Plantar Calcaneal Spur Research Articles

Calcaneal and dorsal spur morphological and morphometric measurements; 'A radiological study'

Aim: The foot is one of the most neglected parts of our body. One of the causes of foot pain is the plantar calcaneal spur (PCS), which is the bone protrusion formed under the calcaneal bone, and the dorsal spur (DS), which is seen dorsal to the calcaneus. Our study aimed to examine PCS and DS morphologically. Materials and Methods: 235 patients with PCS were included in this retrospective study. Plantar calcaneal spur length (PCSL), plantar calcaneal spur thickness (PCST), Fowler-Philip angle (FPA), and plantar calcaneal fat tissue thickness (PCFT) with radiology in patients with the calcaneal spur, and also to classify plantar calcaneal spur (PCS) and dorsal spur (DS). Results: Bilateral PCS was found in 57.4% of the patients. DS was found in 43.5% of the patients with right PCS and 40.3% of the patients with left PCS. Large DS types were found at a higher level in males than females. Right PCFT was found to be significantly higher in patients with PCS compared to the control group (p=0.034). Conclusion: It was concluded that the majority of PCS patients had bilateral PCS, DS could be seen and there was a strong correlation between PCSL and PCST.

Plantar calcaneal spurs and their connection with lumbar herniating discs

Introduction: Calcaneal spurs are bony triangular projections of varying sizes that are found on the calcaneum. By analyzing the incidence of plantar spurs and lumbar herniated disks, the current research aims to provide a reliable baseline for determining the pathological significance of spurs with herniated disks. Methods: Consecutive patients who had visited a local physiotherapy clinic for plantar calcaneal spurs between October 2022 and February 2023 with no self-reported comorbidities such as diabetes or vascular diseases were qualified for the study. Of the eligible subjects, a total of 84 patients were randomly selected from the clinic’s database. All 84 patients were subjected to weight-bearing lateral foot radiographs and magnetic resonance imaging scans. A Visual Analog Scale (VAS) was used to measure heel pain. Associations between the presence of spurs, herniated disks, sex, body mass index (BMI), and heel pain were then explored. Results: Of the 84 patients, 40 were males (48%) and 44 females (52%), with a mean age of 64.2 ± 5.6 years. The mean BMI was 28.5 ± 5.2 kg/m2. From the analysis of the imaging examination results, of the 84 patients with calcaneal spurs, 40 (48%) had lumbar disk herniation at L5-S1, 38 (45%) at L4-L5, 1 (1%) high lumbar herniations, and 5 (6%) no hernia. Women accounted for 45% of L5-S1 herniations and 41% of L4-L5 herniations. Pearson correlation between the variables speaks for a positive weak (r = 0.33) and significant relationship between VAS and weight and between VAS and BMI (r = 0.436, p < 0.001). Conclusion: Given the high percentage of patients suffering concomitantly from plantar calcaneal spurs and discal hernias (94%), we assume that there might be a probable link between the two disorders.

Occurrence of calcaneal spurs on skeletal remains of historical populations in the context of footwear development.

This communication is focused on monitoring the occurrence of plantar and dorsal exostoses (spurs) on the calcanei of skeletons from various dated historical periods. A total of 361 calcanei from 268 individuals were evaluated (prehistoric sites - Podivín, Modřice, Mikulovice; mediaeval sites - Olomouc-Nemilany, Trutmanice; modern age sites - the former Municipal Cemetery in Brno in Malá Nová Street, collections of the Department of Anatomy, Masaryk University, Brno). Differences in period footwear for individual population samples were taken into account when interpreting the findings. Health defects were sought for individual types of historical footwear, which could have a causal connection with the occurrence of exostoses on the calcanei. Plantar calcaneal spur occurred most frequently in the mediaeval population (23.5 %; N = 51), less frequently in prehistory (14.1 %; N = 85) and least in modern times (9.8%; N = 132). Similar results were observed for dorsal calcaneal spur in the attachment of the Achilles tendon, but with higher values. In the Middle Ages, its incidence was highest (47.0 %; N = 51), followed by prehistoric times (32.9 %; N = 85), with the least found from the modern age (19.9 %; N = 132). However, the results obtained correspond only to a certain extent to the defects in footwear in the relevant historical period.

