Plantar Spur Research Articles

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.

Bilateral plantar and achilles tendon spurs.

Context: A calcaneal spur, also known as an enthesophyte, is an abnormal bone growth on the underside of the calcaneus, which is the most common site for a bone spur to occur. Although there is consensus that calcaneal spurs are a common cause of heel pain, approximately 20% of calcaneal spurs are asymptomatic and their pathology is still not fully understood. Objective: Report the presence of a plantar spur on the calcaneus and another on the insertion of the Achilles tendon bilaterally. Case report: Female patient, 58 years old, housewife, came to our clinic with a history of pain in the heel region bilaterally when walking, more pronounced on the left, which started approximately two years ago. An X-ray of the ankles and feet was requested, where an enthesophyte could be seen at the insertion of the Achilles tendon and in the plantar fascia of the Achilles in both the right and left foot. After diagnosing the presence of enthesophytes, she was medicated with a non-hormonal anti-inflammatory drug and referred to physical therapy. After a year, the pain improved and she returned to his daily walking activities. Conclusion: Conservative clinical treatment produced satisfactory results in the treatment of calcaneal spurs.

Study of calcaneal spur and its correlation with the talar articular facets of calcanei

Background & aims: A spur is bony outgrowth at the site of attachment of a ligament or tendon into bone. The aim of this study is to analyse the incidence of calcaneal spur in relation to morphological variations of talar articular facets of calcaneus. Material & Method: Study comprised of 350 dry adult calcanei of unknown age and sex from Department of Anatomy, B. J. Medical College, Ahmedabad. Calcanei were classified according to its talar articular facets and compare its relation with the calcaneal spur. Result: Out of the 350 calcanei 128 presented with spurs among them planter spur in 21.4%; dorsal spur in 10.2% and both spurs in 4.8%. Maximum incidence of calcaneal spurs were found in Type 1 calcanei 75% followed by 17.96% in Type 2, 7% in Type 3 and 0.7% in type 4. Conclusion: Calcaneal spurs are related to type of calcanei with the highest frequency in Type 1 and least in Type 4. Anatomical knowledge of the correlation between calcaneal spur and type of calcaneus may be of significant clinical interest to foot and ankle surgeons in clinical practice. Keywords: Dorsal spur, plantar spur, talar articular facets.

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

Why heel spurs are traction spurs after all

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.

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.

Radiological classification and prevalence of plantar spur and their relationship with plantar fasciitis

Introduction: A presence or consequences of the plantar spur as a cause of plantar fasciitis are currently uncertain. But literature is deficient with conflicting findings regarding the relationship between the PS and PF. The study was undertaken to assess the incidence of types and sizes of the plantar spurs and to find the relationship between the plantar spur and plantar fasciitis. Material & Methods: We studied 30 patients with the complaints of plantar fasciitis having plantar spur were included. Length and size of the plantar spur were assessed radiologically using lateral view ankle X-rays. Pain and functional assessment were evaluated using VAS and AOFAS score before and after treatment. Results: Length of the plantar spur was classified as type 0/absent in 4 patients, 1/small in 4 patients, 2/medium in 12 patients and 3/large in 10 patients Plantar spur size was measure spurs as 10mm. The highest incidence spurs size was 5-10mm and >10mm accounts for 36.67% each (n=11). Statistically, significant improvement was found in the mean VAS and AOFAS score in all the patients after treatment especially patient with a medium sized spur (grade 2).Cohen’s Kappa statistic showed excellent intra and inter-observer agreement. Conclusions: These suggest that the presence or consequences of the plantar spur are not necessarily as a cause of plantar fasciitis. These results may enlighten the knowledge to understand the role of the plantar spur in a patient with plantar fasciitis.

Calcaneal spurs among San and Khoi skeletons.

Only few studies considered the prevalence of calcaneal enthesophytes commonly called heel spurs among historic skeleton samples. In the present study the frequency of plantar calcaneal spurs among 54 19(th) century Khoisan skeletons was analyzed. Five individuals (9.6 %) had a plantar calcaneal spur at the right side or left side. Calcaneal spurs were more likely to occur in older individuals. More than 20 % of the individuals aged between 40 and 60 years (mature) showed plantar spurs, while 6.2 % of the individuals aged between 20 and 40years had plantar spurs; however this difference was not significant. No sex differences were present in the prevalence of calcaneal spurs. Male and female individuals did not differ in the metric dimensions of the calcanceal spurs significantly.

Erratum for “Association of Achilles Tendinopathy and Plantar Spurs”

Erratum for “Association of Achilles Tendinopathy and Plantar Spurs”

Association of Achilles tendinopathy and plantar spurs.

