From the Guidelines
Heel spur treatment should begin with conservative approaches, focusing on reducing pressure and inflammation, before considering more invasive options. The most effective initial treatment options include open-backed shoes, orthoses, and NSAIDs, as recommended by the American College of Foot and Ankle Surgeons 1.
Key Treatment Strategies
- Rest and ice application for 15-20 minutes several times daily to reduce pain and inflammation
- Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily)
- Wear supportive shoes with cushioned heels and consider over-the-counter orthotic inserts or custom orthotics prescribed by a podiatrist
- Stretching exercises targeting the plantar fascia and Achilles tendon should be performed several times daily, particularly before getting out of bed and after periods of rest
- A night splint can help maintain a stretched position overnight
- Physical therapy may be beneficial for proper stretching techniques and modalities like ultrasound
- Weight loss is recommended for overweight patients to reduce pressure on the heel
According to the American College of Foot and Ankle Surgeons 1, 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 a limited number of corticosteroid injections.
Advanced Treatment Options
- Casting or use of a fixed-ankle walker-type device during activity
- Surgery (plantar fasciotomy) and extracorporeal shock wave therapy may be considered if no improvement occurs after two to three months
- Other diagnoses may need to be explored, such as insertional Achilles tendonitis or neurologic heel pain, which can occur due to irritation or entrapment of one or more nerves innervating the heel 1.
It is essential to continue initial treatments until symptoms resolve, and surgery should only be considered after exhausting non-surgical options for at least 6-12 months. Heel spurs develop as calcium deposits where the plantar fascia attaches to the heel bone, often resulting from chronic plantar fasciitis, which is why treatment focuses on addressing the underlying inflammation and mechanical stress 1.
From the Research
Heel Spur Treatment Options
- Conservative therapies such as rest, ice massage, nonsteroidal anti-inflammatory drugs, specific plantar fascia stretching exercises, and orthoses are the preferred initial treatments 2
- Injection therapies using a corticosteroid or platelet-rich plasma typically provide short-term relief 2
- Extracorporeal shock wave therapy and surgery may be considered if conservative treatment is ineffective 2
- Rest, ice, massage, the use of correct exercise and complying with a doctor's advice all play an important part in helping to recover from heel pain condition 3
- Getting good quality, suitable shoes with the appropriate amount of support for the whole foot is also important 3
Efficacy of Treatment Options
- Almost all patients respond to conservative nonsurgical therapy 3
- Surgery is the last treatment option if all other treatments have failed 3
- The use of an NSAID may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen 4
- A complete plantar fascia release is performed through a medial longitudinal incision, with prominent heel spurs and degenerated areas in the plantar fascia resected, resulting in satisfactory results in most cases 5
Diagnosis and Treatment Approach
- Diagnosis is mostly based on clinical examination, with the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggesting the diagnosis 3
- A combination of causative factors may be present, or the true cause may remain obscure, making treatment challenging 6
- There is no consensus on the efficacy of any particular conservative treatment regimen, but nonsurgical treatment is ultimately effective in approximately 90% of patients 6