Does the slope and length of the plantar calcaneal spur affect the clinic?

Since some of the patients with plantar calcaneal spur (PCS) do not have pain, we aimed to investigate the effect of the slope and length of the spur on this situation. The length and slope of PCS were measured by examining the radiological images of 50 patients in this prospective study. VAS, AOFAS and FFI scores of the patients were determined. Patients were divided into groups according to PCS length and slope. According to the slope of the spur, the mean AOFAS, FFI and VAS scores were, respectively; 94, 38, 1.3 in below 20 degrees; 80.1, 86.8, 4.8 in 20-30 degrees; and 70.1, 106, 6.7 in above 30 degrees. According to the length of the spur, the mean AOFAS, FFI and VAS scores were respectively; 84.9, 68.2, 3.7 in those with length 0-5 mm; 81.1, 81.7, 4.5 in those with a length of 5-10 mm; and 71.7, 102.5, 6.4 in those with a length of >10 mm. A significant correlation was found between the angle and length of the PCS with the values of VAS, AOFAS and FFI (p<0.05). We observed that PCSs with a slope of less than 30 degrees and shorter than 10 mm do not create a serious clinical picture. If there is severe pain and functional impairment in individuals with this characteristic spur, investigation of other possible causes of heel pain must be considered.

Radiological Evaluation of the Relationship Between Plantar Fasciitis and Foot Arch Angles in Adults

Objective: The foot arch deformation increases plantar fasciitis (PF) and plantar calcaneal spur (PCS) for-mation. As a result, the heel fat pad becomes thinner. This study investigated the relationship between plantar fasciitis and foot arch angles. Methods: We performed a retrospective review of patients who had PF patients (n = 53) and healthy individu-als (n = 71) without PF. We have evaluated the presence of PCS and heel fat pad thickness measurements on magnetic resonance imaging (MRI), and the lateral talus-first metatarsal angle (Meary’s angle), lateral talocal-caneal angle, and calcaneal inclination angle measurements were performed on X-ray images. Results: The mean age of the PF group was significantly higher than the control group (p = 0.001). The degrees of Meary’s angle and calcaneus inclination angle were significantly higher in the PF group (p &amp;lt; 0.001 and p = 0.026, respectively) than in the control group. The incidence of PCS was significantly higher in the PF group (p = 0.028). In the binary logistic regression analysis model, high Meary’s angle and calcaneal pitch angle were found to be associated with the risk of PF. There was also a significant association between age and the pres-ence of PCS and PF. Conclusion: Changes in Meary’s angle and calcaneal pitch angle were significant risk factors for PF.

Effectiveness of extracorporeal shock wave therapy according to plantar calcaneal spur types

Objective: The aim of this study is to group patients with plantar heel pain and calcaneal spurs detected via lateral foot x-rays based on the angle between the spur and the calcaneus and compare the efficacy of an Extracorporeal shock wave therapy (ESWT) treatment between these groups. Materials and Methods: The patients were divided into three groups based on the measurement the angle between the plantar calcaneal spur and the calcaneus. Those with a measured angle of &lt;30° were classified as Group 1, ranging between 30–60° as Group 2, and &gt;60° as Group 3. Demographic characteristics, spur length, visual analog scale (VAS) and foot function index score (FFI), and pain and function evaluation were used as the pre-and posttreatment data in each group. Results: Out of the 170 patients, 96 (56.5%) were included in Group 1, 65 (38.2%) were in Group 2, and 9 (5.3%) in Group 3. The posttreatment VAS and FFI scores of the patients were significantly lower than the pretreatment scores (p &lt; 0,001). It was determined that the highest and lowest VAS and FFI score changes in the posttreatment period was in Group 3 and Group 1, respectively. In the correlation analysis, a positive correlation was found between the measured angle value and pretreatment VAS and FFI scores, age, and spur length. Conclusion: ESWT is an effective treatment method for calcaneal spurs, but further studies are needed on PCS classifications and the efficacy of the treatment selected based on these classifications.

