Does the slope and length of the plantar calcaneal spur affect the clinic?

Since some of the patients with plantar calcaneal spur (PCS) do not have pain, we aimed to investigate the effect of the slope and length of the spur on this situation. The length and slope of PCS were measured by examining the radiological images of 50 patients in this prospective study. VAS, AOFAS and FFI scores of the patients were determined. Patients were divided into groups according to PCS length and slope. According to the slope of the spur, the mean AOFAS, FFI and VAS scores were, respectively; 94, 38, 1.3 in below 20 degrees; 80.1, 86.8, 4.8 in 20-30 degrees; and 70.1, 106, 6.7 in above 30 degrees. According to the length of the spur, the mean AOFAS, FFI and VAS scores were respectively; 84.9, 68.2, 3.7 in those with length 0-5 mm; 81.1, 81.7, 4.5 in those with a length of 5-10 mm; and 71.7, 102.5, 6.4 in those with a length of >10 mm. A significant correlation was found between the angle and length of the PCS with the values of VAS, AOFAS and FFI (p<0.05). We observed that PCSs with a slope of less than 30 degrees and shorter than 10 mm do not create a serious clinical picture. If there is severe pain and functional impairment in individuals with this characteristic spur, investigation of other possible causes of heel pain must be considered.

Do the presence, size, and shape of plantar calcaneal spurs have any significance in terms of pain and treatment outcomes in patients with plantar fasciitis?

BACKGROUND: : The purpose of this study was to determine the effect of the presence, size, or type of calcaneal spurs on pain or the outcomes of extracorporeal shock wave therapy (ESWT) therapy in patients with plantar fasciitis. METHODS: Seventy-four patients with unilateral plantar fasciitis who had no pain in the contralateral foot, either currently or in the past, were included in the study. The length, base width, type, and presence of plantar calcaneal spurs in both heels of the patients were determined using radiography. A total of five sessions of ESWT (3 bar, 2000 shocks/session, 12 Hz frequency) with an interval of 3 days were performed on the painful sides of the patients. Symptom duration and numerical rating scale (NRS) scores were recorded pretreatment and 1 week and 12 weeks after treatment. RESULTS: : Spurs were detected in 85.1% of painful feet and 71.6% of painless feet, this difference was statistically significant (p = 0.046). There was no significant correlation between the type of the spurs and whether the foot was painful. Patients with spur sizes of >5 mm or with horizontal and hooked spurs had a higher NRS decrease than patients with spur sizes of ≤5 mm or with a vertical spur. Symptom duration, spur length, and base width were found to be correlated with pretreatment NRS scores. DISCUSSION: The presence and size of calcaneal spurs are associated with pain. However, it should be kept in mind that a high rate of spurs can also be found in painless feet, so spur is not the only factor that causes pain. Patients with a spur size of ≤5 mm or a vertical spur have less pain relief with ESWT.

Síndrome de Haglund: «¿Qué tengo en el talón?» / Haglund's syndrome: «What's wrong with my heel?»

Se presenta un caso de un síndrome de Haglund que cursa con dolor en retropié y se manifiesta con la tríada de tendinitis aquílea, bursitis retrocalcánea y deformidad de Haglund.Se diagnosticó clínica y radiológicamente (radiografía y ecografía) y la paciente recibió tratamiento conservador, con buena evolución.(AU)

We report a case of Haglund's syndrome that presents with hindfoot pain and the triad of Achilles tendinitis, retrocalcaneal bursitis and Haglund's lesion.This was diagnosed clinically and radiologically (x-ray and ultrasound) and the patient received conservative treatment with good course.(AU)

Prevalencia y biometría del espolón calcáneo en la población chilena: estudio radiológico / Prevalence and biometry of the calcaneal spur in the Chilean population: radiological study