Plantar spurs and Achilles tendinopathy are common causes of heel pain. In the authors' practice, it was anecdotally noted that patients with Achilles tendinopathy often presented with plantar spurs. Nonetheless, there is a shortage of studies investigating whether Achilles tendinopathy and plantar spurs exist concomitantly. A better understanding of the association between the 2 pathologies might help physicians recognize and treat both conditions, educate patients about Achilles tendinopathy and plantar spurs, and ultimately investigate possible underlying causes of both pathologies that could be addressed together. The authors examined the prevalence of plantar spurs in patients diagnosed with Achilles tendinopathy as well as demographic differences within the unilateral and bilateral Achilles tendinopathy populations. A total of 785 patient records were retrospectively reviewed. Mean patient age was 56.2±15.5 years (46.9% men and 53.1% women). Seventy-two (9.2%) patients were affected bilaterally by Achilles tendinopathy. Lateral radiographs were reviewed by an orthopedic surgeon to identify the presence of plantar spurs. A total of 329 (41.9%) patients with Achilles tendinopathy were found to have a concomitant plantar spur. Patients with unilateral Achilles tendinopathy and a plantar spur were more likely to be women (58.7% vs 49.8%, P=.020) and older (62.7 vs 51.7 years, P<.001). In the bilateral Achilles tendinopathy group, there were 46 (63.9%) patients with at least one foot presenting with a plantar spur. The study's findings suggest a significant association between Achilles tendinopathy and plantar spurs. Older women with Achilles tendinopathy are at greater risk of being affected by plantar spurs.

Changes in prevalence of calcaneal spurs in men &amp; women: a random population from a trauma clinic

BackgroundThis study reports the changing prevalence of ankle (Achilles and plantar) spurs with age, in order to comment on their significance to rheumatologists.Methods1080 lateral ankle radiographs from each of 9 (50 men and 50 women) age cohorts from 2 to 96 years old of patients attending a trauma clinic were examined and spurs classified as small or large.ResultsThe prevalence of both Achilles and plantar spurs in relation to the age categories and sex was variable. Overall, there was 38% of the population who had a spur (Achilles or plantar) and only third (11%) with spurs at both sites (Achilles and plantar). Large spurs were more prevalent in older individuals (40 to 79 years). There were no large plantar spurs in individuals <40 years of age and only 2% for the Achilles. The prevalence of spurs (Achilles and plantar) was significantly higher for woman than men in individuals <50 years of age. There was a notable moderate positive correlation (r = 0.71) between both plantar and Achilles spurs for women <30 years of age but no correlation for men (r = -0.03).ConclusionPlantar and Achilles spurs are highly prevalent in older people and the radiographic appearance of spurs differs between men and women. In individuals < 50 years of age, spur (Achilles and plantar) formation is more common in women than in men. Additionally, there was a notable moderate positive correlation between Achilles and plantar spurs for women <30 years of age.

A study of calcaneal enthesophytes (spurs) in Indian population.

Introduction:Calcaneus or os calcis forms a major component of the skeleton of foot providing posterior pillars for bony arches of the foot. It is largest of seven tarsal bones of foot and forms prominence of heel. Many times anterior to calcaneal tuberosity an osteophytic outgrowth has been observed (calcaneal or heel spur) extending along entire width, for about 2-2.5 cm. The apex of spur seen embedded in plantar fascia, directly anterior to its origin. Hence, the study of calcaneal spurs has been undertaken.Materials and Methods:The material for the study consisted of 200 dry (100 right and 100 left), adult calcanei of unknown age and sex obtained from Department of Anatomy. The calcaneal enthesophytes/spurs were studied in detail and classified according to types of calcaneum.Results:Maximum incidence of calcaneal spurs were found in Type I calcanei (11%) and no calcaneal spurs were found in Type III calcanei. Total incidence of dorsal calcaneal spurs in all types of calcanei was maximal (15.5%). The incidence of plantar spurs was 6.5% being highest in Type I calcanei (4%). The incidence and type of calcaneal spurs were compared with those of previous studies and etiology of heel pain has been discussed. Correlation between type of calcanei and spurs has been studied for the 1st time.Conclusion:Calcaneal spurs are related to type of calcanei with the highest frequency in Type I and least in Type III (no spurs seen in Type III and least in Type IV). Other factors, which contribute toward increase in incidence of spurs, are increasing age and weight, concurrent orthopedic diseases, and heel pain.

Effect of Field Size and Length of Plantar Spur on Treatment Outcome in Radiation Therapy of Plantar Fasciitis: The Bigger the Better?

Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved. A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses. Treatment response depended upon age >53 years, length of heel spur ≤6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident. Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice.

