IJAR.2023.157
Type of Article: Original Research
Volume 11; Issue 3 (September 2023)
Page No.: 8670-8676
DOI: https://dx.doi.org/10.16965/ijar.2023.157
Heel Pain and Calcaneal Enthesophytes: A Radiological Evaluation
Archana Rani 1, Rakesh Kumar Verma 2, Arvind Kumar Pankaj 3, Nikhil Aggarwal 4, Rakesh Kumar Diwan 5, Garima Sehgal *6
1 Professor, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India. ORCiD: 0000-0003-3057-7743
2 Professor Jr. Grade, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India. ORCiD: 0000-0002-8984-7587
3 Professor Jr. Grade, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India. ORCiD: 0000-0002-4270-0756
4 Senior Resident, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India. ORCiD: 0000-0002-4653-7060
5 Professor, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India. ORCiD: 0000-0002-3886-204X
*6 Professor Jr. Grade, Department of Anatomy, King George’s Medical University, Uttar Pradesh, Lucknow, India. ORCiD: 0000-0002-4987-5487
Corresponding Author: Dr. Garima Sehgal, Department of Anatomy, King George Medical University, Shah Mina Road, Lucknow, Uttar Pradesh, India. – 226003 E-Mail: garimasehgal@kgmcindia.edu
ABSTRACT
Introduction: The calcaneal spur is the leading cause of heel pain. While prior anatomical studies have often utilized cadaveric specimens, there is a dearth of data correlating heel pain with the presence of a calcaneal spur across different age groups and gender.
Aim: To evaluate the association of heel pain with plantar, dorsal, or both calcaneal spur and their correlation with age and gender in the North Indian population.
Materials and Methods: A cross-sectional observational study was conducted at King George’s Medical University UP, Lucknow, from January 2023 to March 2023. Informed consent from the patients and ethical approval from the institutional research committee was obtained for this research. Lateral radiographs of ankle joints of 213 patients attending orthopedics OPD with complaints of heel pain were reviewed independently by two observers. The age and sex of the patients were also noted. Data were statistically analyzed using Statistical Package for Social Sciences (SPSS) v23.
Results: In 186 (87.32%) patients with heel pain, Calcaneal spur was present. A maximum number of subjects with heel pain were noticed in the age group 51-60 years for both males and females. Plantar and dorsal spurs were highly prevalent in males than females. Plantar spurs were found to be more common than dorsal spurs.
Conclusion: Most heel pains were associated with a spur, and the prevalence of spur differed between men and women due to differences in their daily activities and occupation. This study provides vital information for orthopedic surgeons treating heel pain patients daily.
Key words: plantar spur, dorsal spur, heel, pain, calcaneum.
REFERENCES
[1]. Plettner P: Exostosen des Fersenbeins. Jahresbericht der GesellschaftfürNatur und Heilkunde in Dresden, 1900.
[2]. Micke O, Seegenschmiedt MH: German cooperative group on radiotherapy for benign diseases. Radiotherapy in painful heel spurs (plantar fasciitis) – Results of a national patterns of care study. Int J Radiat Oncol Biol Phys. 2004, 58:828-43. 10.1016/S0360-3016(03)01620-1
[3]. Healey JE, Seybold WD, Johnson D, Osburn WA: A Synopsis of Clinical Anatomy. WB Saunders, Philadelphia, London, Toronto; 1969.
[4]. Robinson HM: Symmetrical reversed plantar calcaneal spurs in children. A normal variant? Radiology. 1976, 119:187-8. 10.1148/119.1.187
[5]. Mücke R, Schönekaes K, Micke O, Seegenschmiedt MH, Berning D, Heyder R: Low-dose radiotherapy for painful heel spur. Retrospective study of 117 patients. Strahlenther Onkol. 2003, 179:774-8. 10.1007/s00066-003-1126-9
[6]. Johal KS, Milner SA: Plantar fasciitis and the calcaneal spur: Fact or fiction? Foot Ankle Surg. 2012, 18: 39-41. 10.1016/j.fas.2011.03.003
[7]. Akkaya S, Akkaya N, Yıldız N, Atalay NS, Fındıkoglu G, Sarsan A, Sahin F: The association of physical examination findings and functional status with radiological and clinical variables in plantar heel pain. Romatol Tıp Rehab. 2011, 21:1-5. 10.21653/tfrd.403242
[8]. Menz HB, Zammit GV, Landorf KB, Munteanu SE: Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? J Foot Ankle Res. 2008, 1:1-7. 10.1186/1757-1146-1-7
[9]. Bergmann JN: History and mechanical control of heel spur pain. Clin Podiatr Med Surg. 1990, 7:243-59.
