Are enlarged peroneal tubercle and accessory anterolateral talar facet associated with calcaneal spur?

BACKGROUND

As the anatomical variations of the foot, enlarged peroneal tubercle (EPT) and accessory anterolateral talar facet (AALTF) have attracted the attention of foot surgeons in recent years. However, EPT and AALTF have not been examined for a relationship with calcaneus spur (CS) as a common osteophyte.

METHODS

The subjects were 369 individuals who died in northeastern Thailand and were preserved as skeletal specimens. The authors examined for the presence of left and right EPT, AALTF, and calcaneus spur (CS). We divided the EPT (+) group with EPT and the EPT (-) group without it and also divided the AALTF (+) group with AALTF and the AALTF (-) group without it. The age at death and the presence of CS were compared statistically between the EPT (+) and EPT (-) groups and between the AATLF (+) and AALTF (-) groups.

RESULTS

Out of the total 369 cases, EPT was found in 117 cases (31.7%), AALTF was positive in 91 cases (24.7%), and CS was found in 194 cases (52.3%). In comparison between EPT (+) and EPT (-) groups, CS was significantly higher (p < 0.0001) in the EPT (+) group, but there was no significant difference in age at death. In comparison between AALTF (+) and AALTF (-) groups, there was no significant difference in age at death or CS.

CONCLUSION

This study showed a strong relationship between EPT and CS, and the prevalence of EPT and AALTF by age in Thailand was first reported. We believe it helps to know the pathogenesis and biomechanism of EPT and AALTF.

TRIAL REGISTRATION

Not applicable.

Efficacy of Extracorporeal Shock Wave and Pulse Electromagnetic Field Therapies in Calcaneal Spurs

BACKGROUND

Various treatment methods are available for calcaneal spur, which can cause disability. Objective: To evaluate the efficacy of pulsed electromagnetic field therapy (PEMFT) added to extracorporeal shock wave therapy (ESWT) on pain and functional capacity in treating calcaneal spurs.

METHODS

Patients with calcaneal spurs who were recommended ESWT or ESWT+PEMFT and whose Foot Function Index (FFI) and visual analogue scale (VAS) values were available in their records were retrospectively analyzed. The two groups were ESWT (n=35) and ESWT+PEMFT (n=40). FFI and VAS scores were obtained from their records before treatment, after treatment, and in the third month after treatment.

RESULTS

The two groups were similar regarding their pre-treatment FFI and VAS scores. In intra-group evaluation, statistically significant decreases were found in terms of the FFI pain, disability, and activity limitation and VAS scores in both groups after treatment and in the third month after treatment compared to the pre-treatment period. In the comparison between the groups, the post-treatment and post-treatment third-month FFI pain, disability, and activity limitation and VAS scores were significantly lower in the PEMFT+ESWT group than the ESWT group (P<0.001).

CONCLUSION

A calcaneal spur is a condition that can cause pain and functional limitation in patients. Various studies have demonstrated the efficacy of ESWT in the treatment of calcaneal spurs. In our study, we observed that PEMFT added to ESWT significantly improved the pain and functionality of the patients. Further studies are needed to evaluate the efficacy of PEMFT in calcaneal spurs.

Comparison between radial and focused types of extracorporeal shock-wave therapy in plantar calcaneal spur: A randomized sham-controlled trial

OBJECTIVES

Both radial and focused types of extracorporeal shock wave therapy (ESWT) have been used in patients with plantar calcaneal spur (PCS). However, no study has yet addressed the comparative effects of these treatments on the condition. Considering radial and focused waves are different from each other, their effectiveness may also be different in clinical practice. The aim of this study was to compare the effects of radial and focused types of ESWT on PCS.

METHODS

Ninety-nine patients with plantar calcaneal spur were randomised into three groups according to ESWT types: focused, radial, and sham. ESWT was applied as three sessions, with 2-4 days intervals (excluding weekends). All patients were evaluated at baseline (week 0) and weeks 1, 5, and 13. The Foot Function Index (FFI) scores were used as outcome measures.

