Plantar Fasciitis and Calcaneal Heel Spur Occurrence and Implications - PDF document

Plantar Fasciitis and Calcaneal Heel Spur Occurrence and Implications ............. 17

!Musculoskeletal Markers: Enthesophytes and Calcaneal Heel Spurs .................. 19

!Plantar Spur Scoring ................................................................

............................. 22!Statement and Elaboration of Project Focus ..........

............................................... 23!Questions and Hy .................

.......................... 55!Table 12. Summary Statistics (dF = 1) for all male compa

risons between Plantar and Dorsal Spurs to Biographical Data and Measurements. .......

.................................... . Summary of ANOVA significance for all measureme

nts when compared to plantar and dorsal spur severity. nature of plantar fasciitis eti

ology. Yet, WeissÕs proposals are augment and advance current clinical research.The

etiology of disease in historic skeletal to examine the etiology of plantar fasciitis

in recent modern historical populations with the combined methodologies of biological

anthropology and clinical research. Biological anthropologyÕs has affinity and expert

ise with the skeletal record and provides CHAPTER 2 esearch focusing specifically on

plantar fasciitis from a biological anthropological perspective is nearly nonexistent

. WeissÕs ambiguity regarding the contribution differences between activity and body

mass (Godde and Taylor 2011). The study of MSMs has matured Notably, atthew functio

nal research (Hens and Godde 2008; Washburn 1951). Washburn argued that physical anth

ropologists must adopt the ÒModern SynthesisÓ of other biological sciences, an approac

h stressing functional and evolutionary interpretations, to maintain relevance for bro

ader scientific questions. John Lawrence Angel was one of the earliest adopters of Was

hburnÕs approach to answer broader behavioral questions by applying new methodologies

with a functional framework (Angel 1952). While both Angel and Washburn inspired a ne

w generation of research, the succeeding two decades were primarily directed towards b

asic research, understanding of engineering theory on bone modeling, and often margina

lized the broader behavioral implications (Hoyte and Enlow 1966; Lovejoy et al. 1976;

Ruff and Hayes 1983). These researchers were not dismissive of the broader behavioral

questions, but were instead attempting to understand the patterns of bone remodeling t

hat were necessary for testing more complex behavioral questions. In the 1970s and 198

0s these efforts began to formalize into coherent methodologies, including the use of

MSMs (Chamay and Tschantz 1972; Woo et al. necessary for the field of physical anthro

pology and human skeletal research to remain relevant to broader society. These calls

for interdisciplinary approaches have facilitated the advent of many projects joining

clinical knowledge with biological anthropologyÕs expertise of the skeletal records,

including WeissÕs (2012) research into the association of calcaneal enthesophytes. Cl

inical and Medical Background for the study of Plantar Fasciitis common use in recogni

tion that the disease can, albeit uncommonly, occur without the presence of a heel spu

r (Cornwall and McPoil 1999; Lemont et al. 2003; Rompe et al. 2007; Thomas et al. 2010

; Weber et al. 2005). More recently, there too has begun a movement to shift the use

of Ôplantar fasciitisÕ to Ôplantar fasciosisÕ to prevent association with inflammation

, denoted by the suffix Ô-itis'; it is now accepted that inflammation is not a factor

term, plantar fasciitis (Beeson 2014; Wh a culprit in musculoskeletal pain, has been r

uled out as a cause for plantar fasciitis (Lemont et al. 2003; Thomas et al. 2010). P

lantar Fasciitis and Calcaneal Heel Spur Occurrence and Implications Plantar fasciiti

s is reported to afflict at least ten percent of the general United States population

at least once during their lives (Mahowald et al. 2011; Rompe et al. 2007). Roughly t

wo million people each year seek clinical treatment, which accounts for almost 15 perc

ent of all foot pain related clinical visits (Rompe et al. 2007). Additionally, the c

ondition is reported to be twice as prevalent in women as men (Myerson 2000), and disp

roportionately affects individuals who are above average weight (Butterworth et al. 20