RESUMEN: El dolor en la región calcánea del pie afecta aproximadamente a un tercio de los adultos mayores de 65 años. Asimismo, una gran cantidad de sujetos que consultan por esta condición, revelan hallazgos radiológicos de un crecimiento anormal en el hueso calcáneo, en su cara plantar, en forma de gancho denominado espolón calcáneo (EC). El objetivo del presente estudio fue relacionar la prevalencia y biometría de los EC en individuos chilenos según sexo y edad. Se realizó un estudio radiológico de tipo descriptivo-correlacional donde se revisaron al azar 400 radiografías de pies en proyección lateral de 200 sujetos chilenos entre 15 y 90 años. El análisis de los 200 exámenes radiográficos mostró que en 135 (67,5 %) de ellos presentaban EC de manera unilateral o bilateral. La presencia de al menos un EC era mayor en las mujeres 104 (52 %) que en los hombres 31 (15,5 %). Sin embargo, esta diferencia no es estadísticamente significativa p= 0,621. La edad promedio de los sujetos que presentaron EC era de 60,4 años, ampliamente superior a quien no lo presentaba (43,5 años), siendo esta diferencia estadísticamente significativa P<0,05. Se puede concluir una prevalencia del 67,5 % de EC en la población de estudio, mayor en las mujeres y directamente relacionada con la edad. Esta información podría ser de gran valor morfológico y médico debido a la escasa literatura existente sobre esta materia en individuos chilenos.

SUMMARY: Pain in the talar region of the foot affects approximately one third of people over 65 years of age. Likewise, a large number of patients who consult for this condition reveal radiological findings of an abnormal growth of the hook-shaped calcaneus called a calcaneal spur (CS). The objective of the present study was to relate the prevalence and biometrics of CS in Chilean individuals according to sex and age. A descriptive-correlational radiological study was carried out where 400 lateral projection radiographs of the feet of 200 Chilean patients between 15 and 90 years of age were randomly reviewed. The analysis of the 200 people examined showed that 135 (67.5%) presented CS unilaterally or bilaterally. The presence of at least one CS is greater in the female sex 104 (52%) than in the male sex 31 (15.5%), however, this difference is not statistically significant p = 0.621. The average age of the people who presented CS is 60.43 years, much higher than those who do not present (43.51 years), this difference being statistically significant P = Sig. It can be concluded a prevalence of 67.5% of CS in the study population, higher in the female sex and directly related to age. This information will be of great morphological and medical value due to the little existing literature on this matter in Chilean individuals.

The relationship between age-related incidences of heel spur with sex and side / Relación entre la incidencia del espolón calcáneo con la edad, sexo y lado

SUMMARY: Heel spur is an osteophytic protrusion larger than 2 mm that lies just anterior to the tuberosity of the calcaneus. Heel spur can be of two types: plantar heel spur and dorsal heel spur. The aim of this study was to evaluate the relationship between the heel spurs incidence with age, sex and side. A total of 2000 bilateral radiographs of 1000 patients (518 men and 482 women) aged 20-93 years who applied to Terme state hospital, Samsun, Turkey due to trauma were examined. Patients were grouped into 10 year age ranges (20-29 years; 30-39 years; 40-49 years; 50-59 years; 60-69 years and over 70 years). The incidences of plantar heel spur, dorsal heel spur, and both were evaluated according to age, sex and side relations. Plantar or dorsal heel spurs were detected in 32.6 % (326 patients) of the patients. The incidences of plantar heel spur, dorsal heel spur, plantar and dorsal heel spur were 26.0 %, 16.9 %, and 10.3 % respectively. According to sex, the incidence of plantar heel spur was higher in women in all age groups. Although the incidence of dorsal heel spur was higher in men in the 6th decade, it was more common in women in other age groups. The incidence of plantar heel spur was 2.615 times higher in the right foot and 2.810 times higher in the left foot in women. As the age increased, the risk of plantar heel spur increased 1.060 times in the right foot and 1.061 times in the left foot. The incidence of dorsal heel spur was 1.510 times higher in the right foot and 1.715 times higher in the left foot in women. As the age increased, the incidence of dorsal heel spur increased in both feet and this increase was 1.055 times in both feet.