RESULTS

Compared with baseline (week 0), at the end of treatment (week 1) and at the follow-up periods (weeks 5, and 13) the FFI scores were significantly reduced in both focused and radial ESWT groups (for all, p < 0.001). When considering the change in data from baseline to follow-up periods (weeks 5, and 13), both focused and radial ESWT groups were significantly superior to the sham group in the all outcome measures (for all, p < 0.05). Importantly, the radial group was significantly superior to focused group based on the changes in the FFI scores (for all, p < 0.05).

CONCLUSION

Both focused ESWT and radial ESWT are effective in plantar calcaneal spur. When considering the degree and continuity of the positive effects, radial ESWT is superior to focused ESWT in plantar calcaneal spur.

Do the presence, size, and shape of plantar calcaneal spurs have any significance in terms of pain and treatment outcomes in patients with plantar fasciitis?

BACKGROUND

: The purpose of this study was to determine the effect of the presence, size, or type of calcaneal spurs on pain or the outcomes of extracorporeal shock wave therapy (ESWT) therapy in patients with plantar fasciitis.

METHODS

Seventy-four patients with unilateral plantar fasciitis who had no pain in the contralateral foot, either currently or in the past, were included in the study. The length, base width, type, and presence of plantar calcaneal spurs in both heels of the patients were determined using radiography. A total of five sessions of ESWT (3 bar, 2000 shocks/session, 12 Hz frequency) with an interval of 3 days were performed on the painful sides of the patients. Symptom duration and numerical rating scale (NRS) scores were recorded pretreatment and 1 week and 12 weeks after treatment.

RESULTS

: Spurs were detected in 85.1% of painful feet and 71.6% of painless feet, this difference was statistically significant (p = 0.046). There was no significant correlation between the type of the spurs and whether the foot was painful. Patients with spur sizes of >5 mm or with horizontal and hooked spurs had a higher NRS decrease than patients with spur sizes of ≤5 mm or with a vertical spur. Symptom duration, spur length, and base width were found to be correlated with pretreatment NRS scores.

DISCUSSION

The presence and size of calcaneal spurs are associated with pain. However, it should be kept in mind that a high rate of spurs can also be found in painless feet, so spur is not the only factor that causes pain. Patients with a spur size of ≤5 mm or a vertical spur have less pain relief with ESWT.

Quality and readability of online information on plantar fasciitis and calcaneal spur

Plantar fasciitis and calcaneal spur are common causes of heel pain in the community. People use the Internet to obtain medical information about diseases. We reviewed Internet information sources on plantar fasciitis and calcaneal spur for quality and readability. The first 50 websites for each search term ("calcaneal spur", "heel spur", and "plantar fasciitis") were scanned on www.google.com . Six different valid tools were used for information quality and readability assessment. We searched for HONCode (Health On the Net Foundation Code) stamps on included websites. The total mean points for DISCERN were 50.52 ± 14.62, and the total mean points for JAMA (Journal of the American Medical Association) were 2.42 ± 1.26. In total, 25.72% of 97 websites had HONCode stamps. The average scores for the readability indicators were calculated to be Flesch-Kincaid Grade Level (FKGL): 7.27 ± 1.71, Gunning Fog: 8.46 ± 2.17, Simple Measure of Gobbledygook (SMOG): 6.89 ± 1.24, and Coleman Liau Index: 15.56 ± 1.85. In our study, when the website resources were examined, there were profit websites the most and website quality and readability were moderate level. A significant proportion of the websites have a financial bias and provide low-quality information. A mechanism for monitoring the quality and readability of online information must be established and managed systematically.

