Öz
Kaynakça
- 1. Chatterton BD, Muller S, Roddy E. Epidemiology of posterior heel pain in the general population: cross-sectional findings from the clinical assessment study of the foot. Arthritis Care Res (Hoboken). 2015;67(7):996-1003. doi: 10.1002/acr.22546.
- 2. Lawrence DA, Rolen MF, Morshed KA, Moukaddam H. MRI of heel pain. AJR Am J Roentgenol. 2013;200(4):845-855. doi: 10.2214/ajr.12.8824.
- 3. Barg A, Ludwig T. Surgical Strategies for the Treatment of Insertional Achilles Tendinopathy. Foot Ankle Clin. 2019;24(3):533-559. doi: 10.1016/j.fcl.2019.04.005.
- 4. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund's deformity. Foot Ankle Int. 2012;33(6):487-491. doi: 10.3113/fai.2012.0487.
- 5. Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current Concepts Review Update: Insertional Achilles Tendinopathy. Foot Ankle Int. 2017;38(10):1160-1169. doi: 10.1177/1071100717723127.
- 6. Krishna Sayana M, Maffulli N. Insertional Achilles tendinopathy. Foot Ankle Clin. 2005;10(2):309-320. doi: 10.1016/j.fcl.2005.01.010.
- 7. Grambart ST, Lechner J, Wentz J. Differentiating Achilles Insertional Calcific Tendinosis and Haglund's Deformity. Clin Podiatr Med Surg. 2021;38(2):165-181. doi: 10.1016/j.cpm.2020.12.003.
- 8. Caudell GM. Insertional Achilles Tendinopathy. Clin Podiatr Med Surg. 2017;34(2):195-205. doi: 10.1016/j.cpm.2016.10.007.
- 9. Şahin R, Sabri Balik M. Does the slope and length of the plantar calcaneal spur affect the clinic? Acta Orthop Belg. 2023;89(1):146-151. doi: 10.52628/89.1.10881.
- 10. Bayrak HÇ, Topaktaş S. [Comparative Outcomes of Percutaneous Plantar Fascia Release, Calcaneal Drilling, and Calcaneal Spur Removal versus ESWT in the Treatment of Plantar Fasciitis]. Osmangazi J Med. 2025;47(3):457-466. doi: 10.20515/otd1634034. [Article in Turkish]
- 11. Kuyucu E, Koçyiğit F, Erdil M. The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis. Int J Surg. 2015;21:28-31. doi: 10.1016/j.ijsu.2015.06.078.
- 12. Boberg JS, Anania MC. Retrocalcaneal exostosis. Anatomy and a new surgical approach. J Am Podiatr Med Assoc. 2002;92(10):537-542. doi: 10.7547/87507315-92-10-537.
- 13. Delgado DA, Lambert BS, Boutris N, et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088. Epub 20180323. doi: 10.5435/JAAOSGlobal-D-17-00088.
- 14. SooHoo NF, Shuler M, Fleming LL. Evaluation of the validity of the AOFAS Clinical Rating Systems by correlation to the SF-36. Foot Ankle Int. 2003;24(1):50-55. doi: 10.1177/107110070302400108.
- 15. Robinson JM, Cook JL, Purdam C, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med. 2001;35(5):335-341. doi: 10.1136/bjsm.35.5.335.
- 16. Chimenti RL, Flemister AS, Tome J, et al. Altered tendon characteristics and mechanical properties associated with insertional achilles tendinopathy. J Orthop Sports Phys Ther. 2014;44(9):680-689. doi: 10.2519/jospt.2014.5369.
- 17. Kaya Ö, Demirtaş Y. [Is the presence radiologically calcaneal spur a factor for heel pain?] MKÜ Tıp Derg. 2022;13(47):281-285. doi: 10.17944/mkutfd.996223. [Article in Turkish]
- 18. Tuncer T, Karakeci ES. Effectiveness of extracorporeal shock wave therapy according to plantar calcaneal spur types. Ann Med Res. 2023;30(5):549-53. doi: 10.5455/annalsmedres.2022.12.372.
- 19. Fiamengo SA, Warren RF, Marshall JL, Vigorita VT, Hersh A. Posterior heel pain associated with a calcaneal step and Achilles tendon calcification. Clin Orthop Relat Res. 1982;(167):203-211.
