Plantar Fasciatis/Calcaneal Spurs

Question 1

Calcaneal Spurs - Definition/Description

Answer 1

occurs when a bony outgrowth forms on the heel bone.

Calcaneal spurs can be located at the back of the heel (dorsal heel spur) or under the sole (plantar heel spur).

The dorsal spurs are often associated with achilles Tendinopathy, while spurs under the sole are associated with Plantar fasciitis

The origin of the spurs appears to be caused by repetitive trauma which produces micro tears in the plantar fascia near its attachment and the attempted repair leads to inflammation which is responsible for the production and the maintenance of the symptoms

Question 2

Cause of pain ? (calcaneal spur)

Answer 2

The apex of the spur lies either within the origin of the planter fascia (on the medial tubercle of the calcaneus)
or superior to it (in the origin of the flexor digitorum brevis muscle).

The relationship between spur formation, the medial tubercle of the calcaneus and intrinsic heel musculature results in a constant pulling effect on the plantar fascia resulting in an inflammatory response.

Question 3

Calcaneal Spur causes?

Answer 3

Current reasoning is that abnormal biomechanics (excessive or abnormal pronation) is the prime etiological factor for a painful plantar heel and inferior calcaneal spur. The spur is thought to be a result of the biomechanical fault and an incidental finding when associated with a painful plantar heel. The most common etiology is thought to be abnormal pronation which results in increased tension forces within the structures that attach in the region of the calcaneal tuberosity.

may develop as a reaction to plantar fasciitis

Question 4

Calcaneal Spur - presentation ?

Answer 4

Most heel pain patients are middle-aged adults. Obesity may be considered a risk factor. Not all heel spurs cause symptoms and are often painless, but when they do cause symptoms people often experience more pain during weight-bearing activities, in the morning or after a period of rest. The pain, however, is not as a result of mechanical pressure on the spur, but from the inflammatory response.

Question 5

Plantarfasciitis - role?

Answer 5

During weight-bearing, the tibia loads the the foot “truss” and creates tension through the plantar fascia (windlass mechanism). The tension created in the plantar fascia adds critical stability to a loaded foot with minimal muscle activity. Evidence of the important stabilizing nature of the plantar fascia is evidence when following cases post surgical releas which may lead to midfoot arthritis, rupture of the secondary stabilizers of the arch (e.g spring ligament) , as well as other pathologies

Question 6

Plantarfasciitis - risk factors?

Answer 6

Loss of ankle dorsiflexion (talocrural joint, deep or superficial posterior compartment)
Pes cavus OR pes planus deformities
Excessive foot pronation dynamically
Impact/weight bearing activities such as prolonged standing, running, etc
Improper shoe fit
Elevated BMI > kg/m2
Diabetes Mellitus (and/or other metabolic conditions

Question 7

Plantarfasciitis - presentation?

Answer 7

Heel pain with first steps in the morning or after long periods of non-weight bearing
Tenderness to the anterior medial heel
Limited dorsiflexion and tight achilles tendon
A limp may be present or may have a preference to toe walking
Pain is usually worse when barefoot on hard surfaces and with stair climbing
Many patients may have had a sudden increase in their activity level prior to the onset of symptoms