Anatomical features of plantar fasciitis in various age cohorts: Based on magnetic resonance imaging.

Due to the lack of further studies on the influence of age factors on plantar fasciitis, this study evaluates the characteristic observation points of magnetic resonance imaging in various age cohorts of patients with plantar fasciitis to help diagnosis. A retrospective analysis of 160 cases of plantar fasciitis patients and normal subjects (who have the disease unrelated to plantar fasciitis) who have undergone an MRI examination in our institution. The two groups were separately divided into young adult subjects (36 to 44years old), middle age adult subjects (45 to 59years old), and older adult subjects (60 to 79years old). Data was gathered regarding plantar fascia thickness, the coronal length of the plantar fascia at the calcaneal origin, the signal intensity of plantar fascia and surrounding structures, and the presence or absence of plantar calcaneal spurs, all of which were assessed objectively by the investigators. There were statistical differences in the thickness of plantar fascia between two groups of three age cohorts (Older adult patients: 0.59 ± 0.09cm; Middle age adult patients: 0.49 ± 0.09cm; Young adult patients: 0.47 ± 0.05cm) (all p < 0.001). In addition, there were also statistical differences in the high signal intensity changes of the plantar fascia and surrounding soft tissues between two groups of three age cohorts (all p < 0.001). In older adult plantar fasciitis patients, with regard to plantar calcaneal spur discovery, there was a statistical difference between the two groups (Chi-square = 12.799. df = 1. p < 0.001). In plantar fasciitis cases where a diagnosis is difficult, abnormalities in the soft tissue surrounding the plantar fascia in patients of low age are noteworthy. In older adult patients, the discovery of plantar calcaneal spurs with abnormal thickening of plantar fascia deserves attention, and abnormal MRI findings are more manifest. But the final diagnosis should be based on the medical history. Level 3.

Do the presence, size, and shape of plantar calcaneal spurs have any significance in terms of pain and treatment outcomes in patients with plantar fasciitis?

: The purpose of this study was to determine the effect of the presence, size, or type of calcaneal spurs on pain or the outcomes of extracorporeal shock wave therapy (ESWT) therapy in patients with plantar fasciitis. Seventy-four patients with unilateral plantar fasciitis who had no pain in the contralateral foot, either currently or in the past, were included in the study. The length, base width, type, and presence of plantar calcaneal spurs in both heels of the patients were determined using radiography. A total of five sessions of ESWT (3 bar, 2000 shocks/session, 12 Hz frequency) with an interval of 3 days were performed on the painful sides of the patients. Symptom duration and numerical rating scale (NRS) scores were recorded pretreatment and 1 week and 12 weeks after treatment. : Spurs were detected in 85.1% of painful feet and 71.6% of painless feet, this difference was statistically significant (p = 0.046). There was no significant correlation between the type of the spurs and whether the foot was painful. Patients with spur sizes of >5 mm or with horizontal and hooked spurs had a higher NRS decrease than patients with spur sizes of ≤5 mm or with a vertical spur. Symptom duration, spur length, and base width were found to be correlated with pretreatment NRS scores. The presence and size of calcaneal spurs are associated with pain. However, it should be kept in mind that a high rate of spurs can also be found in painless feet, so spur is not the only factor that causes pain. Patients with a spur size of ≤5 mm or a vertical spur have less pain relief with ESWT.

