Sunday, July 17, 2005
Is the calcaneal spur in the plantar fascia?
In a Yahoo Groups Discussion on manipulation, a question was asked:
"What is the best treatment for plantar fascitis induced heel spurs... " to which I replied:
"Since when did heel spurs have anything to do with the plantar fascia?"
Needless to say there was some interesting comments that followed, mostly based on what people were taught as students, and NOT on a reading of the research evidence.At the end of the day, all the published evidence I have seen, is that the spur is not in the plantar fasica, so how can plantar fasica "traction" cause heel spurs?One poster (Peter Morgan) did back up what I said with this:
"McCarthy DJ, Gorecki GE. The anatomical basis of inferior calcaneal lesions. JAPMA 1979;69:527This is quoted as finding the spur in the origin of the flexor digitorum brevis. ALSO, they asserted "the origin of flexor digitorum brevis, quad. plantae, long plantar ligament, abductor hallucis muscle and abductor digiti minumi are all sites of potential spur formation."
THIS WAS PUBLISHED IN 1979!!!! -- why do people still talk about the calcaneal heel spur as being due to traction of the plantar fascia. Now, I finally found one of the other more recent references showing the same thing:
"Heel Spur Formation and the Subcalcaneal Enthesis of the Plantar Fascia TSUKASA KUMAI and MIKE BENJAMIN Objective. To describe the structure and significance of subcalcaneal heel spurs associated with the plantar fascia. Methods. The enthesis of the plantar fascia was removed from 17 elderly cadavers by sagittal saw cuts either side of the medial tuberosity, radiographs were taken, and the tissue was processed for routine histology. Sagittal sections were stained with toluidine blue, Masson's trichrome, or alcian blue, and sections were matched with the corresponding radiographs. Results. Spurs develop on the deep surface of the plantar fascia but their formation is heralded by degenerative changes that occur within it. According to differences between small and large spurs, we propose that there are 3 stages in their development: (1) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (2) thickening of the subchondral bone plate at the enthesis as small spurs form; (3) development of vertically oriented trabeculae buttressing the proximal end of larger spurs. The spurs grow by a combination of intramembranous and chondroidal ossification. Conclusion. Contrary to popular belief, subcalcaneal heel spurs cannot be traction spurs as they do not develop within the plantar fascia itself. They are thus fundamentally different from heel spurs in the Achilles tendon. We suggest instead that they develop as a consequence of degenerative changes that occur in the plantar fascia enthesis. (J Rheumatol 2002;29:1957-64) "
That was 3 yrs ago. There are other references, I just don't have them handy. Is it not time to "put this one to bed"? What say you? Discussion
New Links:
Podiatry Today:
Building Referrals And Relationships With Primary Care Providers
How To Detect Pediatric Osteomyelitis
Point-Counterpoint: Is Ischemia A Direct Risk Factor For Ulceration?
ePodiatry:
Next newsletter is online
Podiatry Arena:
Flat-footed 'are high achievers' (General Issues Forum)
Pits on sole of foot - whats your diagnosis? (General Issues Forum)
Strange but simple question - Indian Foot? (General Issues Forum)
Is a calcaneal spur in the plantar fascia? (General Issues Forum)
Diagnostic Test for Osteoporosis (General Issues Forum)
Hard orthosis crushing soft soles (Sports Forum)
Where Should the First Ray be When Casting for Orthoses? (Biomechanics Forum)
Quality of life of caregivers of diabetes patients with foot ulcers (Diabetic Foot Forum)
Should small children have shoes? (Pediatrics Forum)
Age-related differences in foot pressure distribution (Gerontology Forum)
Sterilising Clippers - quick survey (Practice Management)
Podiatry Today (Journals Online)
Journal of Foot and Ankle Surgery (Journals Online)
Future Podiatry Student (USA Forum)
HPC Registered, but who runs your club? (UK Forum)
Health Select Committee Enquiry into Podiatry 2005? (UK Forum)
Baron: Government complacency over chiropody services (UK Forum)
Clinical Biomechanics Boot Camp #3 (Australia Forum)
Unprofessional Conduct Decision released by Vic Registration Board (Australia Forum)
Podiatry Student in Beauty Contest (New Zealand Forum)
Michael Flattley? (BreaK Room)
Doctors Differ From Patients on Religion (BreaK Room)
In Case of Emergency (BreaK Room)
"What is the best treatment for plantar fascitis induced heel spurs... " to which I replied:
"Since when did heel spurs have anything to do with the plantar fascia?"
Needless to say there was some interesting comments that followed, mostly based on what people were taught as students, and NOT on a reading of the research evidence.At the end of the day, all the published evidence I have seen, is that the spur is not in the plantar fasica, so how can plantar fasica "traction" cause heel spurs?One poster (Peter Morgan) did back up what I said with this:
"McCarthy DJ, Gorecki GE. The anatomical basis of inferior calcaneal lesions. JAPMA 1979;69:527This is quoted as finding the spur in the origin of the flexor digitorum brevis. ALSO, they asserted "the origin of flexor digitorum brevis, quad. plantae, long plantar ligament, abductor hallucis muscle and abductor digiti minumi are all sites of potential spur formation."