14; Hooper et al. 2006), and those individuals who spend a majority of their occupatio

nal time on their feet or are subject to plantar stresses such as runners (Iradukunda

et al. 2013; Werner et al. 2010). Banadda et al. (1992) also specifically confirmed t

hese tre t is reported as high as 80 percent (Fakharian and Kalhor 2006; Hurwitz and P

arekh 2012), 60 percent (Amis et al. 1988; Smith et al. 2007), and as low as 50 percen

t (Myerson 2000). It is also observed that heel spur occurrence in symptomatic popula

tions is not correlated with age ese exceptions have cast doubt on the heel spurs impo

rtance, by asserting that its presence is expected regardless of symptomatic and asymp

tomatic status. Asymptomatic heel spurs have also been reported to occur twice as fr

equently in females (Fakharian and Kalhor 2006). This trend is in agreement with othe

r planter fasciitis literature 2002; Hawkey and Merbs 1995; Weiss 2003; Weiss 2004; W

eiss et al. 2012). In other words, enthesophytes are produced proportionally to the m

agnitude of biomechanical forces that are involved. The occurrence of musculoskeletal

stress markers, etheses, has been correlated with age, gender, body size, and activity

(Rogers et al. 1997; Weiss 2004; Weiss et al. 2012). MSMs have been demonstrated to

positively correlate with age, activity, and body size, and manifest disproportionally

more in males (Godde and Taylor 2011; Godde and Taylor 2013; Villotte et al. 2010; We

iss et al. 2012). The literature has also shown that enthesophyte growth is inhibited

in cold environments, due to reduced blood flow by way of vasoconstrictive responses

to conserve heat (Hawkey and Merbs 1995). Hawkey and Merbs (1995) also observed that

enthesophyte formation differs in children, since biomechanical forces in children dis

tribute over larger areas and are not generally concerted on the entheses. It is impor

tant to distinguish and be aware of the various factors and trend incongruities when a

ssessing causality and correlations for MSM presences (Moroney et al. 2014; Weiss et a

l. 2012). In fact, a poor understanding of trends in entheses has been proposed as th

e cause for the recent attempts to invalidatecalcaneal heel spurs as a cause occurren

ce would positively Statement and Elaboration of Project Focus This project builds upo

n WeissÕs (2012) pioneering efforts to advance our understanding of foot disease etiol

ogy by focusing primarily on plantar calcaneal spurs and plantar fasciitis. WeissÕs (

2012) labors assessing non-specific calcaneal spurs in historical populations has demo

nstrated that the skeletal record is both applicable and valuable for assessing the pr

esently perplexing etiology of plantar fasciitis. This project focused on historical

remains in order to examine calcaneal heel spur etiology and improve our understanding

of long-term chronological trends.Specifically, study examined recent modern historic

al skeletons housed and curated at the Cleveland Museum of Natural History. The Cleve

land Museum of Natural HistoryÕs collection is well documented, diverse, and large; ac

cordingly, the CHAPTER 4 MATERIALS AND METHODS This study was conducted using the Ha

mann-Todd Collection housed at the Cleveland Museum of Natural History in Ohio (CMHTC)

. The Hamann-Todd Collectionone of the largest, most well-documented collections in t

he world and 39 obese individuals (Quigley 2001). The large distribution of BMI made

the collection a great source to assess weight correlates with heel spur occurrence.

Materials This study examined the skeletal remains of 299 individuals from the Hamann

-Todd Collection, retaining 293 individuals in the analysis. Six individuals were exc

luded from analysis as the result of having abnormally low Body Mass Index (BMI), cons

idered less than 16.0 Table 1. Sample Size by Age and Sex Distribution Age Range Mal

es Females Total 20-29 1 3 4 30-39 42 22 64 40-49 42 26 68 Table 2. Sample Size by BMI

and Sex Distribution BMI Males Females Total Underweight (less than 18.5) 23 13 36 N

ormal Weight (18.5 to 24.9) 78 75 153 Overweight (25 to 29.9) 62 25 87 Obese (30.0 and

greater) 9 4 13 Collection Methods The medial calcaneal tuberosity and posterior tub

erosity were evaluated Moderate enthesophyte growth: The medial calcaneal tuberosity

has a clear plateau and has developed a recessed concavity in the sagittal view and co

ntains enthesophyte growth in excess of two millimeters. 3 Severe enthesophyte growth:

The medial calcaneal tuberosity has a severe and deep recessed concavity in the sagit