A Case Report of Bilateral Calcaneal Spur Fracture after Fall from a Height

Introduction

A calcaneal spur (also known as a heel spur) is a bony outgrowth from the calcaneal tuberosity. Calcaneal spurs are typically detected by X-ray examination. It is a form of exostosis, and it can be fractured as result of trauma as any other bone. An inferior calcaneal spur is located on the inferior aspect of the calcaneus and is typically a response to plantar fasciitis over a period but may also be associated with ankylosing spondylitis (typically in children). A posterior calcaneal spur develops on the back of the heel at the insertion of the Achilles tendon. The only abnormal physical sings are localized tenderness beneath the calcaneum, X-ray sometimes shows a bony spur projecting forward from the under surface of the calcaneal tuberosity. We report a -60-year-old male presented with painful swelling of both heels, after fall from height about 1-2 m, the patient had chronic plantar fasciitis. X-ray done, revealed bilateral calcaneal spur fracture (distal tip), associated with posterior calcaneal spur. The patient treated with well-padded posterior slab for 2-3 weeks, ice pack, analgesia, and non-weight bearing.

Case Reports

A 60-year-old man had history of trauma (fall from height about 1-2 m) on his heels, he presented with painful swelling on both heels, with mild limitation of ankle movement. On examination, there were a tender, swelling, mild ecchymosis around the heels, with painful limitation of ankle motion, and pain on weight-bearing. Radiological examination was done for spine, pelvis, hips, all within normal, and ankle X-ray. A/P and lateral revealed bilateral fracture of calcaneal spur. The patient was treated with rest, elevation, ice pack ,and analgesia for 2-3 days, then applications of back slab for 2-3 weeks. By the end of 3rd weeks, the back slab was removed and continue crepe bandage and non-steroidal anti-inflammatory drugs. After 2-3 months of follow-up, the patient no longer had swelling and pain, only mild symptoms of painful heel syndrome.

Conclusion

This article presents a rare case of bilateral calcaneal spur fracture in the patient with plantar fasciitis and calcaneal spur, following trauma to both heels, so an awareness of this condition as one of the differential diagnoses of painful heels following trauma.

Effects of intralesional pulsed radiofrequency treatment on pain in patients with calcaneal spur: results of 460 patients

Background

This study aimed to investigate the efficacy of intralesional pulsed radiofrequency (RF) in the treatment of calcaneal spur and the results of patients who underwent single and double sessions of RF treatment.

Methods

The population of this retrospective study consisted of 460 patients who were diagnosed with calcaneal spur with clinical examination and direct radiography. The Wong-Baker Faces Pain Rating Scale and The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were used to determine the pain status and functional capacities of the patients. Posttreatment evaluation was carried out on average in the 6th week.

Results

The study involved 460 patients, 76.9% of whom were female, with the average age of 50.8 ± 10.9 years in total. Of the patients 43% was given RF therapy in a single session, and 57% of them in double sessions. After the RF procedure, the number of patients whose pain decreased according to both AOFAS and Wong-Baker pain scoring systems increased statistically significantly (p < 0.001). There was a statistically significant increase in the AOFAS-pain scores and the total AOFAS scores and a significant decrease in the Wong Baker-pain scale after treatment. However, there was no significant change in treatment success with respect to the number of RF sessions. Although not statistically significant, the differences in the AOFAS-pain scores and in the total AOFAS scores were found to be higher in patients who underwent single session RF, while the difference in the Wong Baker-pain ranking was higher in patients who received double sessions RF.

Conclusion

Intralesional pulsed RF procedure can be preferred as a relatively less invasive method that does not have any serious complications in patients with persistent calcaneal spurs who do not respond to the use of oral anti-inflammatory drugs and shoe insoles, nor corticosteroid injection to the lesion area.

Comparison of effects of low-level laser therapy and extracorporeal shock wave therapy in calcaneal spur treatment: A prospective, randomized, clinical study

Objectives

In this study, we aimed to evaluate and compare the efficacy of low-level laser therapy (LLLT) and extracorporeal shock wave therapy (ESWT) in the treatment of calcaneal spurs.

