Got heel pain? It could be a plantar calcaneal enthesophyte, also known as a heel spur.
Plantar calcaneal spurs are bony growths caused by stress on the plantar fascia which causes heel pain, especially after rest.
This is a bony growth on the heel bone and can be very painful, especially when you walk or stand. Generally speaking, these bony growths appear under the heel and causes pain especially after rest. According to recent studies, 38% of the individuals with heel pain have plantar calcaneal spurs.
Moreover, there are several factors which can put you at risk of developing those spurs. In fact, 70% of patients with heel spurs are overweight.
For this reason, we’ll cover the plantar calcaneal enthesophyte causes, symptoms and treatments so you can find relief.
What is Plantar Calcaneal Enthesophyte
Plantar calcaneal spurs, also known as heel spurs or calcaneal spurs, are bony growths that form where the plantar fascia attaches to the heel bone, or calcaneus.
These growths are a response to repetitive stress or microtrauma at the tendon insertion points, which causes inflammation and subsequent bone growth. In other words the body is trying to protect itself from ongoing stress by forming a bony barrier.
These enthesophytes arise from the calcaneal tuberosity, which can be either the medial or lateral tuberosity, closely attached to the calcaneus. The calcaneus plays a big role in maintaining the arch of the foot and absorbing tension from weight bearing activities.
Heel spurs is closely related to the plantar fascia, a thick band of tissue that runs along the bottom of the foot. The Achilles tendon which attaches at the back of the heel can also be involved.
Risk Factors
Several factors can increase the risk of plantar calcaneal enthesophytes.
One of the biggest risk factors is obesity. High body mass index (BMI) puts more stress on the feet making you more prone to heel spurs. Age also plays a role; people over 40 and men in middle age are more at risk.
Occupations that require prolonged standing or heavy weight bearing activities can also lead to plantar calcaneal enthesophytes.
Foot biomechanics, particularly abnormalities such as excessive pronation or flat feet can increase the tension on the plantar fascia which can contribute to heel spur formation.
Repetitive strain and overuse of the plantar fascia are major contributors to these bony growths.
Causes of Plantar Calcaneal Enthesophyte
These causes range from chronic strain on the plantar fascia to genetic factors, each contributing to the abnormal bone growth at the attachment site of the plantar fascia on the heel bone.
Let’s dive deeper into these causes.
1. Chronic Plantar Fascia Strain
Repetitive stress on the plantar fascia leads to inflammation which in turn stimulates bone growth.
This chronic strain can come from various activities and conditions making the plantar fascia a common site of discomfort and pain.
2. Foot Biomechanics Issues
Abnormalities in foot biomechanics such as flat feet or high arches can increase the tension on the plantar fascia.
Poor gait mechanics can further aggravate this tension and contribute to heel spur formation.
3. Obesity and Excess Body Weight
Excess body weight puts more pressure on the heel which can cause stress and bone growth over time. This makes weight management a key factor in both prevention and treatment of heel spurs.
4. Prolonged Standing or Walking
Occupations that require long periods of standing or walking can cause chronic stress on the heel which can contribute to plantar calcaneal enthesophytes. This is especially true for those who spend long hours on hard surfaces.
5. Aging and Degenerative Changes
As we age the plantar fascia loses elasticity which can cause stress on the heel and subsequent bone formation. Degenerative changes in the foot’s structure can further aggravate this issue.
6. Poor Footwear
Shoes with no arch support or cushioning can put more pressure on the heel and plantar fascia making poor footwear a major contributor to heel spur development.
7. Repetitive Impact Activities
High impact activities such as running, dancing and jumping can put excessive stress on the plantar fascia and heel bone leading to heel spur formation.
8. Inflammatory Conditions (e.g., Plantar Fasciitis)
Chronic inflammation at the plantar fascia attachment site often caused by conditions like plantar fasciitis can lead to bone spur formation. This inflammation stimulates the bone to grow as a protective response.
9. Genetic Factors
Family history of heel spurs or foot structural abnormalities can increase the risk of developing plantar calcaneal enthesophytes. Genetics play a big role in our predisposition to this condition.
10. Calcium Deposits
Abnormal calcium metabolism or deposits can contribute to enthesophyte formation making calcium deposits another factor in heel spur development.
Symptoms and Diagnosis
Many people with plantar calcaneal enthesophytes are asymptomatic but symptoms can occur and usually manifest as localized chronic plantar heel pain especially when walking. This pain is often most intense after periods of inactivity such as the first steps in the morning.