RESUMEN: El espolón calcáneo es una protuberancia osteofítica de más de 2 mm que se encuentra por delante de la tuberosidad del calcáneo. El espolón calcáneo puede ser de dos tipos: espolón calcáneo plantar y espolón calcáneo dorsal. El objetivo de este estudio fue evaluar la relación entre la incidencia de espolón calcáneo con la edad, el sexo y el lado. Se examinaron un total de 2000 radiografías bilaterales de 1000 pacientes (518 hombres y 482 mujeres) de 20 a 93 años de edad que fueron solicitadas en el hospital estatal de Terme, Samsun, Turquía debido a un traumatismo. Los pacientes se agruparon en rangos de edad de 10 años (20-29 años; 30-39 años; 40-49 años; 50-59 años; 60-69 años y mayores de 70 años). Las incidencias de espolón calcáneo plantar, espolón calcáneo dorsal y ambos se evaluaron de acuerdo con la edad, el sexo y lados. Se detectaron espolones calcáneos plantares o dorsales en el 32,6 % (326 pacientes) de los pacientes. Las incidencias de espolón calcáneo plantar, espolón calcáneo dorsal, espolón calcáneo plantar y dorsal fueron del 26 %, 16,9 % y 10,3 %, respectivamente. Según el sexo, la incidencia de espolón calcáneo plantar fue mayor en mujeres en todos los grupos de edad. Aunque la incidencia del espolón calcáneo dorsal fue mayor en hombres en la sexta década, era más común en mujeres en otros grupos de edad. La incidencia de espolón calcáneo plantar fue 2,6 veces mayor en el pie derecho y 2,8 veces mayor en el pie izquierdo en mujeres. A medida que aumentaba la edad, el riesgo de espolón calcáneo plantar aumentaba 1,06 veces en el pie derecho y 1,061 veces en el pie izquierdo. La incidencia de espolón calcáneo dorsal fue 1,510 veces mayor en el pie derecho y 1,715 veces mayor en el pie izquierdo en mujeres. A medida que aumentaba la edad, la incidencia de espolón calcáneo dorsal aumentaba en ambos pies y este aumento era de 1,055 veces en ambos pies.

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.

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 methods: We 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. Results: 181 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 (1.11­11.0) and p = 0.033]. Conclusion: The 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.

Radiologic and Demographic Characteristics of Patients With Plantar Calcaneal Spur.

Many people with heel pain in the general population are often diagnosed with plantar calcaneal spurs (PCS). The aim of this study was to evaluate the radiological and demographic characteristics of PCS patients and to compare the differences with the control group. In 2018, 420 patients with weightbearing lateral ankle X-ray images were included in the study. The patients were divided into 2 groups as PCS group and control group. Groups were compared age and age group (20-29, 30-39, 40-49, 50-59, 60-69, 70 and over) weight, height, body mass index (<25, 25-30, >30), chronic diseases as demographically and were also compared radiologically as calcaneal inclination angle (CIA), lateral talocalcaneal angle (LTCA), Bohler angle and Gissane angle. A statistically significant relationship was found between gender and PCS. Plantar calcaneal spur is more common in females than in males (X2:8.101, p < .03). PCS was less common in patients with BMI <25 and 25-29.9, whereas PCS is more common in patients with BMI >30 (X2:7.698, p < .021). Although the CIA angle was within normal limits in both groups, it was significantly lower in patients with PCS than in the control group(p < .05). There was no statistically significant difference between the 2 groups in terms of age, chronic disease, LTCA, Bohler angle, Gissane angle. Female gender and obesity are among the risk factors for PCS formation. CIA may have an important role in PCS formation. In order to clarify the etiology and pathophysiology of PCS, further studies with radiological features are needed.

A Radiographic Study of Biomechanical Relationship between the Achilles Tendon and Plantar Fascia.

BACKGROUND: Previously, scholars have concluded that the Achilles tendon and the plantar fascia were closely biomechanically related, although there is little clinical evidence of the relationship between the two. To investigate the biomechanical relationship between the Achilles tendon and the plantar fascia, the author used standing lateral ankle radiographs of patients with insertional Achilles tendonitis to determine the biomechanical relationship between the Achilles tendon and plantar fascia. METHODS: The author collected standing lateral ankle radiographs from patients with insertional Achilles tendonitis who accepted surgical treatment in the author's hospital from March 2009 to July 2018. According to whether there were bone spurs on the posterior side of the calcaneus, patients were divided into group A (spur present on the posterior side) and group B (spur not present on the posterior side). The positive rates of spurs on the plantar side of the calcaneus were determined in group A and group B. The chi-square test was used to compare the measurement results between the two groups. RESULTS: In group A, 13 heels were positive for calcaneal bone spurs, and the positive rate was 65.0%. In group B, 3 heels were positive for plantar calcaneal spurs, and the positive rate was 12%. Among all 16 patients with positive plantar calcaneal spurs, 13 had posterior calcaneal spurs (accounting for 81.3%), and 3 had negative results, accounting for 18.7%. There was a significant difference between the results in groups A and B (P < 0.05). CONCLUSION: There is a relationship between posterior calcaneal spurs and plantar calcaneal spurs in patients with insertional Achilles tendonitis, which can be inferred as resulting from the increasing tension in the biomechanically complex relationship between the Achilles tendon and the plantar fascia.

