Trip Answers

Question answered:16/07/07 Warning! this question is over two years old.

GP Notebook has a section on calcaneal spurs [1], which states:

 

“The presence of a spur does not add much to the differential diagnosis of heel pain because:
 - spurs may form in the absence of pain
 - plantar fasciitis may be painful and not stimulate spur formation”

 

Similarly, Merck’s Manual of Geriatrics [2] advises in a section on plantar fasciosis:

 

“If findings are equivocal, a heel spur seen on x-ray may support the diagnosis; however, absence does not rule out the diagnosis, and visible spurs may not be the cause of symptoms.”

 

The American online textbook eMedicine [3] highlights a lack of consensus in this area, stating:

 

“Considerable disagreement exists regarding the role of heel spurs and plantar fasciitis. Heel spurs are increasingly prevalent with age. Spurs usually are within the muscles superior to the fascia and are not ossification of the fascia origin. The possibility of spurs causing heel pain indirectly through compression of the nerve to the abductor digiti quinti muscle or through stretching the plantar fascia has implications for surgical treatment of this condition.”

 

In relation to heel pain more generally, GP Notebook [4] contains the following advice:

 

“The causes of a painful heel can be considered in terms of age of the patient.

 

Possible causes of heel pain include:
• in young children: Sever's disease
• young adults: achilles tendititis
• older adults (40-60 yr): plantar fasciitis

 

…The commonest cause of inferior heel pain is plantar fasciitis. However other causes should also be considered.

 

Differential diagnosis of inferior heel pain

 

Causes relating to plantar fascia:
• plantar fasciitis - by far the most common cause of pain below the heel
• rupture
• enthesopathies

 

Causes relating to soft tissues:
• fat pad atrophy
• heel bruise - bruised heel syndrome
• subcalcaneal bursitis

 

Causes relating to bone:
• calcaneal stress fracture
• primary and secondary tumours
• Paget's disease
• infection
• gout may rarely present as otherwise typical plantar fasciitis

 

Causes relating to nerves:
• tarsal tunnel syndrome
• trapped abductor digitii quinti nerve
• sciatica radiculopathy (S1)”

 

Advice on the management of these conditions can be accessed by following the links within GP Notebook.  If you require any further information on the management of any of these conditions, please let us know via the Contact Us link: http://www.clinicalanswers.nhs.uk/index.cfm?action=contact.

 

References
1. Calcaneal spurs. GP Notebook.  [Accessed 16 July 2007] (http://www.gpnotebook.co.uk/simplepage2.cfm?ID=637927427&linkID=37742&cook=yes)
2. Plantar Fasciosis.  Merck Manual of Geriatrics 3rd edition 2006. (http://www.merck.com/mrkshared/mmg/sec7/ch56/ch56c.jsp)
3. Plantar Fasciitis.  eMedicine.  [Accessed 16 July 2007] (http://www.emedicine.com/orthoped/topic542.htm)
4. Heel Pain.  GP Notebook.  [Accessed 16 July 2007] (http://www.gpnotebook.co.uk/simplepage.cfm?ID=1060438071)

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