Comparison between radial and focused types of extracorporeal shock-wave therapy in plantar calcaneal spur: A randomized sham-controlled trial

ABSTRACT Objectives Both radial and focused types of extracorporeal shock wave therapy (ESWT) have been used in patients with plantar calcaneal spur (PCS). However, no study has yet addressed the comparative effects of these treatments on the condition. Considering radial and focused waves are different from each other, their effectiveness may also be different in clinical practice. The aim of this study was to compare the effects of radial and focused types of ESWT on PCS. Methods Ninety-nine patients with plantar calcaneal spur were randomised into three groups according to ESWT types: focused, radial, and sham. ESWT was applied as three sessions, with 2–4 days intervals (excluding weekends). All patients were evaluated at baseline (week 0) and weeks 1, 5, and 13. The Foot Function Index (FFI) scores were used as outcome measures. Results Compared with baseline (week 0), at the end of treatment (week 1) and at the follow-up periods (weeks 5, and 13) the FFI scores were significantly reduced in both focused and radial ESWT groups (for all, p < 0.001). When considering the change in data from baseline to follow-up periods (weeks 5, and 13), both focused and radial ESWT groups were significantly superior to the sham group in the all outcome measures (for all, p < 0.05). Importantly, the radial group was significantly superior to focused group based on the changes in the FFI scores (for all, p < 0.05). Conclusion Both focused ESWT and radial ESWT are effective in plantar calcaneal spur. When considering the degree and continuity of the positive effects, radial ESWT is superior to focused ESWT in plantar calcaneal spur.

The frequency of Achilles and plantar calcaneal spurs in gout patients

Background/aim Gout may cause various radiographic abnormalities such as cartilage loss, spurs, sclerosis, and periostal new bone formation. The purpose of this study was to investigate the frequency of Achilles and plantar spurs and related factors in gout patients.Matherial and methodsWe performed a retrospective review of gout patients, treated at Hacettepe University hospitals between 2014 and 2019. We identified patients from the hospital records using the ICD-10 code (M10). Demographic and clinical features, comorbidities, and foot radiographies were collected. The radiographies were evaluated by a rheumatologist (U.K.) who was experienced in musculoskeletal radiography. Factors predicting the spurs were analyzed by logistic regression analysis.Results181 patients who had lateral foot radiograph were included in this study. Eighty-one (44.7%) patients had score ≥ 2 Achilles spur, 81 (44.7%) patients had score ≥ 2 plantar spur, and 22 (12.1%) patients had no spur. Age, disease duration, duration between the gout diagnosis and appearing spur, the presence of metabolic comorbidities and hypertension were higher in both Achilles and plantar spurs than no spur group. Forty (22.1%) patients had score ≥ 2 both Achilles and plantar spur. In this group, the mean age was older and the proportion of metabolic comorbidities was higher than the groups of Achilles and plantar spur with a score 0 or 1. Predictor of the development of large or moderate-severe calcaneal spur was the existence of metabolic comorbidity [OR (95% CI): 3.49 (1.11–11.0) and p = 0.033].ConclusionThe presence of metabolic comorbidities increases the frequency of calcaneal spurs in gout patients. This condition can be explained by the impaired microvascular structure and increased hypoxia resulting in calcification on the tendon and ligament insertion sites.

Association between Achilles and Plantar Calcaneal Spur in Pakistani Population Presenting with Pain

Aim: To evaluate the prevalence and associationbetween Achilles and plantar calcaneal spurs in Pakistani population. Study design: Cross sectional study. Place and duration of study: The study was conducted in the radiology department Combined Military Hospital Lahore from October 2020 to December 2020. Methodology: Three hundred and thirty five patients were enrolled. The age and sex of the patients were recorded. Lateral foot and/ or ankle radiographs were evaluated for presence of calcaneal spurs. Results:Mean age 38 years.There were 268 (80%) males and 67 (20%) females. 30.7% patients had a calcaneal spur in our population irrespective of age and gender. 13% patients had both posterior and inferior calcaneal spurs. There was higher prevalence of inferior calcaneal spur irrespective of age and gender.Posterior calcaneal spur was seen in 20% of males and in 15% of females. A total of 44 (68%) patients with posterior plantar spur were found to have a concomitant inferior calcaneal spur.Inferior calcaneal spur was seen in 25% of males and in 28% of females and positive correlation between posterior and inferior calcaneal spurs. Conclusion: There is a high prevalence of calcaneal spurs, which increases with advances of age. Inferior calcaneal spurs tend to be more prevalent in females. Furthermore, there is a significant association between the presence of posterior calcaneal spurs and the concomitant inferior calcaneal spurs. Key words: Achilles, Plantar, Calcaneal, Spur