[Open Heel Spur Surgery - Our Experience]. / Resekce patní ostruhy operacní cestou ­ nase zkusenosti.

PURPOSE OF THE STUDY The plantar calcaneal spur (inferior calcar calcanei) is a frequent source of foot pain. The study presents the results of calcaneal spur excision by open surgery. It covers the indication, surgical approach, postoperative care, and presents the results reported at least one year after the surgery. MATERIAL AND METHODS The group consists of 42 heel spurs in 41 patients operated on in the period 2000-2016. The mean age was 44.5 years, with the age range 37-75 years. In 18 cases the surgery was performed on the right side, in 24 cases on the left side, the group was composed of 24 women and 17 men. Difficulties were suffered for the period of 8 months to 10 years before the surgery, the conservative treatment always continued for at least 6 months. The patients were assessed by the AOFAS questionnaire and the VAS score preoperatively and at 6 and 12 months postoperatively. Also, control radiographs were used to assess any potential recurrence. The surgical approach, the surgery per se and the postoperative care are described in detail. RESULTS The AOFAS score was 56 (45-75) preoperatively, 89.8 (82-98) at 6 months postoperatively and 90.4 (82-98) at one year after the surgery. The VAS score was 7 (5-9) preoperatively, 2 (0-4) at 6 months postoperatively, and 2 (0-3) at one year after the surgery. The average operative time was 35 minutes (20-50). The average length of stay in hospital was 3.8 days (2-5). The average duration of postoperative treatment was 16 weeks (12-26). Early complications involved one case of paresthesia experienced along the outside of the foot, which faded away. In one case the control radiograph at a one-year follow-up revealed recurrence of a heel spur. DISCUSSION Removal of plantar calcaneal spur is indicated after the conservative treatment options have been exhausted. By open surgery, results comparable to arthroscopy are achieved, but with fewer complications, while providing a better view of the surgical wound, a possibility to perform additional interventions in this region under visual control, a considerably lower exposure to X-ray, and it is also inexpensive. The scar is of minimum size and comparable to those after arthroscopy. CONCLUSIONS Heel spur surgery is a safe procedure with minimum complications. Nonetheless, it is indicated only once the conservative treatment options have been exhausted. Key words:calcaneus bone, plantar calcaneal spur.

Plantar fasciitis treated with endoscopic partial plantar fasciotomy-One-year clinical and ultrasonographic follow-up.

BACKGROUND: Endoscopic operations for plantar fasciitis generally have good clinical outcome. The aim of this study was to record the effect of endoscopic partial fasciotomy and heel spur removal and evaluate by ultrasonography whether the fascia regenerates and the heel spur reforms. METHODS: Eleven consecutive patients were evaluated before and 3, 6 and 12 months after surgery. Operations were performed endoscopically using a deep fascial approach with a medial and a lateral portal. Bony spurs were removed and the medial half of the plantar fascia was transected. All patients followed a standardized rehabilitation program. RESULTS: Median Foot Function Index values decreased from 119 pre-surgery to 69 and 12 (p=0.004), at 3 months and 1year post-operatively respectively. Median VAS-score for first step pain was likewise reduced from median 71mm to 29mm and 7mm (p=0.004), respectively. Median fascial thickness at the medial insertion was 6.0mm (range 4.6-6.8mm) pre-operatively. A heel spur was present in 9 cases. One year postoperatively a well-defined fascia in the area of resection was demonstrated in 8 cases. In the rest of the cases scar tissue made it impossible to clearly outline the fascia. Nine of the feet showed good medial fascial tensioning. There was no evidence of recurrence of the bony spur. CONCLUSIONS: Endoscopic partial plantar fascia resection reduced pain symptoms and increased function significantly 3 months after operation, with additional effect achieved 12 months after surgery. Based on ultrasonography the resected fascia regenerated/healed, and a calcaneal spur did not recur.

A Rare Cause of Heel Pain: A Calcaneal Spur Fracture.

