From the Guidelines
Treatment for a heel bone spur should initially focus on conservative measures, including rest, ice application, and over-the-counter anti-inflammatory medications, as well as supportive shoes and orthotic inserts to reduce pressure on the spur. According to the American College of Foot and Ankle Surgeons 1, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated).
- Key considerations in managing heel bone spurs include:
- Reducing pressure on the affected area
- Managing pain and inflammation
- Promoting healing and preventing further irritation
- The use of local injections of corticosteroids is not recommended initially 1, but may be considered in refractory cases.
- If no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and additional treatments may include a customized orthotic device, night splinting, or use of a fixed-ankle walker-type device during activity 1.
- Surgery is typically only considered after failed conservative treatment, and other options like extracorporeal shock wave therapy may also be explored 1.
- It is essential to continue treatments until symptoms resolve, and to explore other diagnoses if no improvement occurs after two to three months 1.
From the Research
Treatment Options for Heel Bone Spur
- Rest, anti-inflammatory medication, and various types of shoe padding are common treatment methods for heel spur syndrome, which includes plantar fasciitis and heel spurs 2
- Cortisone may be injected into the heel if symptoms continue, and surgery may be necessary if conservative treatment is unsuccessful 2
- Accurate diagnosis is crucial in planning a treatment protocol for heel spurs, considering differential diagnoses and underlying medical conditions that may contribute to the symptoms 3
Conservative Treatments
- Nonsteroidal anti-inflammatory drugs (NSAIDs), orthoses, physical therapy, and physical agents (e.g. extracorporeal shock wave therapy (ESWT), laser) are treatment options for plantar heel pain 4
- Injected corticosteroids may lead to lower heel pain visual analogue scores (VAS) in the short-term (< 1 month), but the potential benefit is diminished in the medium-term (1 to 6 months follow-up) 4
Invasive Procedures
- Steroid injection, locally injectable NSAID, platelet-rich plasma injections, autologous blood injections, botulinum toxin injections, and dry needling are invasive procedures that have been used to treat heel pain, but the available evidence for these comparisons is very low quality 4
- Serious adverse events relating to steroid injection, such as plantar fascia ruptures and injection site infections, are rare but under-reported, and a higher risk cannot be ruled out 4