Patients and methods

A total of 62 patients (14 males, 48 females; mean age: 47.6±11.7 years; range, 18 to 70 years) who were diagnosed with calcaneal spurs based on clinical examination and plain radiography between April 2019 and September 2019 were included in this study. A total of 15 sessions of plantar fascia gastroc-soleus stretching exercises and cold pack treatments were given to both groups. The LLLT (904 nm wavelength, 3,000 Hz, 8 J/cm2 dose to the painful heel area and insertion of the plantar fascia on the medial calcaneal area, five points for a total of 5 min for three weeks) was applied to the first group (n=31), whereas ESWT (10 Hz, 2,000 shock waves with a 2.5 bar pressure into the areas of the painful heel, insertion of the plantar fascia on the medial calcaneal area) was applied the second group (n=31). All patients were evaluated using the Visual Analog Scale (VAS) and Foot Function Index (FFI) before and after treatment.

Results

In both groups, the median VAS and FFI scores after treatment showed a significant improvement, compared to pre-treatment scores (p=0.001). There was no significant difference between the groups in terms of the median post-treatment VAS scores (p>0.05). In the ESWT group, the median FFI pain and total scores after treatment were significantly lower than in the LLLT group (p=0.033). The change in the median FFI pain and total scores were significantly higher in the ESWT group (p=0.046).

Conclusion

Both treatment modalities are effective and not superior to each other in terms of disability and activity limitation reduction, although a greater improvement in the FFI pain and total scores can be achieved with the ESWT. Based on these findings, we recommend both non-invasive treatment methods to be used in the treatment of calcaneal spurs in the clinical practice.

The effect of high intensity laser therapy in the management of painful calcaneal spur: a double blind, placebo-controlled study

To evaluate the effect of high-intensity laser therapy (HILT) in patients with calcaneal spur. The patients were randomized to receive either HILT + exercise (n = 21) (five times a week for a period of 3 weeks) or placebo HILT + exercise (n = 21) (five times a week for a period of 3 weeks). Pain severity (with visual analog scale (VAS) and with Roles and Maudsley score (RMS)), functionality (with Foot and Ankle Outcome Score (FAOS)), plantar pressure measurement, and quality of life (with short form-36 (SF-36)) of the patients were evaluated at baseline, at 4 weeks, and 12 weeks. A significant improvement in the VAS (p < 0.001), RMS (p < 0.001), and most of the SF-36 subgroup scores (p < 0.05) and most of the FAOS subgroup scores (p < 0.05) at 4 and 12 weeks after treatment was achieved in both groups. Besides, there was no significant difference in VAS (p > 0.05) and RMS (p > 0.05) between the groups. FAOS symptoms (p = 0.022) and quality of life (p = 0.038) subgroups were higher in the placebo group at 12 weeks. Significant improvements were observed in dynamic pedographic measurements in the HILT group (p < 0.05), and dynamic measurement values were significantly higher in the HILT group compared to placebo group (p < 0.05). Although the evaluation parameters, except dynamic pedographic measurements, have improved in both groups, our study results showed no superiority of HILT over placebo. To conclude, when the main complaint is pain in patients, only exercise therapy can be an economical, practical, and reliable treatment.

The age dependent change in the incidence of calcaneal spur

Objective

The aim of the present study was to evaluate the association between the calcaneal spur incidence and age, gender and side.

Methods

Lateral ankle X-rays of 1335 patients (550 (41.2%) females and 758 (58.8) males; mean age: 46.5 ± 13.5 years) who referred to our hospital because of trauma were reviewed. Incidence of plantar calcaneal spur, posterior calcaneal spur and association of such incidences with age, gender and side were all evaluated.

Results

Incidences of plantar calcaneal spur and posterior calcaneal spur were detected as 32.2% (male: 31%, female: 34%) and 13.1% (male: 11%, female: 16%), respectively. Incidence of plantar calcaneal spur increased by age whereas there was not any association with gender and location. The highest incidence was detected as 41.8% over 70 years of age. Incidence of posterior calcaneal spur increased by age and female gender whereas no significant association was observed with location. The highest incidence was detected as 22.3% between 61 and 70 years of age.

