From the Guidelines
Achilles bone spurs can be effectively treated with conservative measures, and surgical intervention should only be considered after 6-12 months of failed conservative treatment. The initial treatment approach should include rest, ice, and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) for pain and swelling, as recommended by the American College of Foot and Ankle Surgeons 1.
Conservative Treatment
Conservative measures should be the first line of treatment, including:
- Physical therapy exercises focusing on gentle stretching of the Achilles tendon and calf muscles, such as heel drops and towel stretches
- Wearing supportive shoes with cushioned heels and using heel lifts or orthotic inserts to reduce pressure on the spur
- Night splints to maintain tendon flexibility while sleeping
- Corticosteroid injections may be considered for persistent pain, although they are used cautiously due to the risk of tendon weakening, as noted in the treatment of heel pain 1
- Extracorporeal shock wave therapy (ESWT) may be beneficial for chronic cases
Surgical Intervention
Surgical techniques, such as excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis, can be effective in carefully selected patients, as discussed in the review of common overuse tendon problems 1. However, surgery should only be considered after a well-managed conservative treatment trial has failed to provide relief.
Treatment Goals
The primary goals of treatment are to reduce inflammation around the spur, improve flexibility of the Achilles tendon, and decrease mechanical pressure on the painful area during movement. By prioritizing conservative measures and reserving surgical intervention for cases where these measures have failed, patients can achieve significant improvement in their symptoms and quality of life.
From the Research
Achilles Bone Spur Treatments
- The available evidence suggests that various treatments can be effective for Achilles tendinopathy, including Achilles bone spurs 2, 3, 4, 5, 6.
- Conservative treatments that have been researched include:
- Nonsteroidal anti-inflammatory medication
- Eccentric exercise
- Stretching
- Orthotics
- Bracing
- Glyceryl trinitrate patches
- Injection therapies (corticosteroids, hyaluronic acid, platelet-rich plasma injections)
- Shock wave therapy
- Low-level laser therapy 2.
- Exercise has the highest level of evidence supporting its ability to reduce insertional Achilles tendinopathy (IAT) pain, and its effects may be enhanced by other treatments such as soft tissue treatment, nutritional supplements, and heel lifts 3.
- Extracorporeal shock wave therapy seems to be the next best nonoperative treatment option to reduce IAT pain when exercise is unsuccessful 3.
- Surgical treatment is recommended when nonsurgical treatment fails, and options include preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, or detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment 4.
- Orthotic devices such as foot orthoses, splints, taping, and bracing are recommended for Achilles tendinopathy, but the evidence for their effectiveness is weak to moderate 5.
- A living systematic review with network meta-analysis found that any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months, and that exercise therapy, exercise+injection therapy, and exercise+night splint therapy were all comparable with injection therapy for midportion tendinopathy at 12 months 6.