Sonographic and histological appearance of heel enthesopathy, what the “heel spurs” really are and what are their consequences

Most common enthesopathy of all the calcaneal insertions is in Achilles tendons, then in plantar aponeurosis and in flexor digitorum brevis origin. The basic diagnostic findings in imaging techniques of the enthesopathy are lesions and scars on the tendons or aponeurosis, erosions, enthesophytes and mixed erosive-enthesophytic changes. In histopathological appearance one can find tissues resembling typical structures of the particular location, oligocellular zones, hyalinization, adipose degeneration, ruptures, signs of repair. Lack of histological inflammatory changes in the affected zones seems to be important. It may also play a role in interpretation of ultrasound images in other enthesis zones as well as in making therapeutic decisions. Another important fact is a secondary or even lack of clinical meaning of so called heel spurs.