Calcaneal spurs: Examining etiology using prehistoric skeletal remains to understand present day heel pain

BackgroundCalcanei are the most common sites for bony spurs. Although calcaneal enthesophytes have been extensively researched, many unknowns remain. Whether biological factors, such as age, weight and genetics, play a greater role in calcaneal spur etiology than activity is still unknown. ObjectivesThe current study examines 121 adults from a prehistoric hunter-gatherer population to aid in understanding bony spur etiology. MethodsCalcaneal spurs are scored as present or absent on the dorsal or plantar side; they are analyzed in regards to their relationships with age, sex, osteoarthritis, cortical index, femoral head breadth and muscle markers. ResultsDorsal and plantar spurs frequencies increase with age (chi-squares=16.90, 7.268, Ps<0.05, respectively). Dorsal spurs were more frequent than plantar spurs (chi-square=38.000; P<0.0001). There is a positive relationship with calcaneal spurs and upper limb and lower limb osteoarthritis (chi-squares=5.587, 7.640, Ps<0.05, respectively). ConclusionsThe data presented support that dorsal spurs are in part the result of activities, but plantar spurs may be a more modern phenomena resulting from long periods of standing and excess weight.

Treatment of Hallux Valgus with Three-dimensional Modification of Mitchell’s Osteotomy

Mitchell's osteotomy gives very good results but there are still some cases where the original method, as well as its modification, cannot address all aspects of deformity. We modified the original Mitchell's method to address pronation and plantar displacement of the first metatarsal. Modification includes formation of lateral and plantar spur with metatarsal displacement and derotation of distal metatarsal fragment in the frontal and horizontal planes with stable screw fixation. We present midterm results of the first 60 patients compared to the original Mitchell method (30 patients). Differences between the groups postoperatively were in declination angle, postoperative metatarsalgia rate, and first metatarsal pronation angle. The technique described eliminated many of the disadvantages of Mitchell's method.

Diagnostic significance of radiologic measurements in posterior heel pain

Background Posterior heel pain is a common complaint in both athlete and non-athlete. For diagnosis of etiology certain angles, lines and soft tissue parameters have been developed in the literature to describe the calcaneal prominence and its relationship to Achilles tendon and its bursae. Objectives A prospective study was undertaken to evaluate the diagnostic values of these angles, lines and soft tissue parameters in posterior heel pain. Materials and methods Seventy-one painful heels in 58 patients (30 males and 28 females, mean ± S.D. age; 41.4 ± 10.82 years) were clinically and radiologically examined. This was compared with 50 heels in 25 control subjects. A lateral weight bearing film of the foot was taken to calculate different angles, lines and soft tissue parameters mentioned in the literature. Results There were 45 Pavlov's parallel pitch line positives and using test of Denis and Huber–Levernieux in only one posterior superior crest extended beyond vertical tangential. There was only one heel with Fowler & Philip angle >75°. There were 10 heels with Steffensen & Evensen angle >65, 5 heels with total angle >90° and 52 heels with Chauveaux–Liet angle >12°. There were 73% true positive for Chauveaux–Liet angle and 63% true positive for parallel pitch line. Among soft tissue parameters ill defined retrocalcaneal recess was present in 61 symptomatic heels, plantar spur in 42 heels, posterior calcaneal step in 33 heels, Achilles tendon calcification in 29 heels, superficial tendo-Achilles bursitis in 58 heels, posterior calcaneal spur in 31 heels and antero posterior diameter of tendo-Achilles more than 9 mm in 68 symptomatic heels. Conclusion Parallel pitch lines, Chauveaux–Liet angle, ill-defined retrocalcaneal recess, superficial tendo-Achilles bursa and anteroposterior diameter of Achilles tendon more than 9 mm about 2 cm above insertion are reliable objective diagnostic indicators of bony deformity of calcaneus and soft tissue affection in patients with posterior heel pain. It is the combination of these bony and soft tissue parameters, which enhance the diagnostic certitude.

Effectiveness and prognostic factors of radiotherapy for painful plantar heel spurs.

