title: Relationship and Classification of Plantar Heel Spurs in Patients With Plantar Fasciitis.
abstract: BACKGROUND
  This study classified plantar heel spurs and their relationship to plantar fasciitis.
  
  
  METHODS
  Patients included those with plantar fasciitis who were treated from 2012 through 2013. Plantar heel spur shape and size were assessed radiographically and correlated to function and pain before and after treatment. Function and pain were scored with the Foot and Ankle Ability Measures and a visual analog scale, respectively. This study included 109 patients with plantar fasciitis.
  
  
  RESULTS
  The plantar heel spur shape was classified as 0/absent in 26 patients, 1/horizontal in 66 patients, 2/vertical in 4 patients, and 3/hooked in 13 patients. The plantar heel spur size was less than 5 mm in 75 patients, 5-10 mm in 28 patients, and greater than 10 mm in 6 patients. Initially, patients with any shape or size to their spur had no difference in function and pain. With treatment, patients with horizontal and hooked spurs had the greatest improvement in function and pain (P < .05). With treatment, patients with larger spurs had the greatest improvement in function and pain (P < .05).
  
  
  CONCLUSIONS
  Plantar heel spurs can be classified by shape and size in patients with plantar fasciitis. Before treatment, neither the spur shape nor size significantly correlated with symptoms. After treatment, patients with larger horizontal or hooked spurs had the greatest improvement in function and pain. These findings may be important when educating patients about the role of heel spurs with plantar fasciitis and the effect of nonsurgical treatment with certain spurs.
  
  
  METHODS
  Level III, comparative series.
authors.affiliation: Orthopaedic Foot and Ankle Surgery, Rothman Institute Orthopaedics, Philadelphia, PA, USA Jamal.ahmad@rothmaninstitute.com.
authors.forename: Jamal
authors.initials: J
authors.lastname: Ahmad
authors.affiliation: Rowan University School of Osteopathic Medicine, Department of Orthopaedic Surgery, Stratford, NJ, USA.
authors.forename: Ammar
authors.initials: A
authors.lastname: Karim
authors.affiliation: Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Daniel
mesh_terms: D036981:Fasciitis, Plantar / Q000473:pathology* / Q000628:therapy; D006365:Heel / Q000473:pathology*; D036982:Heel Spur / Q000145:classification / Q000473:pathology*; D006801:Humans; D010147:Pain Measurement; D064232:Visual Analog Scale
keywords: heel; plantar; plantar fasciitis; spur