Calcaneal spur

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Calcaneal spur
Other namesHeel spur
Achilles insertional calcific tendinosis.jpg
A radiograph showing osteophytes on the posterior and inferior aspects of the calcaneus
Specialty Rheumatology   OOjs UI icon edit-ltr-progressive.svg

A calcaneal spur (also known as a heel spur) is a bony outgrowth from the calcaneal tuberosity (heel bone). [1] Calcaneal spurs are typically detected by x-ray examination. [2] It is a form of exostosis.

Contents

When a foot is exposed to constant stress, calcium deposits build up on the bottom of the heel bone. Generally, this has no effect on a person's daily life. However, repeated damage can cause these deposits to pile up on each other, causing a spur-shaped deformity, called a calcaneal (or heel) spur. [3]

An inferior calcaneal spur is located on the inferior aspect of the calcaneus and is typically a response to plantar fasciitis over a period, but may also be associated with ankylosing spondylitis (typically in children). A posterior calcaneal spur develops on the back of the heel at the insertion of the Achilles tendon. [3]

An inferior calcaneal spur consists of a calcification of the calcaneus, which lies superior to the plantar fascia at the insertion of the plantar fascia. A posterior calcaneal spur is often large and palpable through the skin and may need to be removed as part of the treatment of insertional Achilles tendonitis. [3]

Signs and symptoms

Inferior calcaneal spur Calcaneal spur.jpg
Inferior calcaneal spur

Major symptoms consist of pain in the region surrounding the spur, which typically increases in intensity after prolonged periods of rest. Patients may report heel pain to be more severe when waking up in the morning. Patients may not be able to bear weight on the afflicted heel comfortably. Running, walking, or lifting heavy weight may exacerbate the issue. [4]

Causes

Plantar fasciitis is a common cause of calcaneal spurs. When stress is put on the plantar fascia ligament, it does not cause only plantar fasciitis, but causes a heel spur where the plantar fascia attaches to the heel bone. [5] The considerations that affect plantar heel pain are the alignment of the foot with lower leg, foot and ankle mobility, strength and endurance of muscle. External influences on plantar heel pain are the amount of time spent on feet while exercising or standing, type of footwear used and type of floor surfaces. [6]

Calcaneal spur develops when proper care is not given to the foot and heels. [2] People who are obese, have flat feet, or who often wear high-heeled shoes are most susceptible to heel spurs. [5] Flat feet can potentially be attributed to the minimal amount of ankle dorsiflexion during stance phase of the gait cycle causing more tension on the plantar fascia. [6]

Diagnosis

Spur outgrowths can be detected through physical exam followed by a lateral foot x-ray.[ citation needed ]

Treatment

It is often seen as a repetitive stress injury, and thus lifestyle modification is typically the basic course of management strategies. For example, a person should begin doing foot and calf workouts. Strong muscles in the calves and lower legs will help take the stress off the bone and prevent heel spurs. Icing the area is an effective way to get immediate pain relief. There are several means to get pain relief from plantar heel pain. [7] Plantar heel pain can be a precursor to many pathologies of the foot. [8] There is evidence that corticosteroid injections may reduce pain for up to one month after the injection, which can have an impact on the formation of calcaneal spurs. Side effects of corticosteroid injections includes peripheral nerve injury, plantar fascia rupture, and post injection flare, among others. [9] Laser therapy, dry needling, and calcaneal taping are also utilized in treating plantar heel pain, however, there is not high quality evidence supporting the clinical usage of such modalities in reduction of pain. [8]

Related Research Articles

Foot Anatomical structure found in vertebrates

The foot is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws or nails.

Human leg Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The human leg, in the general word sense, is the entire lower limb of the human body, including the foot, thigh and even the hip or gluteal region. However, the definition in human anatomy refers only to the section of the lower limb extending from the knee to the ankle, also known as the crus or, especially in non-technical use, the shank. Legs are used for standing, and all forms of locomotion including recreational such as dancing, and constitute a significant portion of a person's mass. Female legs generally have greater hip anteversion and tibiofemoral angles, but shorter femur and tibial lengths than those in males.

Heel Part of the foot in the back

The heel is the prominence at the posterior end of the foot. It is based on the projection of one bone, the calcaneus or heel bone, behind the articulation of the bones of the lower leg.

Achilles tendon Tendon at the back of the lower leg

The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone. These muscles, acting via the tendon, cause plantar flexion of the foot at the ankle joint, and flexion at the knee.

Calcaneus

In humans and many other primates, the calcaneus or heel bone is a bone of the tarsus of the foot which constitutes the heel. In some other animals, it is the point of the hock.

Pes cavus

Pes cavus, also known as high arch, is a human foot type in which the sole of the foot is distinctly hollow when bearing weight. That is, there is a fixed plantar flexion of the foot. A high arch is the opposite of a flat foot and is somewhat less common.

Plantar fascia Aponeurosis of the sole of the foot

The plantar fascia is the thick connective tissue (aponeurosis) which supports the arch on the bottom of the foot. It runs from the tuberosity of the calcaneus forward to the heads of the metatarsal bones.

Plantar fasciitis Connective tissue disorder of the heel

Plantar fasciitis is a disorder of the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin. The pain typically comes on gradually, and it affects both feet in about one-third of cases.

