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The meaning of heel spurs

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Heel spurs are outcroppings of calcification on the heel, about the texture of a potato chip. Despite their ominous appearance on x-rays have never seemed to be all that medically important. As the authors of a new paper (“The Conundrum of Calcaneal Spurs: Do They Matter?”) point out, “spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors.” But surely they aren’t entirely meaningless? No, probably not.

Moroney et al. looked at about a thousand heel x-rays, found spurs in about 12%, 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 entirely innocuous and are more common in people whose lower limb tissues are under seige from age and weight. It’s mildly interesting data, but I’m not sure it matters much, and we can probably do without the grandiosity and just file this one under No Shit, Sherlock.

For what it’s worth — a little data-based context — I have added this reference to my plantar fasciitis tutorial.

“The Conundrum of Calcaneal Spurs: Do They Matter?”
Moroney et al. Foot & Ankle Specialist. Volume 7, Number 2, 95–101. Apr 2014.

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