Why heel spurs are traction spurs after all

Area of Science:

• Orthopedics
• Anatomy
• Histology

Background:

• The pathological nature and causative forces of plantar and posterior heel spurs remain unclear.
• Previous studies often examined spur locations separately, potentially missing shared developmental pathways.

Purpose of the Study:

• To investigate the histological characteristics of plantar and posterior heel spurs.
• To determine if these spurs share common developmental mechanisms and their relationship to mechanical forces.

Main Methods:

• X-ray scanning of 19 cadaver feet to identify calcanei with plantar or posterior spurs.
• Histological assessment of seven plantar and posterior spurs.
• Comparison with five spur-free Achilles tendon and three plantar fascia entheses as controls.

Main Results:

• Plantar spurs were intra- or supra-fascial; posterior (Achilles) spurs were intra-fascial.
• Both spur types exhibited trabecular architecture, fibrocartilage at entheses, and spur tips aligned with soft tissues.
• Spurs had tapered bases and bulky tips, suggesting adaptation to traction rather than compression.

Conclusions:

• Plantar and posterior heel spurs are likely non-pathological calcaneal exostoses, primarily resulting from traction forces.
• Common histological features indicate a uniform developmental mechanism for both spur types.
• Heel spurs appear morphologically ill-suited for compressive loads.