What Causes Bone Spurs?

Calcaneal spurs are a common and frequently-occurring disease in the elderly. It is reported that 15% of all patients treated for foot problems are heel pain, and 73% of them are caused by calcaneus spurs. Calcaneal spurs are osteophytes that extend forward at the calcaneal tuberosity. Its tip is buried in the starting point of the plantar fascia and the short toe flexor tendon. The cause of the calcaneal spur is that after the heel pad is degenerated, the pressure on the heel is directly transmitted to the calcaneus, which stimulates local ligaments, fascia, and periosteum. Causes congestion, edema, osteogenesis and ossification; it can also be caused by traction and stimulation of the fascia fascia and short toe flexor muscle attachment; it can also be seen in rheumatoid arthritis. In short, the calcaneus spur is the end result of inflammatory stimulation of its attached tissue. It is generally asymptomatic. If there are clinical manifestations, local pain, tenderness, weight-bearing pain, and claudication only occur during the inflammation phase of the attached tissue.

Chinese name: Calcaneus spur

Foreign name: calcanean spur

Calcaneal bone spurs I. Etiology and related diseases

The formation of calcaneus spurs is related to factors such as chronic strain leading to degeneration of surrounding soft tissue and abnormal biomechanical mechanisms of the foot.

1 Calcaneal spurs 1, patellar aponeurosis and long patellar ligament

The plantar fascia is a thickened middle part of the deep plantar fascia, which is triangular and contains more longitudinal fibers. The back end is slightly narrower, and it is attached to the medial part of the anterior edge of the heel tubercle. The two sides send out the muscle space to the deep side and stop at the 1-5th metatarsal. The plantar aponeurosis is like the bowstring, which is tight between the calcaneal tuberosity and the metatarsal head. It is the strongest part that supports the longitudinal arch of the foot. The plantar long ligament, like the plantar aponeurosis, starts from the calcaneal tuberosity and stops forward at the cheekbones, and together with the plantar aponeurosis, maintains the role of the longitudinal arch of the foot. The longitudinal arch of the affected foot is deeper than that of the healthy foot, and the growth sites of the bone spurs are at the calcaneal attachment of the plantar fascia and the long iliac ligament. Caused by long-term tension and tension.

2 Calcaneal spurs 2, short toe flexor and abductor hallucis

The calcaneal spur is located in the point of attachment of the flexor digitorum and abductor hallucis rather than in the plantar fascia. The plantar fascia is suspended below the calcaneus and is located on the sacral side of the calcaneus spur. Bone spurs are the result of the compensatory response of the foot to stabilize itself during abnormal pronation.

3 Calcaneal spurs 3. Biomechanical mechanism

The relationship between the abnormal changes in foot biomechanics and the formation of calcaneus spurs has received increasing attention. Abnormal joint mechanics may prolong pronation force during the gait cycle. As a result, normal loads cannot be carried by the primary structures such as bone and major ligaments, but by secondary structures such as the joint capsule and secondary ligaments. . When the plantar aponeurosis is subjected to a force exceeding its physiological limit, this repetitive long-term overload will induce the inflammatory process, form degeneration, fibrosis, cause plantar aponentitis, and then bone spurs.

Calcaneal spurs can cause heel pain and cause heel pain.

Calcaneal Spurs II. Clinical Symptoms and Differential Diagnosis

1 Calcaneal spurs 1. Clinical symptoms

(1) Heel pain

Heel pain is the main symptom of calcaneal bone spurs. The mild one has only discomfort, and the severe one has a tear-like sharp pain. It becomes worse when standing or walking. Patients often cannot reach the ground with their toes and clump along the heel. Heel bone spurs caused by calcaneus spurs often have the following onset characteristics: due to the plantar fascia on the periosteum, the subcalcaneal spurs can cause pain in the early stages of formation, although the spurs are small at this time, even X-ray examination Can't find it either. As the bone spurs increase, the pain often disappears, which may be related to the adaptive change of the foot. Therefore, the typical bone spurs on the X-ray can be asymptomatic. After an asymptomatic period, or due to local trauma, bone spurs can spontaneously produce pain.

(2) Tenderness

Extensive tenderness in the soles of the feet can occur, most notably at the medial calcaneal nodules. During ankle dorsiflexion, the fingers press the entire inner fascia with force, and tenderness proves the presence of fasciitis. This suggests that heel pain caused by calcaneus spurs is related to the stimulation of surrounding soft tissues.

(3) Deepening of arch

The arch of the affected foot deepens, and the plantar long ligament and plantar aponeurosis can be clearly felt at the arch of the foot like a bowstring when the foot is stretched [1], indicating that the plantar long ligament and plantar tendon are extremely tight.

2 Calcaneal spurs 2, differential diagnosis

With the above-mentioned typical symptoms and signs, combined with X-ray examination, calcaneus spurs can be diagnosed. In severe cases, the clinical symptoms are: stubborn pain at the bottom of the heel, which starts in the morning or after rest, and the symptoms are obvious when walking. Examination revealed obvious tenderness at the calcaneal tuberosity and deepened arch of the affected foot; X-ray examination showed that a beak-like bone spur was formed at the affected calcaneal tubercle.

Calcaneal Spurs

1 Calcaneal spurs 1, oral nonsteroidal anti-inflammatory drugs

Oral nonsteroidal anti-inflammatory drugs are preferred. Intraheel injections are usually effective. When accompanied by inflammatory symptoms and signs, such as mild fever, swelling, and subsequent history of jumping pain (calcaneal bursitis), injecting a mixture of insoluble and soluble sterols can control the symptoms. The injection needle is inserted vertically through the medial heel , Then turn to the pain point in the center of the heel.

2 Calcaneal spurs 2. Needle-knife treatment

Needle-knife treatment of calcaneus bone spurs is simple, safe, quick, effective, low recurrence rate, less pain for patients, and low cost. It has been widely used in clinical practice, and the clinical reports are quite abundant. But needle knife operation has not been standardized. Needle knife operation seems simple, but it is complicated. It requires the surgeon to master local fine anatomy, understand the physiological role of each anatomical structure, and have a deep understanding of the etiology and pathogenesis of the disease.