Heel pain is a complaint frequently encountered in orthopedic clinics that has peculiar symptoms and may have various etiologic causes. Calcaneal spur fracture is an extremely rare cause of heel pain, and only four cases had previously been reported in the English language literature. We present a 45-year-old woman who had heel pain on her right foot after falling from a height onto the heel. Radiographic examination of her right foot showed a fractured calcaneal spur, which was successfully treated with conservative methods. Calcaneal heel pain is a complaint that may be attributable to many different etiologic causes, which often have specific symptoms, and we frequently encounter them in the orthopedic clinic. Calcaneal spur fracture after trauma should be remembered in the differential diagnosis of heel pain as a rare cause. Our case is the fifth reported case in the English language literature of this extremely rare condition.

Coexistence of plantar calcaneal spurs and plantar fascial thickening in individuals with plantar heel pain.

Objectives: To examine associations between plantar calcaneal spurs, plantar fascia thickening and plantar heel pain (PHP), and to determine whether tenderness on palpation of the heel differentiates between these presentations. Methods: Adults aged ⩾50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months underwent a detailed clinical assessment. PHP in the past month was documented using a foot manikin. Plantar calcaneal spurs were identified from weight-bearing lateral radiographs and plantar fascia thickening (defined as >4 mm) from ultrasound. Tenderness on palpation of the plantar fascia insertion was documented. Associations between these factors and PHP were explored using generalized estimating equations. Results: Clinical and radiographic data were available from 530 participants (296 women, mean [s.d.] age 64.9 [8.4] years), 117 (22.1%) of whom reported PHP. Plantar calcaneal spurs and plantar fascia thickening were identified in 281 (26.5%) and 501 (47.3%) feet, respectively, but frequently coexisted (n = 217, 20.4%). Isolated plantar calcaneal spurs were rare (n = 64, 6.0%). Participants with PHP were more likely to have a combination of these features compared with those without PHP (odds ratio 2.16, 95% CI 1.24, 3.77, P = 0.007). Tenderness on palpation of the heel was not associated with plantar calcaneal spurs or plantar fascia thickening, either in isolation or in combination, in those with PHP. Conclusion: Plantar calcaneal spurs and plantar fascial thickening are associated with PHP, but frequently coexist. Tenderness on palpation of the heel does not appear to differentiate between clinical presentations of PHP.

Digit-Like Bony Anomaly of the Hindfoot: A Case Report.

We report the case of an asymptomatic digit-like bony anomaly located on the plantar aspect of the calcaneus, which was incidentally found on radiographs of a 50-year-old male with a tibial shaft fracture. To the best of our knowledge, this is the first description of such an anomaly in the foot. The differential diagnosis includes accessory ossicles, polydactyly, heel spur, heterotopic ossification, osteochondroma, and pelvic digits.

Mid-Sole Release of the Plantar Fascia Combined With Percutaneous Drilling of the Calcaneus for Treatment of Resistant Heel Pain.

BACKGROUND: Heel pain with or without calcaneal spur is a challenging problem. Once conservative measures have failed, surgery may be indicated; there has been debate about the best surgical procedure. Two standard operative procedures have been either releasing the plantar fascia or removing the spur with drilling of the calcaneus. In this study, we evaluated the results of percutaneous drilling of the calcaneus combined with mid-sole release of the plantar fascia for treatment of resistant heel pain. METHODS: This study included 20 cases with resistant heel pain after failure of conservative measures for 6 months. Clinical, radiological evaluation and scoring patients' conditions according to the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scale was done preoperatively and postoperatively. Percutaneous drilling of the calcaneus combined with mid-sole release of the plantar fascia was done in all cases, and the functional results were evaluated through the follow-up period that extended from 9 to 16 months with a mean duration of 12 ± 2.3 months. RESULTS: There was statistically significant improvement in the mean AOFAS Ankle-Hindfoot scale score from 50.8 ± 7.5 preoperatively to 91.6 ± 7 postoperatively at the last follow-up. There were no surgery-related complications, and the mean time for full recovery was 8 ± 3.7 weeks with no recurrence of pain by the last follow-up. CONCLUSIONS: The results were very satisfactory with using this minimally invasive and simple technique for treatment for resistant heel pain. LEVEL OF EVIDENCE: Level IV, retrospective case series.

The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations.

The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain.

Classification of Calcaneal Spurs and Their Relationship With Plantar Fasciitis.

