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Annals of the Royal College of Surgeons... Nov 2012In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major... (Review)
Review
INTRODUCTION
In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major management options. We also review the literature and discuss the condition.
METHODS
A literature search was performed using PubMed and MEDLINE(®). The following keywords were used, singly or in combination: 'plantar fasciitis', 'plantar heel pain', 'heel spur'. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken.
FINDINGS
Plantar fasciitis is a common and often disabling condition. Because the natural history of plantar fasciitis is not understood, it is difficult to distinguish between those patients who recover spontaneously and those who respond to formal treatment. Surgical release of the plantar fascia is effective in the small proportion of patients who do not respond to conservative measures. New techniques such as endoscopic plantar release and extracorporeal shockwave therapy may have a role but the limited availability of equipment and skills means that most patients will continue to be treated by more traditional techniques.
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Blood Proteins; Botulinum Toxins; Diagnosis, Differential; Fasciitis, Plantar; Foot Orthoses; Humans; Injections, Intralesional; Life Style; Lithotripsy; Muscle Stretching Exercises; Patient Education as Topic; Steroids
PubMed: 23131221
DOI: 10.1308/003588412X13171221592456 -
Chinese Journal of Traumatology =... 2015Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger's heel, tennis heal, policeman's heel are used to describe it. Mechanical... (Review)
Review
Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger's heel, tennis heal, policeman's heel are used to describe it. Mechanical factors are the most common etiology of heel pain. Common causes of hell pain includes: Plantar Fasciitis, Heel Spur, Sever's Disease, Heel bump, Achilles Tendinopathy, Heel neuritis, Heel bursitis. The diagnosis is mostly based on clinical examination. Normally, the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggest the diagnosis. Several therapies exist including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments had failed. Rest, ice, massage, the use of correct exercise and complying with a doctor's advice all play important part in helping to recover from this hell pain condition, but getting good quality, suitable shoes with the appropriate amount of support for the whole foot is the most important.
Topics: Foot Diseases; Heel; Humans; Pain Management; Physical Examination
PubMed: 26643244
DOI: 10.1016/j.cjtee.2015.03.002 -
Journal of Anatomy Jun 2017The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology... (Review)
Review
The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain.
Topics: Calcaneus; Fascia; Fasciitis, Plantar; Heel Spur; Humans; Radiography
PubMed: 28369929
DOI: 10.1111/joa.12607 -
Cureus Aug 2022Feet are often the most neglected part of the body, all the while being the highly dependent part of daily work and mobility. The lack of attention to them can lead to... (Review)
Review
Feet are often the most neglected part of the body, all the while being the highly dependent part of daily work and mobility. The lack of attention to them can lead to painful conditions such as calcaneal spurs and associated conditions. Calcaneal spurs are bony projections that form around the calcaneal bone, the strongest, most significant, and posterior-most bone in the feet. The classic symptom of the calcaneal spur is talalgia, commonly known as heel pain. There are many causes of heel pain, which are usually associated with calcaneal spurs. Hence it becomes imperative to diagnose and treat them effectively. The development of calcaneal spur is shrouded in mystery, and why a few individuals are more prone to developing the condition than others depends on their gender, age, occupation, and lifestyle. Calcaneal spurs are seen in association with many diseases. It is also regarded as the etiological factor in plantar fasciitis and increasing body weight and as a complication in arthropathies, Gout, pes cavus, and pes planus. This review article aims to highlight a relationship between those factors while also summarizing the treatment modalities present today. Hence, it promotes the usage of a model for administering treatment based on a tier-wise follow-up procedure, where the response to a particular treatment is recorded. If it does not resolve the spur, the treatment progresses to the next tier. This review article hopes to shed light on the understanding and treatment of calcaneal spurs.
PubMed: 36185871
DOI: 10.7759/cureus.28497 -
Journal of Foot and Ankle Research Jan 2022Medical imaging can be used to assist with the diagnosis of plantar heel pain. The aim of this study was to synthesise medical imaging features associated with plantar... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Medical imaging can be used to assist with the diagnosis of plantar heel pain. The aim of this study was to synthesise medical imaging features associated with plantar heel pain.
METHODS
This systematic review and meta-analysis conducted searches in MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to 12th February 2021. Peer-reviewed articles of cross-sectional observational studies written in English that compared medical imaging findings in adult participants with plantar heel pain to control participants without plantar heel pain were included. Study quality and risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Sensitivity analyses were conducted where appropriate to account for studies that used unblinded assessors.
RESULTS
Forty-two studies (2928 participants) were identified and included in analyses. Only 21% of studies were rated 'good' on quality assessment. Imaging features associated with plantar heel pain included a thickened plantar fascia (on ultrasound and MRI), abnormalities of the plantar fascia (on ultrasound and MRI), abnormalities of adjacent tissue such as a thickened loaded plantar heel fat pad (on ultrasound), and a plantar calcaneal spur (on x-ray). In addition, there is some evidence from more than one study that there is increased hyperaemia within the fascia (on power Doppler ultrasound) and abnormalities of bone in the calcaneus (increased uptake on technetium-99 m bone scan and bone marrow oedema on MRI).
CONCLUSIONS
People with plantar heel pain are more likely to have a thickened plantar fascia, abnormal plantar fascia tissue, a thicker loaded plantar heel fat pad, and a plantar calcaneal spur. In addition, there is some evidence of hyperaemia within the plantar fascia and abnormalities of the calcaneus. Whilst these medical imaging features may aid with diagnosis, additional high-quality studies investigating medical imaging findings for some of these imaging features would be worthwhile to improve the precision of these findings and determine their clinical relevance.
