Understanding Plantar Calcaneal Spurs: A Detailed Review
A Plantar Calcaneal Spur (PCS) is a bony growth that develops on the underside of the heel bone (calcaneus). It forms at the point where the plantar fascia—the connective tissue that stretches along the bottom of your foot—attaches to the calcaneus. These spurs are typically small but can become quite painful. They often cause heel pain or talalgia, which is a common complaint among those affected.
Anatomy of the Plantar Calcaneal Spur
Plantar calcaneal spurs are most commonly located on the calcaneal tuberosity. The tuberosity is the thickened part of the heel bone where several structures in the foot, including the plantar fascia, attach. The plantar fascia is a dense band of connective tissue that plays a key role in supporting the arch of the foot and absorbing the shock of walking or standing. As the plantar fascia endures repetitive stress, it can lead to the development of calcaneal spurs.
There are two types of calcaneal spurs: plantar calcaneal spur and dorsal calcaneal spur, with the former being more commonly associated with pain.
What Causes Plantar Calcaneal Spurs?
The exact cause of PCS is not fully understood, but several theories exist:
- Traction Theory: Chronic traction, or pulling, of the plantar fascia at its attachment to the calcaneus is thought to lead to inflammation and ossification (bone formation). This is often exacerbated by conditions like flat feet (pes planus) where the arch collapses, increasing the tension on the fascia.
- Vertical Compression Theory: This theory suggests that repetitive vertical forces, such as those exerted during walking or standing for long periods, lead to stress and microfractures in the heel bone. Over time, the body responds by forming a protective bony growth (the calcaneal spur) to redistribute the forces and protect the calcaneus.
- Heel Pad and Fascia Thickening: Research has shown that the heel pad tends to thicken with age and weight gain, which can cause the plantar fascia to lose its elasticity. This loss of flexibility increases tension on the heel, leading to the formation of spurs.
Risk Factors for Developing PCS
Several factors can contribute to the development of plantar calcaneal spurs:
- Age: The likelihood of developing PCS increases with age. In older individuals, changes in walking patterns, such as increased heel and mid-foot contact time, may contribute to the formation of spurs.
- Obesity: Overweight individuals are more likely to develop PCS due to the increased load on the feet, which puts additional stress on the plantar fascia and the heel bone.
- Foot Structure: Conditions like flat feet (pes planus) or high arches (pes cavus) can alter the distribution of pressure on the feet, leading to excessive strain on the calcaneus and plantar fascia.
- Gender: Some studies suggest that women, particularly those under 50, may be at a higher risk of developing PCS compared to men, possibly due to wearing high-heeled shoes that alter foot mechanics.
- Arthritis: Conditions like rheumatoid arthritis and osteoarthritis have been associated with an increased prevalence of PCS, suggesting that joint inflammation may play a role in spur formation.
Symptoms of PCS
While many individuals with PCS experience no symptoms, the most common symptom is heel pain, which often worsens with walking or standing for prolonged periods. The pain is typically felt at the bottom of the heel and is often described as sharp or stabbing, especially when taking the first steps in the morning. In some cases, PCS may also cause swelling and irritation in the surrounding tissues.
Treatment Options for PCS
Treatment for PCS varies depending on the severity of symptoms. In most cases, conservative measures are sufficient:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These medications help reduce pain and inflammation associated with PCS.
- Physical Therapy: Stretching exercises targeting the gastrocnemius-soleus muscles can help improve flexibility and relieve tension on the plantar fascia.
- Orthotic Devices: Custom shoe inserts can help redistribute pressure on the heel and provide cushioning to reduce pain.
- Extracorporeal Shock Wave Therapy (ESWT): This therapy uses high-energy sound waves to stimulate healing in the affected area and reduce pain.
- Cryo-Ultrasound Therapy: This treatment combines cold therapy and ultrasound to reduce inflammation and alleviate pain.
- Surgical Options: In severe cases where conservative treatments fail, surgery may be necessary. Surgical procedures include endoscopic plantar fasciotomy to release the tension in the plantar fascia and spur resection to remove the bony growth.
Conclusion
Plantar calcaneal spurs are a common cause of heel pain, particularly in older adults and individuals who are overweight or have abnormal foot mechanics. While the exact cause of PCS remains debated, several theories suggest that factors like repetitive stress, increased weight, and aging contribute to their formation. Fortunately, most cases of PCS can be managed effectively with conservative treatments like stretching exercises, orthotics, and shockwave therapy. In rare cases, surgical intervention may be required.
If you’re experiencing heel pain and suspect that you may have a calcaneal spur, it’s important to consult with a healthcare provider for an accurate diagnosis and appropriate treatment.
Do you have more questions?
Q. What is a calcaneal spur?
A. A calcaneal spur is a bony outgrowth from the heel bone that forms where the plantar fascia connects to the heel.
Q. What causes a calcaneal spur?
A. Calcaneal spurs are caused by chronic inflammation of the plantar fascia leading to bone growth at the heel.
Q. What are the symptoms of a calcaneal spur?
A. Symptoms can include sharp pain in the heel, especially when standing up after rest, and pain during walking or running.
Q. How is a calcaneal spur diagnosed?
A. Diagnosis is typically made based on a clinical examination and confirmed with an X-ray showing the bony growth.
Q. Who is at risk of developing a calcaneal spur?
A. People who are obese, have flat feet or high arches, wear poorly fitting shoes, or engage in repetitive activities like running are at higher risk.
Q. How is a calcaneal spur treated initially?
A. Initial treatment includes rest, ice application, stretching exercises, orthotics, anti-inflammatory medications, and proper footwear.
Q. When is surgery considered for a calcaneal spur?
A. Surgery is considered when conservative treatments fail to relieve symptoms after an extended period.
Q. What does surgery for a calcaneal spur involve?
A. Surgery may involve removing the spur and releasing part of the plantar fascia to reduce tension.
Q. What is the recovery like after surgery for a calcaneal spur?
A. Recovery typically involves rest, gradual weight-bearing, physical therapy, and a slow return to activities.
Q. Can calcaneal spurs come back after treatment?
A. Yes, there is a possibility that a calcaneal spur can recur, especially if the underlying causes are not addressed.
Q. What non-surgical treatments help manage calcaneal spur pain?
A. Non-surgical treatments include stretching exercises, orthotic devices, physical therapy, proper footwear, and anti-inflammatory medications.
Q. How can calcaneal spurs be prevented?
A. Prevention involves maintaining a healthy weight, wearing supportive shoes, avoiding repetitive stress on the heel, and performing regular stretching exercises.
Q. Is a calcaneal spur the same as plantar fasciitis?
A. No, but they are closely related; plantar fasciitis refers to inflammation of the plantar fascia, while a calcaneal spur is a bony growth that may develop due to chronic inflammation.
Q. Why does the pain from a calcaneal spur feel worse in the morning?
A. Pain often feels worse in the morning because the plantar fascia tightens overnight, and stretching it during the first steps puts tension on the spur.
Dr. Mo Athar