[10]. Kumai T, Benjamin M: Heel spur formation and the subcalcaneal enthesis of the plantar fascia. J Rheumatol. 2002, 29:1957-64.
[11]. Li J, Muehleman C: Anatomic relationship of heel spur to surrounding soft tissues: greater variability than previously reported. Clin Anat. 2007, 20:950-5. 10.1002/ca.20548
[12]. Weiss E: Calcaneal spurs: examining etiology using prehistoric skeletal remains to understand present day heel pain. Foot (Edinb). 2012, 22:125-9. 10.1016/j.foot.2012.04.003
[13]. Williams PL, Smibert JG, Cox R, Mitchell R, Klenerman L: Imaging study of the painful heel syndrome. Foot Ankle. 1987, 7: 345–9. 10.1177/107110078700700607
[14]. Prichasuk S, Subhadrabandhu T: The relationship of pes planus and calcaneal spur to plantar heel pain. Clin Orthop Relat Res. 1994, 306:92-6.
[15]. Lourdes RK, Ram GG: Incidence of calcaneal spur in Indian population with heel pain. Int J Res Orthop. 2016, 2:174-6. 10.18203/issn.2455-4510.IntJResOrthop20163126
[16]. Bassiouni M: Incidence of calcaneal spurs in osteo-arthrosis and rheumatoid arthritis, and in control patients. Ann Rheum Dis. 1965, 24:490-3. 10.1136/ard.24.5.490
[17]. Banadda BM, Gona O, Vaz R, Ndlovu DM: Calcaneal spurs in a black African population. Foot Ankle. 1992, 13:352-4. 10.1177/107110079201300611
[18]. Beytemür O, Oncü M: The age dependent change in the incidence of calcaneal spur. Acta Orthop Traumatol Turc. 2018, 52: 367-71. 10.1016/j.aott.2018.06.013
[19]. Toumi H, Davies R, Mazor M, Coursier R, Best TM, Jennane R, Lespessailles E: Changes in prevalence of calcaneal spurs in men & women: a random population from a trauma clinic. BMC Musculoskelet Disord. 2014, 15:87. 10.1186/1471-2474-15-87
[20]. Benjamin M, Moriggl B, Brenner E, Emery P, McGonagle D, Redman S: The “enthesis organ” concept: why enthesopathies may not present as focal insertional disorders. Arthritis Rheum. 2004, 50:3306-13. 10.1002/art.20566
[21]. Schepsis AA, Jones H, Haas AL: Achilles tendon disorders in athletes. Amer J Sports Med. 2002, 30:287-305. 10.1177/03635465020300022501
[22]. Tyrdal S, Finnanger AM: Osseous manifestations of ‘handball goalie’s elbow. Scand J Med Sci Sports.1999, 9:92-7. 10.1111/j.1600-0838.1999.tb00215.x
[23]. Irving DB, Cook JL, Menz HB: Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006, 9:11-22. 10.1016/j.jsams.2006.02.004
[24]. Riepert T, Drechsler T, Urban R, Schild H, Mattern R: The incidence, age dependence and sex distribution of the calcaneal spur. An analysis of its X-ray morphology in 1027 patients of the central European population. Rofo. 1995, 162:502-5. 10.1055/s-2007-1015925
[25]. Shama SS, Kominsky SJ, Lemont H: Prevalence of non-painful heel spur and its relation to postural foot position. J Am Podiatry Assoc. 1983, 73:122-3. 10.7547/87507315-73-3-122
[26]. Shaibani A, Workman R, Rothschild BM: The significance of enthesopathy as askeletal phenomenon. Clin Exp Rheumatol. 1993, 11:399-403.
[27]. Kuyucu E, Koçyiğit F, Erdil M: The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis. Int. J. Surg. 2015, 21:28-31. 10.1016/j.ijsu.2015.06.078
[28]. Kosmahl EM, Kosmahl HE: Painful plantar heel, plantar fasciitis, and calcaneal spur: etiology and treatment. J Orthop Sports Phys Ther. 1987, 9:7-24. 10.2519/jospt.1987.9.1.17
[29]. Benjamin M, Toumi H, Suzuki D, Hayashi K, McGonagle D: Evidence for a distinctive pattern of bone formation in enthesophytes, Ann Rheum Dis. 2009, 68: 1003-10. 10.1136/ard.2008.091074
