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Observational Study
. 2019 Feb 1;58(2):237-245.
doi: 10.1093/rheumatology/key266.

Coexistence of plantar calcaneal spurs and plantar fascial thickening in individuals with plantar heel pain

Hylton B Menz  1   2 , Martin J Thomas  1   3 , Michelle Marshall  1 , Trishna Rathod-Mistry  1 , Alison Hall  1 , Linda S Chesterton  1 , George M Peat  1 , Edward Roddy  1   3
Affiliations
Observational Study

Coexistence of plantar calcaneal spurs and plantar fascial thickening in individuals with plantar heel pain

Hylton B Menz et al. Rheumatology (Oxford). .

Abstract

Objectives: To examine associations between plantar calcaneal spurs, plantar fascia thickening and plantar heel pain (PHP), and to determine whether tenderness on palpation of the heel differentiates between these presentations.

Methods: Adults aged ⩾50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months underwent a detailed clinical assessment. PHP in the past month was documented using a foot manikin. Plantar calcaneal spurs were identified from weight-bearing lateral radiographs and plantar fascia thickening (defined as >4 mm) from ultrasound. Tenderness on palpation of the plantar fascia insertion was documented. Associations between these factors and PHP were explored using generalized estimating equations.

Results: Clinical and radiographic data were available from 530 participants (296 women, mean [s.d.] age 64.9 [8.4] years), 117 (22.1%) of whom reported PHP. Plantar calcaneal spurs and plantar fascia thickening were identified in 281 (26.5%) and 501 (47.3%) feet, respectively, but frequently coexisted (n = 217, 20.4%). Isolated plantar calcaneal spurs were rare (n = 64, 6.0%). Participants with PHP were more likely to have a combination of these features compared with those without PHP (odds ratio 2.16, 95% CI 1.24, 3.77, P = 0.007). Tenderness on palpation of the heel was not associated with plantar calcaneal spurs or plantar fascia thickening, either in isolation or in combination, in those with PHP.

Conclusion: Plantar calcaneal spurs and plantar fascial thickening are associated with PHP, but frequently coexist. Tenderness on palpation of the heel does not appear to differentiate between clinical presentations of PHP.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Standardized images used to identify presence of plantar calcaneal spurs Spurs were considered to be present of a score of 2 or above was documented.
<sc>Fig</sc>. 2
Fig. 2
Ultrasound measurement of plantar fascial thickness
<sc>Fig</sc>. 3
Fig. 3
Stacked bar chart of imaging findings according to presence of plantar heel pain
See this image and copyright information in PMC

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