Calcaneal Spur Diagnosis and Treatment
A plantar calcaneal enthesophyte refers to an osteophyte which is located anteriorly to the medial tuberosity of the calcaneus.
This is caused by repeated micro-trauma at the insertion of the plantar fascia into the calcaneus leading to inflammation and tenderness under the medial heel during weightbearing activities.
A major biomechanical factor contributing to the ossification of the enthesis is a compromised or weakened medial longitudinal arch which increases calcaneal eversion and consequently, tension to the plantar fascia.
This was further elaborated by Kogler et al. in their study which focused on the biomechanical effects of longitudinal arch support mechanisms on plantar aponeurosis strain.
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The results of the study revealed foot orthoses to be effective arch supports which helped to considerably decrease strain in the plantar aponeurosis by stabilising the apical bony structure of the foot’s arch.
Irving et al. conducted another study which investigated the aetiology of chronic plantar heel pain by matching eighty participants with bilateral heel pain to a control group.
A significant association was determined between a pronated foot type and chronic plantar heel pain, making it a prominent risk factor in the development of the condition.
These results have long-term implications in the treatment and orthotic management of both calcaneal spurs and plantar fasciitis.
Imbalances caused by weak intrinsic foot muscles, can cause some of the extrinsic muscles to work overtime in order to overcome these imbalances, particularly the extensor hallucis longus, flexor digitorum longus, extensor digitorum longus and flexor hallucis longus.
This leads to hyperextension of the metatarsophalangeal joints and flexion of the interphalangeal joints which ultimately exaggerates the longitudinal arch of the foot via the windlass mechanism.
Contrary to the common misconception that orthotics weaken the intrinsic muscles, the augmented calibration process at MASS4D® ensures that the resultant orthotic provides the correct balance of a resistant force to allow optimal muscle function.
Muscles are allowed to work unaffected throughout their functional range of motion, weaker muscles are coaxed into strengthening and joint alignment is re-established.
This causes stabilisation of the medial longitudinal arch and reduces the high tensile forces on the plantar fascia ligament, restoring the optimal functioning of the foot.
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References:
- Irving D., Young A. M., Cook J., Menz H. (2007) Obesity and pronated foot type may increase the risk of chronic plantar heel pain: A matched case-control study. BioMed Central Musculoskeletal Disorders: May 2007, Vol. 8, No. 41, doi:10.1186/1471-2474-8-41.
- Kogler G.F., Solomonidis S.E., Paul J.P. (1996) Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain. Clinical biomechanics: July 1996, Vol. 11, No. 5, pp. 243-252
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