THIS WAS PUBLISHED IN 1979!!!! -- why do people still talk about the calcaneal heel spur as being due to traction of the plantar fascia. Now, I finally found one of the other more recent references showing the same thing:
"Heel Spur Formation and the Subcalcaneal Enthesis of the Plantar Fascia TSUKASA KUMAI and MIKE BENJAMIN Objective. To describe the structure and significance of subcalcaneal heel spurs associated with the plantar fascia. Methods. The enthesis of the plantar fascia was removed from 17 elderly cadavers by sagittal saw cuts either side of the medial tuberosity, radiographs were taken, and the tissue was processed for routine histology. Sagittal sections were stained with toluidine blue, Masson's trichrome, or alcian blue, and sections were matched with the corresponding radiographs. Results. Spurs develop on the deep surface of the plantar fascia but their formation is heralded by degenerative changes that occur within it. According to differences between small and large spurs, we propose that there are 3 stages in their development: (1) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (2) thickening of the subchondral bone plate at the enthesis as small spurs form; (3) development of vertically oriented trabeculae buttressing the proximal end of larger spurs. The spurs grow by a combination of intramembranous and chondroidal ossification. Conclusion. Contrary to popular belief, subcalcaneal heel spurs cannot be traction spurs as they do not develop within the plantar fascia itself. They are thus fundamentally different from heel spurs in the Achilles tendon. We suggest instead that they develop as a consequence of degenerative changes that occur in the plantar fascia enthesis. (J Rheumatol 2002;29:1957-64) "
That was 3 yrs ago. There are other references, I just don't have them handy. Is it not time to "put this one to bed"? What say you? Discussion
New Links:
Podiatry Today:
Building Referrals And Relationships With Primary Care Providers
How To Detect Pediatric Osteomyelitis
Point-Counterpoint: Is Ischemia A Direct Risk Factor For Ulceration?
ePodiatry:
Next newsletter is online
Podiatry Arena:
Flat-footed 'are high achievers' (General Issues Forum)
Pits on sole of foot - whats your diagnosis? (General Issues Forum)
Strange but simple question - Indian Foot? (General Issues Forum)
Is a calcaneal spur in the plantar fascia? (General Issues Forum)
Diagnostic Test for Osteoporosis (General Issues Forum)
Hard orthosis crushing soft soles (Sports Forum)
Where Should the First Ray be When Casting for Orthoses? (Biomechanics Forum)
Quality of life of caregivers of diabetes patients with foot ulcers (Diabetic Foot Forum)
Should small children have shoes? (Pediatrics Forum)
Age-related differences in foot pressure distribution (Gerontology Forum)
Sterilising Clippers - quick survey (Practice Management)
Podiatry Today (Journals Online)
Journal of Foot and Ankle Surgery (Journals Online)
Future Podiatry Student (USA Forum)
HPC Registered, but who runs your club? (UK Forum)
Health Select Committee Enquiry into Podiatry 2005? (UK Forum)
Baron: Government complacency over chiropody services (UK Forum)
Clinical Biomechanics Boot Camp #3 (Australia Forum)
Unprofessional Conduct Decision released by Vic Registration Board (Australia Forum)
Podiatry Student in Beauty Contest (New Zealand Forum)
Michael Flattley? (BreaK Room)
Doctors Differ From Patients on Religion (BreaK Room)
In Case of Emergency (BreaK Room)
Sunday, July 03, 2005
New Links This Week
Podiatry Today:
Conquering Plastic Surgery Complications In Wound Care
How To Differentiate Between Infected Wounds And Colonized Wounds
A Closer Look At Diabetic Foot Infections
ePodiatry:
Newsletter
Podiatry Arena:
Energise Powerpoint Presentations (advert) (General Forum)
Supplementary Prescribing Rights (UK) (General Forum)
Care Pathways for podiatry (General Forum)
Plantar feedback contributes to the regulation of leg stiffness (Biomechanics Forum)
Running barefoot vs running with shoes (Sports Forum)
Running shoe technology does not reduce injuries (Sports Forum)
Foot silicone injections (Foot Surgery Forum)
Screw Fixation Versus Casting Jones Fractures (Foot Surgery Forum)
Podiatry Today (Journals Online)
Court TV program to focus on Podiatrist's case (USA Forum)
Sailor put on 1 year NHS waiting list - to have his toenails cut (UK Forum)
Podiatry Course in UK (UK Forum)
One in three NHS trusts face cash shortfall this financial year (UK Forum)
Gap between NHS policy makers and doctors is "enormous" (UK Forum)
Podiatry and search engine words in Australia (Australia Forum)
Unprofessional Conduct Decision released by Vic Registration Board (Australia Forum)
Active Release Technique for Podiatrists (Australia Forum)
Amputate healthy limb? (Break Room)
Start training them young .... (Break Room)
Conquering Plastic Surgery Complications In Wound Care
How To Differentiate Between Infected Wounds And Colonized Wounds
A Closer Look At Diabetic Foot Infections
ePodiatry:
Newsletter
Podiatry Arena:
Energise Powerpoint Presentations (advert) (General Forum)
Supplementary Prescribing Rights (UK) (General Forum)
Care Pathways for podiatry (General Forum)
Plantar feedback contributes to the regulation of leg stiffness (Biomechanics Forum)
Running barefoot vs running with shoes (Sports Forum)
Running shoe technology does not reduce injuries (Sports Forum)
Foot silicone injections (Foot Surgery Forum)
Screw Fixation Versus Casting Jones Fractures (Foot Surgery Forum)
Podiatry Today (Journals Online)
Court TV program to focus on Podiatrist's case (USA Forum)
Sailor put on 1 year NHS waiting list - to have his toenails cut (UK Forum)
Podiatry Course in UK (UK Forum)
One in three NHS trusts face cash shortfall this financial year (UK Forum)
Gap between NHS policy makers and doctors is "enormous" (UK Forum)
Podiatry and search engine words in Australia (Australia Forum)
Unprofessional Conduct Decision released by Vic Registration Board (Australia Forum)
Active Release Technique for Podiatrists (Australia Forum)
Amputate healthy limb? (Break Room)
Start training them young .... (Break Room)
