From the Guidelines
Bidirectional calcaneal enthesophytes should be treated with conservative measures, including open-backed shoes, orthoses, and NSAIDs, as initial treatment options, according to the American College of Foot and Ankle Surgeons 1. Treatment of bidirectional calcaneal enthesophytes typically begins with conservative measures, including:
- Open-backed shoes to reduce pressure on the area
- Orthoses or heel lifts to redistribute pressure
- NSAIDs, such as ibuprofen or naproxen, for pain and inflammation
- Decreased activity and weight loss, if indicated
- Stretching exercises targeting the plantar fascia and Achilles tendon, performed 2-3 times daily These measures can help alleviate symptoms and improve quality of life. If symptoms do not improve within six to eight weeks, other diagnoses may need to be considered, and patients should be referred to a podiatric foot and ankle surgeon 1. In some cases, immobilization, corticosteroid injections, or physical therapy may be added to the treatment plan. Surgery, such as resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa, may be considered if conservative treatments fail after 6-12 months 1. It is essential to note that local injections of corticosteroids are not recommended as an initial treatment option 1. The goal of treatment is to reduce pain and inflammation, improve function, and enhance quality of life, while minimizing the risk of morbidity and mortality.
From the Research
Bidirectional Calcaneal Enthesophytes
- Bidirectional calcaneal enthesophytes refer to bony projections that form on the calcaneus bone in both the posterior and inferior directions.
- The development of calcaneal enthesophytes is often associated with conditions such as plantar fasciitis, Achilles tendinopathy, and retrocalcaneal bursitis 2.
- Symptoms of calcaneal enthesophytes can include heel pain, swelling, and difficulty wearing shoes 3.
Treatment Options
- Treatment options for calcaneal enthesophytes can include surgical resection of the enthesophyte, as well as functional lengthening of the Achilles tendon and gastroc-soleal muscle complex 3.
- Endoscopic treatment of insertional Achilles tendinopathy is also a possible option, which can include resection of the enthesophyte and posterosuperior calcaneal prominence, and reinsertion of the tendon using anchors 4.
- Open debridement of the retrocalcaneal bursa, calcaneal osteophyte, and diseased tendon is another surgical approach that can be used to treat calcaneal enthesophytes 5.
Diagnostic Imaging
- Diagnostic imaging, such as ultrasound and MRI, can be used to evaluate the presence and extent of calcaneal enthesophytes, as well as to diagnose other conditions that may be contributing to symptoms 6.
- The use of advanced imaging diagnostics can help to confirm the diagnosis and guide treatment decisions.
Complications and Outcomes
- Complications of surgical treatment for calcaneal enthesophytes can include irritation of the suture knot, recurrence of the bony prominence, and dehiscence 3.
- Outcomes of treatment can vary, but studies have shown that surgical resection of the enthesophyte and functional lengthening of the Achilles tendon can be effective in reducing symptoms and improving function 3.