Heel Spur: Causes

Pathogenesis (development of disease)

The development of plantar fasciitis is considered multifactorial.

It is a mechanical overload reaction from that leads to repetitive microtrauma. As a result, bone material accumulates at the attachment of tendons, forming thorn-like bone outgrowths.

Depending on the location of the calcaneal spur, two forms can be distinguished:

  • Lower calcaneal spur (= plantar calcaneal spur) – ossification in the attachment area of the small foot muscles on the underside of the calcaneus (plantar aponeurosis → plantar aponeuritis or plantar fasciitis: inflammation of the tendon plate of the sole of the foot) [most common form; plantar aponeuritis in flat feet; usually flattening of the longitudinal arch of the foot (eg. E.g., buckling flat foot); Cause: injury due to overloading with repetitive microtrauma of the plantar aponeurosis (coarse tendon plate (aponeurosis) on the planta pedis, which is stretched out between the foot muscles and the skin)]
  • Upper or posterior heel spur (= Haglund heel or. Haglund exostosis) – ossification at the petrous attachment of the Achilles tendon, which is congenital or acquired [in athletes; shortened calf muscles (→ when rolling the foot does not stretch the muscle → extension in the upper ankle joint is blocked → increased forces at the attachments of the Achilles tendon and plantar fascia)Note: Haglund exostosis leads in the course to retrocalcaneal bursitis (bursitis). Affected are often women between 20 to 30 years; the finding is not uncommon bilateral (bilateral).

Etiology (causes)

Behavioral causes

  • Misuse/overuse of the foot
  • Predominant activities in standing and running activities.
  • Change of footwear from padded shoes to thin soles
  • Physical activity
    • Athletes:
      • Running (long distance runner)
      • Sudden change of load (start of training after sports break).
  • Overweight (BMI ≥ 25; obesity).

Disease-related causes

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Obesity (obesity)

Musculoskeletal system and connective tissue (M00-M99).

  • Malalignments of the foot such as the bent-lowered foot and hollow foot (lat. Pes cavus or Pes excavatus)).
  • Insertion tendopathy of the plantar fascia (soft tissue components of the connective tissue of the sole of the foot) at the calcaneus (heel bone) – irritation at the junction between tendons and bones (= insertion), which are usually caused by overloading.
  • Shortening of the Achilles tendon
  • Shortened calf muscles (83% of cases).
  • Decreased mobility of the ankle joint