She estimated a recent weight gain of 15 pounds. Lumbar weightbearing views demonstrated a mild left convex scoliosis and spondylosis. A lateral view of the left foot demonstrated the presence of a moderate calcaneal heel spur. This may result in either a calcaneal spur or plantar fasciitis. If the foot flattens or becomes unstable during critical times during the gait cycle, the attachment of the plantar fascia onto the heel may begin to stretch and pull away from the calcaneus.
Heel spurs are visible on x-ray, most prominent on a lateral foot view.
The heel pain is especially noticeable to the patient during the toe-off phase of gait. Many patients report onset of pain when getting out of bed and an acute inability to tolerate weightbearing on the affected heel. The patient may also report either a sudden increase in daily activities, an increase in weight or a change in footwear. The most frequent cause, however, is an abnormal motion of the foot known as hyperpronation. Counter-rotation of the tibia against the femur, the result of excessive pronation, causes two heads of the tendon to torque against each other and stretch the tendon.