Long-term effect and prognostic factors of alow-dose radiotherapy of painful plantar calcaneal spurs : Aretrospective unicenter study.

To estimate the long-term effect of low-dose radiotherapy of painful plantar calcaneal spurs, and to verify possible prognostic factors. In this retrospective unicenter study, electronic patient files of patients with painful plantar calcaneal spurs treated with low-dose radiotherapy between July 2009 and February 2020 were reviewed. The low-dose radiotherapy consisted of atotal dose of 3.0 Gy given with afraction dose of 0.5 Gy three times aweek. The pain reduction was estimated using apatient questionnaire with avisual analogue scale. Kaplan-Meier statistics and Cox regression analysis were used for the statistical analysis. Altogether, 864 heels of 666patients were reviewed. The probability of an insufficient pain control 10years after low-dose radiotherapy was 45.9% (95% confidence interval 39.4-52.4%) in the subset of patients with aminimum follow-up of 3months (582 heels of 467patients). Patients with an unsatisfactory pain reduction 3months after low-dose radiotherapy were offered are-irradiation. Forty percent of the patients who received are-irradiation developed good pain reduction. Occurrence of an initial aggravation of pain during or within 3months after low-dose radiotherapy (p = 0.005), and treatment of bilateral painful plantar calcaneal spurs (p = 0.008) were identified as significant unfavorable prognostic factors on univariate analysis. On multivariate analysis, the initial aggravation of pain remained as independent significant prognostic factor (p = 0.01). No clear radiation toxicity was observed. Low-dose radiotherapy is asafe and effective treatment option for patients with painful plantar calcaneal spurs. An initial aggravation of pain during or within 3months after radiotherapy was identified as unfavorable prognostic factor for the treatment outcome. Re-irradiation of patients with an unsatisfactory pain reduction after low-dose radiotherapy is effective and should be offered to patients.

Radiologic and Demographic Characteristics of Patients With Plantar Calcaneal Spur

Many people with heel pain in the general population are often diagnosed with plantar calcaneal spurs (PCS). The aim of this study was to evaluate the radiological and demographic characteristics of PCS patients and to compare the differences with the control group. In 2018, 420 patients with weightbearing lateral ankle X-ray images were included in the study. The patients were divided into 2 groups as PCS group and control group. Groups were compared age and age group (20-29, 30-39, 40-49, 50-59, 60-69, 70 and over) weight, height, body mass index (<25, 25-30, >30), chronic diseases as demographically and were also compared radiologically as calcaneal inclination angle (CIA), lateral talocalcaneal angle (LTCA), Bohler angle and Gissane angle. A statistically significant relationship was found between gender and PCS. Plantar calcaneal spur is more common in females than in males (X2:8.101, p < .03). PCS was less common in patients with BMI <25 and 25-29.9, whereas PCS is more common in patients with BMI >30 (X2:7.698, p < .021). Although the CIA angle was within normal limits in both groups, it was significantly lower in patients with PCS than in the control group(p < .05). There was no statistically significant difference between the 2 groups in terms of age, chronic disease, LTCA, Bohler angle, Gissane angle. Female gender and obesity are among the risk factors for PCS formation. CIA may have an important role in PCS formation. In order to clarify the etiology and pathophysiology of PCS, further studies with radiological features are needed.

The Relationship between Calcaneal Spur Type and Plantar Fasciitis in Chinese Population.

