their trabecular architecture or the tip direction in relation to the attached soft tissues. The Achilles tendon and the plantar fascia via the calcaneus in neonates, forming an apophyseal area, which is ossifying throughout life and leaves only the insertions of the soft tissues into the calcaneus[18] This given study investigated and compared the histological characteristics of posterior calcaneal spurs, plantar calcaneal spurs, and spur-free controls.

Results

Discussion

Conclusion