The efficacy of radiation treatment (RT) for plantar heel pain has been reported repeatedly. Yet, the results referring to the pain relief rate, to long-term effects and prognostic factors are not consistent. In this paper, the effectiveness (pain relief rate and long-term results) and prognostic factors of RT for plantar heel pain have been investigated. From January 2000 to October 2000, 62 patients (73 heels) with painful plantar heel spurs and a minimum pain history of 3 months were treated and evaluated in a prospective study. Mean age was 54 years (range 28-84 years). All patients were treated with a total dose of 5 Gy in seven fractions (= one series), given twice a week at a single-dose sequence of 0.25-0.25-0.5-1.0-1.0-1.0-1.0 Gy (10-MV photons, source-skin distance [SSD] 100 cm, direct portal, field size 12 x 17 cm). The mean duration of heel pain before RT was 26 weeks (= 6.5 months; range 3-120 months). By means of a visual analog scale (VAS) the patients had to self-assess the quantity of their heel pain once before, three times during and four times after RT at a longterm median follow-up of 28 and 40 months. Additionally, the patients had to assess their mechanical heel stress extent during RT. Effectiveness was estimated according to the patients' judgment of pain reduction. A significant reduction of heel pain extent measured by VAS has been observed already during the RT series (before RT: 6.3 +/- 1.5 vs. 3.8 +/- 2.1 at the end of RT; p < 0.001). 6 weeks after RT (FU 1) pain reduction (> 20%) was achieved in 60 heels (82.3%; n = 73), in 64 heels (91.4%; n = 70) after a mean follow-up of 28 months (FU 2), and in 61 heels (89.7%; n = 68) after a mean follow-up of 40 months (FU 3), respectively. Sufficient pain relief (> 80% compared to initial extent) was observed in 18/73 heels (24.6%) at FU 1 (FU 2: 42/70; 60.0%; FU 3: 37/68; 54.4%), including 13/73 heels (17.8%) with complete pain relief (FU 2: 39/70; 55.7%; FU 3: 36/68; 52.9%). Partial improvement (50-80% pain reduction) was observed in 27/73 heels (37.0%) at FU 1 (FU 2: 14/70; 20.0%; FU 3: 15/68; 22.1%), and minor partial improvement (20-50% pain reduction) in 15/73 heels (20.5%) at FU 1 (FU 2: 8/70; 11.4%; FU 3: 9/68; 13.2%), respectively. No change was seen in 13/73 heels (17.8%) at FU 1 (FU 2: 6/70; 8.6%; FU 3: 7/68; 10.3%). Older patients (p = 0.04) and patients who avoided heel stress during the period of RT (p < 0.01) demonstrated a better short-term response (FU 1); both effects were lost 28 and 40 months after RT. Moreover, significant differences in the extent of heel pain reduction by RT were observed in dependence on previous pain duration (at FU 2-3). The results confirm the high efficacy of RT in painful plantar spur and add new aspects to formerly published data concerning the time course of changes in heel pain reduction. Pain relief can be expected during and shortly after RT. In addition, the initial success can be transformed into effective long-term results > 2 years after RT; however, further improvement is not to be expected. As a new prognostic factor, the reduction of mechanical heel stress during RT may ameliorate the short-term results, whereas short heel pain history improves the long-term results. Especially for older patients, RT should be taken into consideration as primary treatment.

Spätergebnisse nach Operationen am rheumatischen Vorfuß und Analyse der Fehlschläge*

Rheumatoid arthritis as a systemic disease frequently involves the forefoot. Hallux valgus with degeneration of the first metatarsophalangeal joint and dorsal subluxation or dislocation of the lateral four metatarsophalangeal joints are classic findings. Lateral drifting of the toes is also a late sequela. 330 deformed forefeet were treated surgically between 1984 and 1989 at the orthopaedic department of the university of Jena. 286 feet (86,6%) could be followed up for a mean of 7.4 years (range 5.1-10.4 years) using clinical, radiological and footprint evaluation. For the exposure of the four lateral metatarsophalangeal joints we used a transverse plantar approach at the level of the metatarsal necks. The resection of the metatarsal heads was done by using an oscillating saw. Treating the hallux valgus deformity we choosed a slight resection of the first metatarsal head (48,2%), Keller's excision arthroplasty (40,0%) or an arthrodesis of the first metatarsophalangeal joint (11,8 %). 35% of the reviewed patients suffered from adverse symptoms including pain in the big toe or the forefoot, problems with footwear and restriction of their walking ability. The lateral metatarsalgia was caused by a bad alignement of the lateral four metatarsals or plantar spurs at the level of the metatarsal stumps. In combination with the resection of the lateral four metatarsal heads arthrodesis of the first metatarsaophalangeal joint provided the best results. Slight resection and modelling of the first metatarsal head provided acceptable results. Keller's excision arthroplasty caused the worst outcome and can no longer be recommended for rheumatoid arthritis forefeet.

Häufigkeit, Altersabhängigkeit und Geschlechtsverteilung des Fersensporns

In 1027 lateral radiograms of the ankle in a Caucasian population, 161 plantar and/or dorsal calcaneal spurs (15.7%) were diagnosed. Plantar spurs were more common than dorsal spurs (11.2 and 9.3% respectively). Prevalence of both spurs increases considerably with the rising age. Dorsal spurs appear slightly earlier than plantar spurs. The spur frequencies are similar in left and right feet. The plantar spurs were significantly (p < 0.0001) more common in women than in men in general, while dorsal spurs were more frequent in men than in women up to the age of 70. The previously reported higher frequencies of plantar and dorsal calcaneal spurs in women than in men are probably a result of a disproportionally higher number of women in higher age in the groups studied. In forensic medicine, calcaneal spurs provide evidence for identity and age of unknown corpses, and to certain extend their profession, physical activities and constitution during life.