Common symptoms of a calcaneal spur include:
- Heel pain especially after rest
- Increased discomfort with prolonged standing or walking
- Limited ankle motion
Diagnosis usually involves physical examination and imaging techniques. X-rays can help identify heel spurs and rule out other causes of heel pain. Limited ankle motion is another symptom that healthcare providers check for during a diagnosis.
Conservative Treatment Options
Conservative treatment options for plantar calcaneal enthesophyte includes physiotherapy, stretching exercises and low impact activities. These methods aim to relieve pain, strengthen the plantar fascia and improve flexibility without the need for surgical intervention.
Physical Therapy
Physical therapy often includes targeted stretching exercises to increase flexibility and reduce discomfort.
Because of this, exercises like calf stretches and heel raises can significantly reduce pain associated with heel spurs, strengthen foot muscles and improve flexibility.
NSAIDs and Pain Management
NSAIDs can help reduce pain and inflammation associated with heel spurs. Use of these medications should be under the guidance of a healthcare provider to avoid side effects of long term use.
Orthotic Devices
Supportive shoes or custom orthotics provides better shock absorption and relief to the heel. Using cushioned insoles can add comfort and prevent foot related issues.
Advanced Treatment Options
For severe cases that don’t respond to conservative treatments, advanced techniques such as Extracorporeal Shock Wave Therapy (ESWT) and low dose radiotherapy are available.
Surgical interventions are considered for recalcitrant cases.
Extracorporeal Shock Wave Therapy (ESWT)
ESWT significantly reduces pain in patients with heel spurs by promoting tissue regeneration and reducing pain. Patients often experience rapid improvement in pain levels, many report reduced symptoms after just a few sessions.
Low Dose Radiotherapy
Low dose radiotherapy is an option for patients with severe pain that don’t respond to standard conservative treatments. This treatment can reduce pain without serious side effects.
Surgical Interventions
Surgical options for chronic cases include procedures like partial plantar fascia release and endoscopic plantar fasciotomy. These interventions are considered when other treatments fail.
Prevention
Preventing plantar calcaneal enthesophyte development involves several strategies, from wearing supportive footwear to maintaining a healthy weight.
Let’s explore these measures.
1. Wear Supportive Footwear
Choosing shoes with good arch support, proper cushioning and shock absorption is crucial to reduce heel stress and prevent heel spurs.
2. Use Orthotic Insoles
Custom or over-the-counter orthotics can help distribute pressure evenly across the foot and provide arch support. This can significantly reduce strain on the plantar fascia and prevent heel spur formation.
3. Maintain a Healthy Weight
Reducing excess body weight lessens the pressure on the plantar fascia and heel bone which is a major factor in both prevention and management of plantar calcaneal enthesophytes.
4. Stretching Exercises
Regularly stretching the plantar fascia, Achilles tendon and calf muscles is essential to maintain flexibility and prevent heel spur formation.
5. Strengthen Foot Muscles
Toe curls and marble pickups can strengthen foot muscles and reduce stress on the heel and prevent plantar calcaneal enthesophytes.
6. Avoid High Impact Activities
Limit high impact activities like running and jumping and opt for low impact exercises like swimming or cycling to protect the plantar fascia and heel bone.
7. Warm-Up and Cool Down
Always warm up before exercise and cool down with stretches to reduce risk of foot injuries including heel spurs.
8. Proper Running Technique
Maintain proper running form and gradually increase activity intensity to avoid overloading the plantar fascia and prevent heel spurs.
9. Rest and Recovery
Take breaks from activities that causes heel pain to allow the plantar fascia to heal and recover and prevent chronic issues and heel spurs.
Living with Plantar Calcaneal Enthesophyte
Regularly massaging the plantar fascia can improve blood circulation in the foot and flexibility. This can lead to better comfort during daily activities and overall quality of life for people with this condition.
Also, wear proper footwear, use orthotic devices and low impact exercises. These adjustments can reduce pain and prevent further complications and make daily life more manageable.
Wrap Up
Mainly, Plantar calcaneal enthesophytes are bony growths that form where the plantar fascia a thick band of connective tissue on the bottom of your foot attaches to your heel bone (calcaneus). These growths, often called heel spurs, develop over time due to repetitive stress or strain on the plantar fascia. While the spurs themselves may not always cause pain, they’re often associated with inflammation and discomfort in the surrounding tissues.
Thus, your age, weight, foot structure and standing for long hours at work may also play a role. As you can see, 30% of retail workers reported heel pain.
From conservative treatments like physical therapy and orthotics to advanced techniques like ESWT and surgical interventions, there are many ways to manage and relieve the pain of this condition.
