A 48-year-old woman presents with a 6-month history of heel pain. The pain is worse in the morning and is aggravated throughout the day by repetitive walking on cement floors at work. On physical examination, she has tenderness over the plantar fascia and the plantar heel. A lateral radiograph is taken of the affected heel (Figure).
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Heel pain is one of the most common musculoskeletal complaints seen by primary care providers and plantar fasciitis is the leading cause of heel pain.1,2 A calcaneal heel spur is a common finding on lateral radiographs in patients with plantar fasciitis and is often a trigger for an orthopedic referral. However, no direct correlation exists between a heel spur and plantar fasciitis. A plantar heel spur is found in 12% of the population and few develop plantar fasciitis.1
The development of a heel spur is thought to be multifactorial and not caused by plantar fasciitis. Factors such as repetitive stress to the heel, tight plantar fascia, and a genetic predisposition for bone spur formation (patients with osteoarthritis, psoriatic arthritis, rheumatoid arthritis, and ankylosing spondylitis) are thought to play a role.2
Obesity is a strong risk factor for developing chronic heel pain and calcaneal spurs. Calcaneal heel spurs also increase in frequency with advanced age (55% of patients are aged 62 years and older), which is thought to be caused by ligament ossification with aging.2
The majority of patients with heel pain and spurs do well with conservative treatments including stretching, ice, nonsteroidal anti-inflammatory drugs, night splints, immobilization, steroid injections, and shock wave therapy (treatment usually progresses in that order). Surgical release of the plantar fascia and excision of the heel spur may be considered in chronic cases, however, heel spur excision alone is not a surgical option as the spur is not the etiology of heel pain.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
1. Moroney PF, O’Neill BJ, Khan-Bhambro K, O’Flanagan SJ, Keogh P, Kenny PJ. The conundrum of calcaneal spurs: do they matter? Foot Ankle Spec. 2014;7(2):95-101. doi:10.1177/1938640013516792
2. Kirkpatrick J, Yassaie O, Mirjalili SA. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations. J Anat. 2017;230(6):743-751. doi:10.1111/joa.12607