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Heel spurs more common in older and heavier patients, but does it matter?

PainSci » bibliography » Moroney et al 2014
updated
Tags: plantar fasciitis, diagnosis, etiology, study_cross-sectional, study_observational, foot, anatomy, leg, limbs, pain problems, overuse injury, injury, tendinitis, pro

Two pages on PainSci cite Moroney 2014: 1. The Complete Guide to Plantar Fasciitis 2. The meaning of heel spurs 

PainSci commentary on Moroney 2014: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Moroney et al. looked at about a thousand heel x-rays, found calcaneal spurs in about 12% of them, and then compared them to some spurless patients. Spurred patients were heavier and had more diabetes, arthritis, and (non-plantar-fasciitis) pain, leading the authors to a rather grand-sounding conclusion:

“We have demonstrated the relevance of a radiographic finding once considered irrelevant.”

In other, humbler words: smoking gun evidence that heel spurs are, shocker, not totally innocuous and are more common in people whose lower limb tissues are under siege from age and weight. This is mildly interesting data, but I’m not so sure that the clinical “relevance” is all that high.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Chronic plantar heel pain is a common and potentially debilitating condition, often caused by plantar fasciitis. Plantar calcaneal spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors. We aimed to test this hypothesis and to investigate predisposing factors for the development of spurs.

METHODS: We reviewed all lateral ankle X rays taken in our institution over a 6-month period and identified all X rays demonstrating calcaneal spurs. Then, we identified a similar number of age- and sex-matched controls without spurs. We contacted both groups by telephone and compared symptoms of heel pain, plantar fasciitis, associated comorbidities, and foot and ankle outcome scores (FAOSs).

RESULTS: We reviewed the X rays of 1103 consecutive patients and found a spur prevalence of 12.4%, more common in women and older patients. Questioning of the spur group and control group found a higher body mass index in the spur group. Patients with spurs were 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis. Patients with spurs had more foot pain and poorer FAOS than the control group, even when patients with plantar fasciitis were excluded.

CONCLUSION: Our results demonstrate that the presence of a plantar calcaneal spur may be an indicator of foot pain independent of plantar fasciitis. Although spurs may not cause foot pain themselves, they may be an indication of other associated conditions. Clinical relevance: We have demonstrated the relevance of a radiographic finding once considered irrelevant.

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