- 20. Lu CC, Cheng YM, Fu YC, Tien YC, Chen SK, Huang PJ. Angle analysis of Haglund syndrome and its relationship with osseous variations and Achilles tendon calcification. Foot Ankle Int. 2007;28(2):181-185. doi: 10.3113/fai.2007.0181.
- 21. Nakajima K. Insertional Achilles tendinopathy: A radiographic cross-sectional comparison between symptomatic and asymptomatic heel of 71 patients. Eur J Radiol Open. 2024;12:100568. doi: 10.1016/j.ejro.2024.100568.
- 22. Johansson KJ, Sarimo JJ, Lempainen LL, Laitala-Leinonen T, Orava SY. Calcific spurs at the insertion of the Achilles tendon: a clinical and histological study. Muscles Ligaments Tendons J. 2013;2(4):273-277.
Posterior calcaneal spur length and angle are predictors of pain and functional limitation in insertional Achilles tendinopathy
Öz
Objectives: This study aimed to quantitatively evaluate the clinical impact of posterior calcaneal spur (PoCS) morphology, specifically spur length and inclination angle, in patients with insertional Achilles tendinopathy (IAT).
Methods: This retrospective study analyzed 200 patients with symptomatic IAT who underwent standardized weight-bearing lateral ankle radiographs. Spur length and inclination angle were measured, and patients were stratified into nine subgroups based on three length categories (<5 mm, 5-10 mm, >10 mm) and three angle categories (<10°, 10-20°, >20°). Clinical outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Victorian Institute of Sport Assessment-Achilles (VISA-A) score. Kruskal-Wallis tests and multivariate linear regression analyses were used to evaluate associations between spur morphology and outcomes.
Results: Both longer spurs (>10 mm) and steeper inclination angles (>20°) were significantly associated with worse clinical scores including higher VAS scores and lower AOFAS and VISA-A scores (P<0.001). Patients with spur lengths >10 mm and angles >20° had a mean VAS score of 7.22±0.65, VISA-A score of 49.72±2.54, and AOFAS score of 60.00±4.24, indicating greater pain and functional limitation. In contrast, patients with spur lengths <5 mm and angles <10° had lower VAS scores (5.18±0.82) and higher VISA-A (63.43±3.92) and AOFAS (72.57±4.33) scores, reflecting lower pain intensity and higher functional capacity (P < 0.001 for all). Regression analysis confirmed that spur length and angle were independent predictors of clinical outcome (P<0.001), while age, sex, and BMI were not statistically significant contributors (P>0.05).
Conclusions: Spur morphology - specifically length and angle - has a measurable impact on symptom severity in IAT. Radiographic evaluation of PoCS morphology should be integrated into clinical decision-making for more tailored management.
Anahtar Kelimeler
Posterior calcaneal spur insertional Achilles tendinopathy spur angle spur length
Etik Beyan
This study was approved by the Bursa City Hospital Scientific Research Ethics Committee (Decision No: 2025-5/3; date: 05.03.2025). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study.
Kaynakça
- 1. Chatterton BD, Muller S, Roddy E. Epidemiology of posterior heel pain in the general population: cross-sectional findings from the clinical assessment study of the foot. Arthritis Care Res (Hoboken). 2015;67(7):996-1003. doi: 10.1002/acr.22546.
- 2. Lawrence DA, Rolen MF, Morshed KA, Moukaddam H. MRI of heel pain. AJR Am J Roentgenol. 2013;200(4):845-855. doi: 10.2214/ajr.12.8824.
- 3. Barg A, Ludwig T. Surgical Strategies for the Treatment of Insertional Achilles Tendinopathy. Foot Ankle Clin. 2019;24(3):533-559. doi: 10.1016/j.fcl.2019.04.005.
- 4. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund's deformity. Foot Ankle Int. 2012;33(6):487-491. doi: 10.3113/fai.2012.0487.
- 5. Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current Concepts Review Update: Insertional Achilles Tendinopathy. Foot Ankle Int. 2017;38(10):1160-1169. doi: 10.1177/1071100717723127.
- 6. Krishna Sayana M, Maffulli N. Insertional Achilles tendinopathy. Foot Ankle Clin. 2005;10(2):309-320. doi: 10.1016/j.fcl.2005.01.010.
