Calcaneal Spurs
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Definition/Description[edit | edit source]
A calcaneal spur, or commonly known as a heel spur, occurs when there is a bone spur (a bony outgrowth) formed on the heel bone. Calcaneal spurs can be located at the back of the heel (dorsal heel spur) or under the sole (plantar heel spur). The dorsal spurs are often associated with achilles Tendinopathy, while spurs under the sole are associated with Plantar fasciitis.
The apex of the spur lies either within the origin of the planter fascia (on the medial tubercle of the calcaneus) or superior to it (in the origin of the flexor digitorum brevis muscle). The relationship between spur formation, the medial tubercle of the calcaneus and intrinsic heel musculature results in a constant pulling effect on the plantar fascia consequent a inflammatory process[1].
Clinically Relevant Anatomy[edit | edit source]
M. Soleus
M. Gastrocnemius
M. Plantaris
M. Abductor Digiti minimi
M. Flexor digitorum brevis
M. Extensor digitorum brevis
M. Abductor hallucis
M. Extensor hallucis brevis
M. Quadratus plantae
Plantar fascia
All of these structures are in a position to exert a traction force on the tuberosity and adjacent regions of the calcaneus, especially when excessive or abnormal pronation occurs. The origin of the spurs appears to be repetitive trauma that produced microtears in the plantar fascia near its attachment and the attempted repair led to inflammation which is responsible for the release and the maintenance of the symptoms.[2],[3],[4],[5]
Epidemiology /Etiology[edit | edit source]
The etiology of the spur has been debated. At the beginning of the twentieth century, gonorrhea was considered a prime ethiological factor. Heredity, metabolic disorders, tuberculosis, systemic inflammatory diseases and many other disorders have also been implicated. Now abnormal biomechanics (excessive or abnormal pronation) enjoys wide support as the prime etiological factor for the painful plantar heel and the inferior calcaneal spur. The spur is thought to be a result of the biomechanical fault and an incidental finding when associated with the painful plantar heel.
The most common etiology involves abnormal pronation with resultant increased tension forces developed in the structures attaching in the region of the calcaneal tuberosity.
Asymptomatic heel spurs are relatively common in the normal, adult population. One epidemiologic study found that 11% of the adult U.S. population demonstrated a calcaneal spur as an incidental radiographic finding.[6]
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References[edit | edit source]
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- ↑ Johal KS .,‘Plantar fasciitis and the calcaneal spur: Fact or fiction?’., Foot Ankle Surg.,18 March 2012
- ↑ Gill LH. Plantar fasciitis: diagnosis and conservative management. J Am Acad Orthop Surg, 1997
- ↑ McCarthy DJ, Gorecki GE: The anatomical basis of inferior calcaneal lesions. J Am Podiatry Assoc 69527-536,1979
- ↑ Young CC, Rutherford DS, Niedfeldt MW. Treatment of plantar fasciitis. Am Fam Physician 2001
- ↑ Heyd, Reinhard, et al. "Radiation therapy for painful heel spurs." Strahlentherapie und Onkologie 183.1 (2007): 3-9
- ↑ McCarthy DJ, Gorecki GE: The anatomical basis of inferior calcaneal lesions. J Am Podiatry Assoc 69527-536,1979