The calcaneal spur is an osteophyte that forms at the plantar fascia and intrinsic muscle origins on the medial calcaneal tuberosity, present in approximately 50 percent of patients with plantar fasciitis but also in 15 to 20 percent of asymptomatic individuals. Its presence does not directly cause plantar heel pain — the inflammation in the adjacent plantar fascia origin and periosteum causes the pain.
The plantar calcaneal spur forms from repetitive microtrauma at the plantar fascia and short flexor muscle origins, with calcium deposition along the stressed fibres. Its presence on radiograph has poor correlation with heel pain severity — many patients have spurs without symptoms and significant plantar fasciitis occurs without visible spurs. Extracorporeal shockwave therapy and plantar fascia stretching treat the enthesopathy regardless of spur presence. Surgical spur excision combined with plantar fasciotomy is occasionally performed for refractory cases.
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