Abstract
Calcaneal spurs are a common cause of heel pain. They can occur anywhere along the calcaneal tuberosity but are most frequently found at the insertion of the plantar fascia. Calcaneal spurs are usually asymptomatic, but when they are painful, the condition is generally the result of inflammation of the insertional fibers of the plantar fascia at the medial tuberosity. Symptomatic calcaneal spurs are often found in association with plantar fasciitis. Like plantar fasciitis, calcaneal spurs can occur alone or may be part of a systemic inflammatory condition such as rheumatoid arthritis, Reiter’s syndrome, or gout. In some patients, the cause seems to be entirely mechanical, and such patients often exhibit an abnormal gait with excessive heel strike. High-impact aerobic exercise has also been implicated in the development of calcaneal spur syndrome.
Keywords
calcaneal spur, calcaneus, Haglund’s deformity, heel pain, foot pain, sports injury, plantar fasciitis, diagnostic sonography, ultrasound guided injection
ICD-10 CODE M77.30
Keywords
calcaneal spur, calcaneus, Haglund’s deformity, heel pain, foot pain, sports injury, plantar fasciitis, diagnostic sonography, ultrasound guided injection
ICD-10 CODE M77.30
The Clinical Syndrome
Calcaneal spurs are a common cause of heel pain. They can occur anywhere along the calcaneal tuberosity but are most frequently found at the insertion of the plantar fascia ( Fig. 135.1 ). Calcaneal spurs are usually asymptomatic, but when they are painful, the condition is generally the result of inflammation of the insertional fibers of the plantar fascia at the medial tuberosity. Symptomatic calcaneal spurs are often found in association with plantar fasciitis. Like plantar fasciitis, calcaneal spurs can occur alone or may be part of a systemic inflammatory condition such as rheumatoid arthritis, Reiter’s syndrome, or gout. In some patients, the cause seems to be entirely mechanical, and such patients often exhibit an abnormal gait with excessive heel strike. High-impact aerobic exercise has also been implicated in the development of calcaneal spur syndrome ( Fig. 135.2 ).
Signs and Symptoms
The pain of calcaneal spurs is most severe when first walking after a period of non–weight bearing and is made worse by prolonged standing or walking. On physical examination, patients exhibit point tenderness over the plantar medial calcaneal tuberosity; they may also have tenderness along the plantar fascia as it moves anteriorly. The pain of calcaneal spurs is increased by weight bearing and is relieved by padding of the affected heel.
Testing
Plain radiographs are indicated in all patients who present with pain thought to be caused by calcaneal spurs, to confirm the diagnosis, as well as to rule out fracture of the spur, occult bony disorders, and tumor. Characteristic radiographic changes are lacking, but radionuclide bone scanning may show increased uptake at the point where the plantar fascia attaches to the medial calcaneal tuberosity ( Fig. 135.3 ). Magnetic resonance imaging (MRI) and ultrasound imaging of the foot are indicated if calcaneal spurs, an occult mass, or a tumor is suspected ( Figs. 135.4 and 135.5 ). MRI, ultrasound imaging, and radionuclide bone scanning may also be useful to exclude stress fractures and other occult findings not visible on plain radiographs ( Fig. 135.6 ). Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, prostate-specific antigen level, erythrocyte sedimentation rate, and antinuclear antibody testing. The injection technique described later serves as both a diagnostic and a therapeutic maneuver.