Conclusion

Incidences of plantar and posterior calcaneal spur were detected as 32.2% and 13.1%, respectively. Both plantar and posterior calcaneal spur incidence increases by age. Posterior calcaneal spur occurs significantly more frequently in females while, no difference is found between the males and females in incidence of the plantar calcaneal spur.

Level of evidence

Level IV, diagnostic study.

Bizarre calcaneal spur: A case report

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.

The effectiveness of raising the heel height of shoes to reduce heel pain in patients with calcaneal spurs

[Purpose] To investigate the effect of heel height on the distribution of plantar foot force and heel pain in patients with a heel spur. [Subjects and Methods] Plantar force was measured using 8 force sensors in 16 patients (3 men, 13 women), with symptomatic heel spur for 4 heel heights (0-4 cm). Sensors were located at the hallux (T1); medial to lateral metatarsals (M1 through M3), mid-foot (MF); and at the central, lateral, and medial heel (CH, LH, and MH). Pain was evaluated using the minimum compression force that caused pain and was measured using an algometer. [Results] Load bearing shifted from the heel (CH) to the mid-foot (MF) and hallux (T1) with increasing heel height. Raising the heel from 2 to 3 cm reduced the magnitude of load bearing, relative to the minimum compression force for pain, by 3.70% at the LH and 2.35% at the MH. Excellent clinical outcomes, defined by a 70-100% decrease in pain, were achieved in 10/16 participants with the use of a 2-cm and 3-cm heel height in men and women, respectively. [Conclusion] Increasing heel height effectively decreases the plantar force on the heel during weight-bearing activities.

Radiotherapy of painful heel spur with two fractionation regimens : Results of a randomized multicenter trial after 48 weeks' follow-up

BACKGROUND

In this randomized multicenter trial, we compared the effect of a lower single dose of 0.5 Gy vs. a standard single dose of 1 Gy concerning pain relief and quality of life, while maintaining a uniform total dose of 6 Gy. On the basis of laboratory observations, the lower single dose would be expected to be more effective.

PATIENTS AND METHODS

A total of 127 patients suffering from painful heel spur were randomized: Patients in the standard group were treated with single fractions of 6 × 1 Gy twice a week, while the experimental group was treated with single fractions of 12 × 0.5 Gy three times a week. Patients who did not show satisfactory pain relief after 12 weeks were offered re-irradiation with the standard dose. The study's primary endpoints were pain relief and quality of life. Therapy results were evaluated and compared based on follow-up examinations after 12 and 48 weeks.

RESULTS

The data of 117 patients could be evaluated. There was no significant difference between the groups concerning the results of a visual analogue scale (VAS), Calcaneodynia Score (CS), and the somatic scale of the 12-Item Short-Form Health Survey(SF-12). Patients undergoing re-irradiation showed a significant benefit concerning pain relief. Their total outcome was comparable to patients showing a good response from the beginning. No relevant acute or chronic side effects were recorded.

CONCLUSION

Both patient groups showed good results concerning pain relief. A fractionation schedule of 12 × 0.5 Gy was not superior to the current standard dose of 6 × 1 Gy. Further trials are necessary to explore the best fractionation schedule.

Characteristic calcaneal ossification: an additional early radiographic finding in infants with fibrodysplasia ossificans progressiva

BACKGROUND

We have clinically encountered children with fibrodysplasia ossificans progressiva who had abnormal calcaneal ossification.

OBJECTIVE

To evaluate whether calcaneal ossification variants are significant radiographic findings in children with fibrodysplasia ossificans progressiva.

MATERIALS AND METHODS

Lateral feet radiographs in nine children who fulfilled the diagnostic criteria of fibrodysplasia ossificans progressiva were reviewed. The studies were obtained during infancy or early childhood.

RESULTS

Fourteen lateral foot radiographs of fibrodysplasia ossificans progressiva were available for this study (ages at examination: 1-104 months). Four children ages 2 months to 11 months showed double calcaneal ossification centers; 7 children had plantar calcaneal spurs that decreased in size with age. Overall, eight of nine children with fibrodysplasia ossificans progressiva demonstrated double calcaneal ossifications and/or plantar calcaneal spurs in infancy or childhood.