- 7. Grambart ST, Lechner J, Wentz J. Differentiating Achilles Insertional Calcific Tendinosis and Haglund's Deformity. Clin Podiatr Med Surg. 2021;38(2):165-181. doi: 10.1016/j.cpm.2020.12.003.
- 8. Caudell GM. Insertional Achilles Tendinopathy. Clin Podiatr Med Surg. 2017;34(2):195-205. doi: 10.1016/j.cpm.2016.10.007.
- 9. Şahin R, Sabri Balik M. Does the slope and length of the plantar calcaneal spur affect the clinic? Acta Orthop Belg. 2023;89(1):146-151. doi: 10.52628/89.1.10881.
- 10. Bayrak HÇ, Topaktaş S. [Comparative Outcomes of Percutaneous Plantar Fascia Release, Calcaneal Drilling, and Calcaneal Spur Removal versus ESWT in the Treatment of Plantar Fasciitis]. Osmangazi J Med. 2025;47(3):457-466. doi: 10.20515/otd1634034. [Article in Turkish]
- 11. Kuyucu E, Koçyiğit F, Erdil M. The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis. Int J Surg. 2015;21:28-31. doi: 10.1016/j.ijsu.2015.06.078.
- 12. Boberg JS, Anania MC. Retrocalcaneal exostosis. Anatomy and a new surgical approach. J Am Podiatr Med Assoc. 2002;92(10):537-542. doi: 10.7547/87507315-92-10-537.
- 13. Delgado DA, Lambert BS, Boutris N, et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088. Epub 20180323. doi: 10.5435/JAAOSGlobal-D-17-00088.
- 14. SooHoo NF, Shuler M, Fleming LL. Evaluation of the validity of the AOFAS Clinical Rating Systems by correlation to the SF-36. Foot Ankle Int. 2003;24(1):50-55. doi: 10.1177/107110070302400108.
- 15. Robinson JM, Cook JL, Purdam C, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med. 2001;35(5):335-341. doi: 10.1136/bjsm.35.5.335.
- 16. Chimenti RL, Flemister AS, Tome J, et al. Altered tendon characteristics and mechanical properties associated with insertional achilles tendinopathy. J Orthop Sports Phys Ther. 2014;44(9):680-689. doi: 10.2519/jospt.2014.5369.
- 17. Kaya Ö, Demirtaş Y. [Is the presence radiologically calcaneal spur a factor for heel pain?] MKÜ Tıp Derg. 2022;13(47):281-285. doi: 10.17944/mkutfd.996223. [Article in Turkish]
- 18. Tuncer T, Karakeci ES. Effectiveness of extracorporeal shock wave therapy according to plantar calcaneal spur types. Ann Med Res. 2023;30(5):549-53. doi: 10.5455/annalsmedres.2022.12.372.
- 19. Fiamengo SA, Warren RF, Marshall JL, Vigorita VT, Hersh A. Posterior heel pain associated with a calcaneal step and Achilles tendon calcification. Clin Orthop Relat Res. 1982;(167):203-211.
- 20. Lu CC, Cheng YM, Fu YC, Tien YC, Chen SK, Huang PJ. Angle analysis of Haglund syndrome and its relationship with osseous variations and Achilles tendon calcification. Foot Ankle Int. 2007;28(2):181-185. doi: 10.3113/fai.2007.0181.
- 21. Nakajima K. Insertional Achilles tendinopathy: A radiographic cross-sectional comparison between symptomatic and asymptomatic heel of 71 patients. Eur J Radiol Open. 2024;12:100568. doi: 10.1016/j.ejro.2024.100568.
- 22. Johansson KJ, Sarimo JJ, Lempainen LL, Laitala-Leinonen T, Orava SY. Calcific spurs at the insertion of the Achilles tendon: a clinical and histological study. Muscles Ligaments Tendons J. 2013;2(4):273-277.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ortopedi |
| Bölüm | Original Article |
| Yazarlar | |
| Erken Görünüm Tarihi | 8 Ağustos 2025 |
| Yayımlanma Tarihi | |
| Gönderilme Tarihi | 1 Temmuz 2025 |
| Kabul Tarihi | 2 Ağustos 2025 |
| Yayımlandığı Sayı | Yıl 2025 EARLY ONLINE |
