Calcaneal Spur

Understanding Plantar Calcaneal Spurs: A Detailed Review

What is a Plantar Calcaneal Spur (PCS)?

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:

  1. 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.
  2. 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.
  3. 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:

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These medications help reduce pain and inflammation associated with PCS.
  2. Physical Therapy: Stretching exercises targeting the gastrocnemius-soleus muscles can help improve flexibility and relieve tension on the plantar fascia.
  3. Orthotic Devices: Custom shoe inserts can help redistribute pressure on the heel and provide cushioning to reduce pain.
  4. Extracorporeal Shock Wave Therapy (ESWT): This therapy uses high-energy sound waves to stimulate healing in the affected area and reduce pain.
  5. Cryo-Ultrasound Therapy: This treatment combines cold therapy and ultrasound to reduce inflammation and alleviate pain.
  6. 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.