Plantar heel pain is a common disease with a high incidence in different races. It significantly reduced the quality of life of patients. However, the cause of PHP is still controversial and there were varieties of physiological factors associated with PHP. The most common pathological factor in the population was plantar fasciitis. Some existing research studies had found a correlation between calcaneal spurs and plantar fasciitis, and this study had found the correlation in Chinese population. It is invaluable not only to understand the relationship between different types of plantar calcaneal spurs and plantar fasciitis but also to identify the most appropriate treatment strategies. A total of 71 patients with calcaneal spurs were chosen from the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. All 71 patients had completed X-rays and MRI scans; then, surgeons had removed their plantar calcaneal spurs. After surgery, all patients were followed up for 12 months; their prognosis was tested by the VAS and AOFAS scores. Type II (29, 40.8%) had the highest incidence in Chinese population, followed with type I (24, 33.8%) and type III (18, 25.4%). Preoperative VAS scores showed that type II (7.72 ± 1.10) was significantly higher than the other two types (P < 0.001). Postoperative VAS scores of type II were higher than those of type I and type III (P < 0.001). Postoperative AOFAS scores of type II were the lowest (P < 0.001). Researchers had proved that type II was more likely to cause PF.

A Radiographic Study of Biomechanical Relationship between the Achilles Tendon and Plantar Fascia

Background Previously, scholars have concluded that the Achilles tendon and the plantar fascia were closely biomechanically related, although there is little clinical evidence of the relationship between the two. To investigate the biomechanical relationship between the Achilles tendon and the plantar fascia, the author used standing lateral ankle radiographs of patients with insertional Achilles tendonitis to determine the biomechanical relationship between the Achilles tendon and plantar fascia. Methods The author collected standing lateral ankle radiographs from patients with insertional Achilles tendonitis who accepted surgical treatment in the author's hospital from March 2009 to July 2018. According to whether there were bone spurs on the posterior side of the calcaneus, patients were divided into group A (spur present on the posterior side) and group B (spur not present on the posterior side). The positive rates of spurs on the plantar side of the calcaneus were determined in group A and group B. The chi-square test was used to compare the measurement results between the two groups. Results In group A, 13 heels were positive for calcaneal bone spurs, and the positive rate was 65.0%. In group B, 3 heels were positive for plantar calcaneal spurs, and the positive rate was 12%. Among all 16 patients with positive plantar calcaneal spurs, 13 had posterior calcaneal spurs (accounting for 81.3%), and 3 had negative results, accounting for 18.7%. There was a significant difference between the results in groups A and B (P < 0.05). Conclusion There is a relationship between posterior calcaneal spurs and plantar calcaneal spurs in patients with insertional Achilles tendonitis, which can be inferred as resulting from the increasing tension in the biomechanically complex relationship between the Achilles tendon and the plantar fascia.

Morphometric analysis and prevalence of plantar calcaneal spurs among the adult population of the Province of Vojvodina

Introduction. Plantar calcaneal spur is a bony outgrowth which is most often located on the inferior aspect of the calcaneus, penetrating the surrounding soft tissues. Symptomatic and asymptomatic cases of plantar calcaneal spurs have been described and their analysis suggested that they may be a variation in regular bone development, but the exact cause is still unknown. The goal of this study was to determine the size, shape and prevalence of plantar spurs in the population of the Province of Vojvodina. Material and Methods. This retrospective research included a total of 272 foot X-rays. The X-rays belonged to the Clinic of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina. The images were analyzed using a publicly available software Xrayline Workstation for 32-bit. Results. There was no statistically significant difference in the size of calcaneal spurs between sexes, as well as between the right/left foot. In regard to their shape, irregular calcaneal spurs were more frequent (61.9%) and all of the spurs were positioned horizontally. Conclusion. The results of this research were in agreement with the available literature data, showing no significant difference in morphometric analysis of the plantar spurs between sexes. Future researches should include data regarding the age, body weight, and comorbidities among examinees.