CONCLUSION

Double calcaneal ossification centers in early infancy and plantar calcaneal spurs in childhood are frequently seen in children with fibrodysplasia ossificans progressiva and may be a useful radiologic indicator for early diagnosis.

Extracorporeal shock-wave therapy effectively reduces calcaneal spur length and spur-related pain in overweight and obese patients

OBJECTIVE

We aimed to evaluate the effects of extra corporeal shock-wave therapy (ESWT) on the calcaneal spur length and pain severity in overweight and obese patients with symptomatic calcaneal spur.

METHODS

In eighty patients with symptomatic calcaneal spur, ESWT was administered on days 0 and 7, and visual analog scale (VAS) scores and calcaneal spur lengths (CSLs) before and 3 months later after treatment were recorded. A lateral heel radiograph was used for computer-aided linear measurements of CSL.

RESULTS

Of 80 patients, 59 (73.7%) were female and 21 were male (26.3%); age was 45.9 ± 8.3 years; BMI was 31.6 ± 4.4 kg/m2; and symptom duration was 2.3 ± 2.4 years. The CSL and VAS score after treatment were significantly lower than those before treatment (CSL before vs. after: 5.7 ± 1.0 vs. 4.4 ± 0.9, p = 0.001; VAS score before vs. after: 8.3 ± 1.4 vs. 4.6 ± 2.2; p = 0.03). The CSLs before and after treatment had a significant strong correlation (r = 0.832, p = 0.001). The VAS scores before and after treatment presented a significant mild correlation (r = 0.242, p = 0.03).

CONCLUSIONS

In overweight and obese patients with symptomatic calcaneal spur, ESWT reduces the CSL and pain severity during a follow-up of three-month duration.

[Physiotherapeutic proceeding in symptomatic calcaneal spur treatment]

Calcaneal spur is one of the most common disorders associated with foot pain. According to appearance of pain in each step during the day, it is important to find the most effective method of treatment. This article is a review of medical reports about non-operative treatment method. It shows that ultrasound therapy was the most common physical intervetion used so far, and mostly occurs to be effective. However one of the comparative studies improves higher efficiency of phonopheresis. Another comparative study, shows higher efficiency of combined ultrasound and laser therapy, than exclusive laser therapy. There haven't been found any articles that would evaluate efficacy of electrotherapy and short wave diathermy (electric field) in the treatment of mentioned disorder. Studies that describe the effect of ESWT treatment were also analyzed in this article, and all of them confirm its effectiveness in heel spur therapy, showing no side-effects. Cryotherapy also causes positive effect in treatment of this disorder. However Cryoultrasound therapy that uses the energy of two interconnected terapeutic techniques which is cryotherapy and ultrasounds, proved to be more effective.

Syringing method as an alternative to Śṛṇga therapy in Vātakaṇṭaka

Calcaneus forms the bone of the foot. Due to abnormal pressures, foot muscles and ligaments are stretched beyond their normal limits that lead to chronic plantar heel pain, among which calcaneal spur tops the list. In Ayurveda, it can be correlated to "Vātakaṇṭaka" (pricking sensation in the foot)-a painful condition of heel caused by its improper placement on the ground. To assess the effect of syringing method (modified Śṛṅga) in the treatment of Vātakaṇṭaka. A 10 ml syringe was for ease, hygiene, and to enable the case to be managed in the outpatient department. A diagnosed case of calcaneal spurs with pain, tenderness, and swelling visited KLE University's Shri BMK Ayurveda Hospital and Research Centre, Belgaum, Karnataka, India. After Snigdha Patrapoṭṭali sveda (a form of sudation therapy), bloodletting was performed by syringing method. In total procedure was performed for 4 times on the patient. Marked subjective relief was observed. Pain from 8 visual analog scale (VAS) came to 2 visual analog scale (VAS) and tenderness and swelling relived completely.