Calcaneal Spurs

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Definition/Description

A calcaneal spur occurs when there is a bone spur, a small bony outgrowth, formed on the heel bone. A more common name for calcaneal spur is heel spur. Calcaneal spurs can be located at the back of the heel or under the sole. Spurs at the back are often associated with Achilles tendonitis, while spurs under the sole are associated with plantar fasciitis.

Epidemiology /Etiology

The etiology of the spur have 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 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.  

Characteristics/Clinical Presentation

The painful heel is a relatively common foot problem but calcaneal spurs are not considered a primary cause of heel pain. Most heel pain patients are middle-aged adults. Many of them are obese, so obesity can be considered a risk factor.

Not all heel spurs cause symptoms but when they to people often experience more pain during weight-bearing activities, in the morning or after a period of rest. The pain however is not the result of pressure of weight on the top of the spur but the experienced pain is coming from an inflammation around tendons where they attach to the bone.  

Differential Diagnosis 

1. Calcaneal stress fracture
2. Nerve entrapment
3. Peroneal Tendinopathy
4. Syndrome- sinus tarsi / Tarsal tunnel 
5. Sever disease (Calcaneal apophysitis)
6. Haglund Deformity (With or without busitis) 

Diagnostic Procedures

The diagnose is based on the patient's history and on results of the physical examination. The suspicion diagnose is confirmed mostly in the X-ray on the calcaneus. Rarely MRI may be required.

Clinical Examination

The assessment should include :

1. Posture of foot (with and without weight bearing & with and without footwear) 
2. Tenderness (Site/ Severity)
3. Range of Motion in ankle and foot
4. Muscle Strength
   
5. Sensation
6. Gait

Medical Management

1. Non steroidal anti inflammatory drugs
2. Steroids - oral /injections

Non Medical Management

Physiotherapy

Calcaneal spurs, both upper and lower spurs, are treated with conventional physiotherapy. 

• Conventional therapy includes ultrasound, Laser, passive and active stretching and strengthening of the muscles of the legs and cold and warmth applications (Contrast Bath). The aim is to eliminate the inflammation surrounding the spur. This kind of treatment may take 6 to 12 months.
• Another proven therapy (D'andrea greve et al., 2009, B)  is radial shockwave therapy. This method consists of very high-energy mechanical waves, pointed at the calcaneal spur. By the growth of blood vessels the inflammation shall be taken away.

• D'andrea greve et al.(2009, B)  claim that their is no difference between both methods of treatment.

                        However there are different studies who claim ESWT is not effective in the treatment of plantar fasciitis. (Buchanan et al. 2002, A2; Haake et al. 2003, A2)   Because of this discrepancy between studies, further support for an effective treatment with ESWT is needed. According to De Vera Barredo et al.(2007, A1)  night splints, massage, taping, acupuncture, walking casts, laser therapy and cryotherapy are more means to help the patient.

Orthosis

1. Night Splints
2. Heel inserts        
3. Foot wear Modification 

When neither of these treatments take away the problem, more aggressive techniques like surgery can be employed.

Resources

 Buzzle.com, Intelligent Life on the web. Calcaneal spur. http://www.buzzle.com/articles/calcaneal-spur.html (accessed 15 november 2010)
MedicineNet.com. Definition of calcaneal spur. http://www.medterms.com/script/main/art.asp?articlekey=7095 (accessed 15 november 2010)

Recent Related Research (from Pubmed)

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