Topics: Adult; Cross-Sectional Studies; Fasciitis, Plantar; Heel; Humans; Pain; Pain Measurement; Ultrasonography
PubMed: 35065676
DOI: 10.1186/s13047-021-00507-2 -
Anesthesiology and Pain Medicine Oct 2023Heel spur is a common medical condition that can cause substantial discomfort and reduce the quality of life of the affected patients. When seeking treatment for a heel... (Review)
Review
Heel spur is a common medical condition that can cause substantial discomfort and reduce the quality of life of the affected patients. When seeking treatment for a heel spur, it is important to consider the differential diagnoses and underlying medical conditions that may contribute to the symptoms. This manuscript aims to explore several distinctive diagnostic possibilities, essential factors to consider, and practical strategies for managing heel spurs. This paper explains the common differential diagnoses and addresses medical conditions related to heel spurs. The importance of accurate diagnosis in planning treatment protocol is highlighted. In addition, we explain treatment strategies, including preventive measures, conservative treatments, and more advanced procedures. Physicians can help relieve pain and improve the quality of life of the affected individuals by considering the diverse aspects of managing heel spurs.
PubMed: 38659999
DOI: 10.5812/aapm-139326 -
American Family Physician Oct 2011Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the... (Review)
Review
Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest. Other causes of plantar heel pain include calcaneal stress fracture (progressively worsening pain following an increase in activity level or change to a harder walking surface), nerve entrapment (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), neuromas, and plantar warts. Achilles tendinopathy is a common condition that causes posterior heel pain. Other tendinopathies demonstrate pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to a Haglund deformity, a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease, a calcaneal apophysitis in children. Medial midfoot heel pain, particularly with continued weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. The syndrome manifests as lateral midfoot heel pain. Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated.
Topics: Achilles Tendon; Calcaneus; Diagnosis, Differential; Fasciitis, Plantar; Foot Diseases; Fractures, Stress; Heel; Heel Spur; Humans; Pain; Tarsal Tunnel Syndrome; Tendinopathy
PubMed: 22010770
DOI: No ID Found -
Agri : Agri (Algoloji) Dernegi'nin... Apr 2022The purpose of this study was to investigate the effectiveness of conventional radiofrequency (CRF) ablation treatment on chronic plantar heel pain due to heel spur.
OBJECTIVES
The purpose of this study was to investigate the effectiveness of conventional radiofrequency (CRF) ablation treatment on chronic plantar heel pain due to heel spur.
METHODS
A total of 20 patients with heel spur who did not respond to conservative treatments were recruited for the study. Under fluoroscopy guidance, CRF was performed to three points at the top, above, and below the heel spur in the longitudinal plane of the foot. Pain intensity, the pressure pain threshold (PPT), and functional status were assessed using a visual analog scale (VAS), pressure algometers, and the Foot Function Index (FFI). All measurements were taken before the procedure, as well as 1, 3, and 6 months following the procedure.
RESULTS
CRF was applied to 20 patients - 16 (80%) females and 4 (20%) males. Their mean age was 51.40+-8.10 years, the mean body mass index was 33.80+-5.47 kg/m2, the mean duration of symptoms was 18.30+-9.02 months, and pes planus was present in 5 patients (25%). A statistically significant decrease was observed in VAS score and PPT and FFI measurements at the 1st, 3rd, and 6th month following CRF compared to before CRF (p<0.001).
CONCLUSION
CRF is an effective, safe, minimally invasive method to reduce pain severity in patients with chronic heel pain due to heel spur in the short (0-3 months) and intermediate term (3-6 months).
Topics: Adult; Catheter Ablation; Female; Heel; Heel Spur; Humans; Male; Middle Aged; Pain; Pain Measurement
PubMed: 35848814
DOI: 10.14744/agri.2021.82542 -
International Journal of Surgery Case... 2018A calcaneal spur, also known as enthesophyte, is an abnormal bone outgrowth at the inferior part of the calcaneus, which is the most common site of bony spur occurrence....
INTRODUCTION
A calcaneal spur, also known as enthesophyte, is an abnormal bone outgrowth at the inferior part of the calcaneus, which is the most common site of bony spur occurrence. Although there is consensus that a calcaneal spur is a common cause of heel pain, approximately 20% of calcaneal spurs are asymptomatic and its pathology remains not fully understood.
PRESENTATION OF CASE
In this report, we present a rare case of a very large and bizarre calcaneal spur in a young adult man. The calcaneal spur was painful, which affected his foot function and was associated with plantar fasciitis. The spur length was measured in the radiograph and exhibited the longest calcaneal spur reported in the literature. The patient was treated conservatively, and he fully recovered his foot function.
DISCUSSION
This case was unique because although the patient presented with an extremely large unilateral calcaneal spur, he was young and did not have any chronic disease; hence, he was treated conservatively. The pain subsided and he regained full function of his foot. This case questions the association between calcaneal spur length and plantar fasciitis symptoms.
CONCLUSION
This case confirms that the length of calcaneal spurs, even extremely long ones, is not associated with the pathology of plantar fasciitis and that surgical treatment is not necessary.
PubMed: 29957453
DOI: 10.1016/j.ijscr.2018.06.006