Undergraduate Honors Theses

Thesis Defended

Spring 2016

Document Type


Type of Thesis

Departmental Honors



First Advisor

Matthew Sponheimer

Second Advisor

Douglas Bamforth

Third Advisor

Patricia Sullivan


This study investigates the relationship in frequency and demographics of calcaneal enthesophytes between the medieval Nubian population of Kulubnarti and modern-day Western societies in order to elucidate any influence that environment and activity may exert on the formation of heel spurs. This investigation also examines the possible difference in activity patterns between the cemeteries and sexes of individuals at Kulubnarti using bioarchaeological analyses of calcaneal pathology. Numerous hypotheses have been put forth by scholars as to the origin of heel spurs, yet a specific cause remains unclear. The leading theories cite microtrauma and degenerative disease as developmental culprits for plantar exostoses and activity-related stress for dorsal exostoses. For this reason, the medieval Nubian population of Kulubnarti, a society prone to higher levels of pedal trauma and stress, was examined. The prevalence and demographics of afflicted individuals were recorded and compared to enthesophyte statistics of modern-day societies. The calcaneal entheses of 98 individuals (n=194 heels) from two different cemeteries were inspected. The presence or absence of heel exostoses, along with the length (in mm) of inferior exostoses, were recorded. X-rays were also conducted on all mummified feet. The data revealed that 50 (51%) individuals exhibited plantar spurs and 35 (35.7%) possessed Achilles tendon spurs. These results exposed much higher frequencies than the average 11-16% prevalence observed in contemporary populations. Inferior enthesophytes were more frequent in the mainland (R) cemetery, which was composed of the land owners; while dorsal enthesophytes were more prevalent in the island (S) cemetery, which comprised the working, lower-class of society. A significant positive correlation was also discovered between the frequency of inferior exostoses and age, whereas dorsal exostoses lacked a relationship to age. The data suggest that microtrauma and macrotrauma in connection with environment and activity-related stresses may be leading etiological factors in the formation of calcaneal enthesophytes. Degenerative changes may also affect the development of plantar spurs.