Heel spur formation and the subcalcaneal enthesis of the plantar fascia.
Heel spur formation and the subcalcaneal enthesis of the plantar fascia.
复制标题
足跟骨刺的形成和足底筋膜的跟骨附着点。
DOI：
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
M. Benjamin
中科院分区：
文献类型：
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作者：
T. Kumai;M. Benjamin
目的
目的：描述跟距下骨刺与足底筋膜的关系及其意义。
方法
从17具老年人尸体的内侧结节两侧通过矢状锯切去除足底筋膜的止点，拍摄X线片，并对组织进行常规组织学处理。用甲苯胺蓝、马森三色或阿辛蓝对切片进行染色，并将切片与相应的X线片匹配。
结果
骨刺发生在足底筋膜的深层，但其形成是由筋膜内发生的退行性变化所预示的，根据小骨刺与大骨刺的不同，我们认为骨刺的形成可分为三个阶段：（1）足底筋膜附着点处软骨细胞团和裂隙的初步形成，（2）附着点处软骨下骨板增厚，形成小骨刺，（3）附着点处软骨细胞团和裂隙的形成，（4）附着点处软骨细胞团和裂隙的形成，（5）附着点处软骨下骨板增厚，（6）附着点处软骨细胞团和裂隙的形成，（7）附着点处软骨细胞团和裂隙的形成。（3）发育垂直方向的骨小梁，支撑大骨刺近端。骨刺通过膜内骨化和软骨样骨化共同生长。
结论
与流行的看法相反，跟后跟下骨刺不能是牵引骨刺，因为它们不在足底筋膜本身内发育。因此，它们从根本上不同于跟腱中的足跟骨刺。相反，我们认为它们是足底筋膜附着点发生退行性变化的结果。
OBJECTIVE
To describe the structure and significance of subcalcaneal heel spurs associated with the plantar fascia.
METHODS
The enthesis of the plantar fascia was removed from 17 elderly cadavers by sagittal saw cuts either side of the medial tuberosity, radiographs were taken, and the tissue was processed for routine histology. Sagittal sections were stained with toluidine blue, Masson's trichrome, or alcian blue, and sections were matched with the corresponding radiographs.
RESULTS
Spurs develop on the deep surface of the plantar fascia but their formation is heralded by degenerative changes that occur within it. According to differences between small and large spurs, we propose that there are 3 stages in their development: (1) an initial formation of cartilage cell clusters and fissures at the plantar fascia enthesis; (2) thickening of the subchondral bone plate at the enthesis as small spurs form; (3) development of vertically oriented trabeculae buttressing the proximal end of larger spurs. The spurs grow by a combination of intramembranous and chondroidal ossification.
CONCLUSION
Contrary to popular belief, subcalcaneal heel spurs cannot be traction spurs as they do not develop within the plantar fascia itself. They are thus fundamentally different from heel spurs in the Achilles tendon. We suggest instead that they develop as a consequence of degenerative changes that occur in the plantar fascia enthesis.