Calcaneal spurs, as a cause of plantar fasciitis, are currently debatable. A prospective study was performed to classify calcaneal spurs according to the findings from an investigation of the relationship between calcaneal spurs and plantar fasciitis. Thirty patients with calcaneal spurs and plantar heel pain underwent calcaneal spur removal and endoscopic plantar fasciotomy. The relationship between the classification of calcaneal spurs and plantar fasciitis was evaluated by endoscopic findings, clinical symptoms, radiographic images, and biopsy findings. The visual analog scale for pain and the American Orthopedic Foot and Ankle Society ankle-hindfoot scores for functional evaluation were used preoperatively and postoperatively, respectively. The mean follow-up period was 24 months. Two separate types of calcaneal spurs were recognized. Type A calcaneal spurs were located superior to the plantar fascia insertion, and type B calcaneal spurs were located within the plantar fascia. Magnetic resonance imaging results showed a more severe plantar fasciitis grade in type B calcaneal spurs preoperatively. Histologic examination showed that the numbers of granulocytes per image in type B spurs were significantly increased compared with those in type A spurs. Statistically significant improvements were found in the mean visual analog scale and American Orthopedic Foot and Ankle Society scores and magnetic resonance imaging results in both groups. The amount of change in the visual analog scale score and American Orthopedic Foot and Ankle Society score, the number of granulocytes per image, and calcaneal spur length showed a high association with the classification of the calcaneal spurs. Calcaneal spurs were completely removed and did not recur in any of the patients on radiographic assessment during the follow-up period. Calcaneal spurs can be classified into 2 distinct types that are indicative of the severity of plantar fasciitis.

Role of radiotherapy in the management of heel spur.

AIMS AND BACKGROUND: The purpose of this study is to investigate the use of low-dose radiotherapy (RT) in benign painful heel spur management. METHODS: Between the years of 2009 and 2012, in Gulhane Military Medical Academy Radiation Oncology Department, patients with heel spur undergoing radiotherapy for pain relief were analyzed retrospectively. In the evaluation of treatment response, Verbal Numeric Scale (VNS) scoring method was used to compare the pain status before and after radiotherapy. Age, gender, laterality, VNS score before RT, VNS score after RT, RT doses of the patients and patients undergoing second course of radiotherapy were recorded. All patients received 8 Gy RT in two fractions with Co-60 teletherapy machine. Statistical Package for Social Sciences, version 16.0 was used for data analysis with the level of significance set at p < 0.05. RESULTS: The total number of patients receiving RT for heel spur pain was 450. Median age was 52 years (range 40-85 years). Two hundred and ninety-two (65%) of the patients were women and 158 (35%) were men. Radiologically calcaneal spurs were bilateral in 432 (96%) patients, whereas unilateral left in 8 (1.8%) patients and unilateral right heel location in 10 (2.2%) patients. Ten (2.2%) of the patient group received second course of RT due to refractory pain. Comparative evaluation of VNS scores before and after RT revealed statistically significant pain relief by radiotherapy (p < 0.05). CONCLUSION: Low-dose radiotherapy is an effective and reliable painkilling treatment method that can be used in the treatment of epin calcanei refractory to medical and surgical treatment.

Radiological characteristics of the calcaneal spurs in psoriatic arthritis.

OBJECTIVES: Inflammation at the entheses is a distinguishing feature of psoriatic arthritis (PsA). Enthesitis at the heel is the most common location at the Achilles and plantar fascia insertions on the calcaneus. This study aimed to 1) describe the morphological features and measurements of plantar calcaneal spurs in subjects with PsA and controls and 2) determine radiological features that differentiate between inflammatory and non-inflammatory calcaneal spurs. METHODS: Weight bearing lateral foot radiographs of 101 subjects with PsA and 38 control subjects without inflammatory arthritis were examined for plantar calcaneal and Achilles spurs. Three measurements were taken from each radiograph: plantar spur base, mid-segment, and length in millimeters. The differences in radiographic measurements, and the presence of fluffy periostitis of the plantar spurs were then compared between PsA patients and controls. RESULTS: Of the 101 subjects with PsA, 76 (75%) had at least one plantar calcaneal spur and 32 (31.5%) had at least one Achilles tendon spur, compared to 18 (47%) and 3 (8%) respectively in control group (p=0.004). Fluffy plantar periostitis was identified in 14 PsA subjects and none of the controls (p=0.01). The dimensions of plantar spurs were significantly different between groups - longer mid-segment distinguished patients with PsA from controls. CONCLUSIONS: Calcaneal spurs are more common in subjects with PsA than controls. Longer mid-segment measurement was associated with PsA. This study indicates that the presence of fluffy plantar periostitis and broad based and longer mid-segment dimensions are radiological features for inflammatory spurs.