Calcaneal spurs: Examining etiology using prehistoric skeletal remains to understand present day heel pain

BackgroundCalcanei are the most common sites for bony spurs. Although calcaneal enthesophytes have been extensively researched, many unknowns remain. Whether biological factors, such as age, weight and genetics, play a greater role in calcaneal spur etiology than activity is still unknown.ObjectivesThe current study examines 121 adults from a prehistoric hunter-gatherer population to aid in understanding bony spur etiology.MethodsCalcaneal spurs are scored as present or absent on the dorsal or plantar side; they are analyzed in regards to their relationships with age, sex, osteoarthritis, cortical index, femoral head breadth and muscle markers.ResultsDorsal and plantar spurs frequencies increase with age (chi-squares = 16.90, 7.268, Ps < 0.05, respectively). Dorsal spurs were more frequent than plantar spurs (chi-square = 38.000; P < 0.0001). There is a positive relationship with calcaneal spurs and upper limb and lower limb osteoarthritis (chi-squares = 5.587, 7.640, Ps < 0.05, respectively).ConclusionsThe data presented support that dorsal spurs are in part the result of activities, but plantar spurs may be a more modern phenomena resulting from long periods of standing and excess weight.