TL 18165 - Relationship between lower limb dysmetria and plantar fasciitis

Introduction: Plantar fasciitis is an inflammatory process of multifactorial etiology that affects the origin of the plantar fascia and surrounding structures. A difference in length between lower limbs is relatively common within the population and can sometimes cause changes in biomechanics and symptoms. The objective of this study is to evaluate the relationship between lower limb dysmetria and plantar fasciitis. Methods: A cross-sectional study was performed to measure the length of the lower limbs by scanometry in patients diagnosed with plantar fasciitis. Other risk factors, such as body mass index, foot shape and the presence of plantar calcaneal spur, were also assessed in foot radiographs. Results: Of the 54 patients included in the study, 44.4% were men, and the mean age was 50.38 (23-73 years); 81.5% had pain in one foot, and 53.7% had feet that were considered plantigrade. We observed dysmetria in 88.9% of the sample, with a mean of 0.749 cm (SD ±0.63). In addition, 46.3% feet with pain showed calcaneal spurs on the radiographs. Conclusion: Approximately 90% of patients showed lower-limb dysmetria and, in most cases, the side with the shorter limb was affected by plantar fasciitis

Coexistence of plantar calcaneal spurs and plantar fascial thickening in individuals with plantar heel pain.

To examine associations between plantar calcaneal spurs, plantar fascia thickening and plantar heel pain (PHP), and to determine whether tenderness on palpation of the heel differentiates between these presentations. Adults aged ⩾50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months underwent a detailed clinical assessment. PHP in the past month was documented using a foot manikin. Plantar calcaneal spurs were identified from weight-bearing lateral radiographs and plantar fascia thickening (defined as >4 mm) from ultrasound. Tenderness on palpation of the plantar fascia insertion was documented. Associations between these factors and PHP were explored using generalized estimating equations. Clinical and radiographic data were available from 530 participants (296 women, mean [s.d.] age 64.9 [8.4] years), 117 (22.1%) of whom reported PHP. Plantar calcaneal spurs and plantar fascia thickening were identified in 281 (26.5%) and 501 (47.3%) feet, respectively, but frequently coexisted (n = 217, 20.4%). Isolated plantar calcaneal spurs were rare (n = 64, 6.0%). Participants with PHP were more likely to have a combination of these features compared with those without PHP (odds ratio 2.16, 95% CI 1.24, 3.77, P = 0.007). Tenderness on palpation of the heel was not associated with plantar calcaneal spurs or plantar fascia thickening, either in isolation or in combination, in those with PHP. Plantar calcaneal spurs and plantar fascial thickening are associated with PHP, but frequently coexist. Tenderness on palpation of the heel does not appear to differentiate between clinical presentations of PHP.

The age dependent change in the incidence of calcaneal spur

ObjectiveThe aim of the present study was to evaluate the association between the calcaneal spur incidence and age, gender and side. MethodsLateral ankle X-rays of 1335 patients (550 (41.2%) females and 758 (58.8) males; mean age: 46.5 ± 13.5 years) who referred to our hospital because of trauma were reviewed. Incidence of plantar calcaneal spur, posterior calcaneal spur and association of such incidences with age, gender and side were all evaluated. ResultsIncidences of plantar calcaneal spur and posterior calcaneal spur were detected as 32.2% (male: 31%, female: 34%) and 13.1% (male: 11%, female: 16%), respectively. Incidence of plantar calcaneal spur increased by age whereas there was not any association with gender and location. The highest incidence was detected as 41.8% over 70 years of age. Incidence of posterior calcaneal spur increased by age and female gender whereas no significant association was observed with location. The highest incidence was detected as 22.3% between 61 and 70 years of age. ConclusionIncidences of plantar and posterior calcaneal spur were detected as 32.2% and 13.1%, respectively. Both plantar and posterior calcaneal spur incidence increases by age. Posterior calcaneal spur occurs significantly more frequently in females while, no difference is found between the males and females in incidence of the plantar calcaneal spur. Level of evidenceLevel IV, diagnostic study.

The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations.

The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain.