Calcaneal Spurs

Definition

• Calcaneal spur, also known as heel spur, is a bony outgrowth on the heel bone.
• Spurs can be located at the back (dorsal heel spur) or under the sole (plantar heel spur).
• Associated conditions:
  • Dorsal spurs: Linked to Achilles Tendinopathy.
  • Plantar spurs: Linked to Plantar fasciitis.
• Spurs result from the constant pulling effect on the plantar fascia, causing inflammation.

Clinically Relevant Anatomy

• Muscles and plantar fascia exert traction force on the calcaneus.
• Causes of spurs:
  • Repetitive trauma, leading to micro tears.
  • Inflammation from attempted repair.

Epidemiology/Etiology

• Etiology debated: Heredity, metabolic disorders, abnormal biomechanics.
• Abnormal pronation considered a prime factor.
• Asymptomatic heel spurs common in adults.

Characteristics/Clinical Presentation

• Heel spurs not a primary cause of heel pain but can exacerbate conditions like plantar fasciitis.
• Symptoms:
  • Localized pain in the medial process of the calcaneal tuberosity.
  • Pain during weight-bearing activities.
  • Pain caused by inflammation, not mechanical pressure.
• Risk factors: Middle-aged adults, obesity.

Types of Calcaneal Spurs

• Type A: Superior to plantar fascia insertion.
• Type B: Extend forward within the plantar fascia.
  • Type B causes severe pain.
• Large, asymptomatic spurs and small, symptomatic spurs.

Differential Diagnosis

• Chronic heel pain may arise from various conditions:
  • Musculoskeletal: Peroneal tendonitis, Haglund's deformity.
  • Traumatic: Calcaneal fractures.
  • Neurological: Baxter nerve entrapment, Tarsal tunnel syndrome.
  • Others: Heel fat pad syndrome.

Diagnostic Procedures

• Diagnosis based on history and physical exam.
• Confirmation through X-ray.

Outcome Measures

• Lower Extremity Functional Scale (LEFS).

Examination

• Consider range of motion, tenderness, atrophy, swelling, gait evaluation, etc.

Management

• Medical Management:
  • Tier I: NSAIDs, Cortisone injections.
  • Tier II: Repeat injections, Botulinum toxin.
  • Tier III: Surgical interventions like fasciotomy.
• Conservative Management:
  • Tier I: Padding, orthotic insoles, stretching, night splints, physiotherapy.
  • Tier III: ESWT, radiofrequency.

Physical Therapy Management

• Low dose radiotherapy, Cryoultrasound therapy, Thermotherapy.
• Laser therapy and conventional treatments aimed at reducing inflammation.

Orthotics

• Used to manage heel pain, providing support and cushioning.

Night Splints

• Used to alleviate pain during rest.

Heel Inserts

• Aim to relieve pressure and distribute shock forces.

Footwear Modification

• Insoles and proper footwear can alleviate pain and correct pronation.

Clinical Bottom Line

• Spurs linked to repetitive trauma and abnormal biomechanics.
• X-ray effective for diagnosis, with a mix of medical and non-medical management depending on patient response.