Obesity is a risk factor for calcaneal spur (CS) formation which is supposed to originate from chronic plantar fasciitis. But histological findings support the thesis that plantar fasciitis is a degenerative fasciosis without inflammation. Diabetes mellitus may contribute to the risk of CS by decreased ability of tissue repair and increased reactive ossification. Thus, we aimed to determine CS incidence in asymptomatic obese subjects with and without type 2 diabetes mellitus. Ninety-three obese patients with type 2 diabetes mellitus (T2DM) and 42 obese subjects without any metabolic disturbances as control were evaluated with lateral calcaneal X-ray in blinded fashion by a radiologist. All participants were informed and written consents have been obtained. Control subjects were subjected to 75 g glucose challenge test and glucose intolerant subjects were excluded. Glycolysed hemoglobin levels were tested by high performance liquid chromatography method. Characteristics were appropriately compared by MannWhitney U or χ2-tests. T2DM and control groups were statistically similar in mean age (59±10.5 vs 55±8 years, P=0.196, respectively) and mean body mass index (BMI) (35.1±4.3 vs 33.1±3.3 kg/m2, P=0.073, respectively). Existence of calcaneal spur was 72 in 93 patients (77%) in T2DM group and 24 in 42 (57%) in control group. Groups were significantly different according to existence of CS (P=0.023). No significant relation was observed between existence of CS and glycolysed hemoglobin levels, diabetes duration, BMI (all P>0.05) in T2DM group.
A recent study reported that incidence of CS 13.2% in general population and 39% of the cases were asymptomatic. Obesity and occupational exposure to pressure on the heel are major causative reasons for CS, but our results emphasize its frequency in patients with T2DM. Clinicians should pay attention the increased incidence of CS in patients with T2DM to avoid foot complications.
Prague, Czech Republic
24 - 28 Apr 2010
European Society of Endocrinology