Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Prof. Sudhir Vinayak

Second Supervisor/Advisor

Dr. Kavulani Mutiso


Imaging and Diagnostic Radiology (East Africa)


Background: Heel pain is a common clinical entity that requires appropriate diagnostic evaluation. Multiple clinical conditions are known to cause heel pain but plantar fasciitis is the most common. Calcaneal spurs are thought to be associated with heel pain and plantar fasciitis but conclusive studies to prove this are sparse. Plain radiography is usually the first line imaging modality for imaging patients with heel pain. Magnetic Resonance Imaging is the gold standard for diagnosing plantar fasciitis but studies have shown ultrasound to be comparable in sensitivity and specificity. The aim is to establish whether a relationship exists between calcaneal spurs and heel pain caused by plantar fasciitis.

Objective: To estimate the strength of association between plantar fasciitis and calcaneal spurs.

Methods: The study was conducted at the Aga Khan Radiology department between October 2016 and March 2017. The study design was a case-control study nested within a cross-sectional study. Patients with heel pain were recruited and had a plain radiograph and ultrasound of one or both feet. Case and control status was determined sonographically by the presence or absence of plantar fasciitis respectively.

Results: A total of 96 heels (55 participants) were evaluated and calcaneal spurs were present in 35 (36% [27%,46%]) which increased to 62 (65% [55%,74%]) on ultrasound. The crude odds ratio for the association between calcaneal spurs and plantar fasciitis was 3.8 [1.4,10.2] p=0.004. After controlling for age, sex and physical activity and accounting for within individual clustering, the adjusted odds ratio was 2.7 [0.9,8.0] p=0.072. There was a statistically significant difference in the mean calcaneal spur length measured on radiographs and ultrasound, 4.7 mm [3.7,5.7 mm] and 3.5 mm [3.0,4.0 mm], p= 0.020.

Conclusion: Calcaneal spurs and plantar fasciitis are common findings among patients with heel pain but there is no statistically significant association between them.

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