Achilles tendinitis

Achilles tendinitis, also known as achilles tendinopathy, occurs when the Achilles tendon, found at the back of the ankle, becomes sore. Achilles tendinopathy is accompanied by alterations in the tendon’s structure and mechanical properties. The most common symptoms are pain and swelling around the affected tendon. The pain is typically worse at the start of exercise and decreases thereafter. Stiffness of the ankle may also be present. Onset is generally gradual.

Achilles tendon rupture Medical condition were the tendon at the back of the ankle breaks

Achilles tendon rupture is when the Achilles tendon, at the back of the ankle, breaks. Symptoms include the sudden onset of sharp pain in the heel. A snapping sound may be heard as the tendon breaks and walking becomes difficult.

Mortons neuroma Benign neuroma of an intermetatarsal plantar nerve

Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces, which results in the entrapment of the affected nerve. The main symptoms are pain and/or numbness, sometimes relieved by ceasing to wear footwear with tight toeboxes and high heels. The condition is named after Thomas George Morton, though it was first correctly described by a chiropodist named Durlacher.

Severs disease

Sever's Disease, otherwise known as apophysitis of the calcaneus, is an inflammation of the growth plate in the heel of growing children. The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children. It usually resolves when the bone has completed growth or activity is lessened. The pain can be eased through stretching.

Arches of the foot

The arches of the foot, formed by the tarsal and metatarsal bones, strengthened by ligaments and tendons, allow the foot to support the weight of the body in the erect posture with the least weight.

Accessory navicular bone

An accessory navicular bone is an accessory bone of the foot that occasionally develops abnormally in front of the ankle towards the inside of the foot. This bone may be present in approximately 2-21% of the general population and is usually asymptomatic. When it is symptomatic, surgery may be necessary.

Calcaneal fracture

A calcaneal fracture is a break of the calcaneus. Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back.

Tailors bunion

Tailor's bunion is a condition caused as a result of inflammation of the fifth metatarsal bone at the base of the little toe.

Plantar calcaneal bursitis is a medical condition in which there is inflammation of the plantar calcaneal bursa, a spongy fluid filled sac that cushions the fascia of the heel and the calcaneus. It is characterized by swelling and tenderness of the central plantar heel area. It is sometimes called 'Policeman's heel'. It sometimes was, and should not be, confused with plantar fasciitis, which is inflammation of the plantar fascia and can affect any part of the foot.

Heel pad syndrome is a pain that occurs in the center of the heel. It is typically due to atrophy of the fat pad which makes up the heel. Risk factors include obesity. Other conditions with similar symptoms include plantar fasciitis. Treatment includes rest, pain medication, and heel cups. It becomes more common with age.

Running injuries affect about half of runners annually. The frequencies of various RRI depend on the type of running, such as speed and mileage. Some injuries are acute, caused by sudden overstress, such as side stitch, strains, and sprains. Many of the common injuries that affect runners are chronic, developing over longer periods as the result of overuse. Common overuse injuries include shin splints, stress fractures, Achilles tendinitis, Iliotibial band syndrome, Patellofemoral pain, and plantar fasciitis.

Plantar fascial rupture

A plantar fascial rupture, is a painful tear in the plantar fascia. The plantar fascia is a connective tissue that spans across the bottom of the foot. The condition plantar fasciitis may increase the likelihood of rupture. A plantar fascial rupture may be mistaken for plantar fasciitis or even a calcaneal fracture. To allow for proper diagnosis, an MRI is often needed.

References

  1. Kirkpatrick J, Yassaie O, Mirjalili SA (June 2017). "The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations". Journal of Anatomy. 230 (6): 743–751. doi:10.1111/joa.12607. PMC   5442149 . PMID   28369929.
  2. 1 2 "Heel and Foot Pain". Patient.info. July 24, 2017. Retrieved December 9, 2017.
  3. 1 2 3 CE4RT.com (November 18, 2013). Radiography of the Foot. p. 19. Retrieved December 9, 2017.
  4. "Plantar Fasciitis and Heel Spurs". Spoc-Ortho.com. Archived from the original on December 10, 2017. Retrieved December 9, 2017.
  5. 1 2 Agyekum EK, Ma K (June 2015). "Heel pain: A systematic review". Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi. 18 (3): 164–9. doi: 10.1016/j.cjtee.2015.03.002 . PMID   26643244.
  6. 1 2 Sullivan J, Pappas E, Burns J (March 2020). "Role of mechanical factors in the clinical presentation of plantar heel pain: Implications for management". Foot. 42: 101636. doi: 10.1016/j.foot.2019.08.007 . PMID   31731071.
  7. "4 Ways to Get Rid of Heel Spurs". wikiHow. 2007-05-04. Retrieved 2016-12-20.
  8. 1 2 Salvioli S, Guidi M, Marcotulli G (December 2017). "The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: A systematic review with meta-analysis". Foot. 33: 57–67. doi:10.1016/j.foot.2017.05.004. PMID   29126045.
  9. David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS, et al. (Cochrane Bone, Joint and Muscle Trauma Group) (June 2017). "Injected corticosteroids for treating plantar heel pain in adults". The Cochrane Database of Systematic Reviews. 6: CD009348. doi:10.1002/14651858.CD009348.pub2. PMC   6481652 . PMID   28602048.
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