From the Guidelines
Bidirectional calcaneal enthesophytes on the dorsal calcaneus should be treated with conservative measures, including rest, ice application, and non-steroidal anti-inflammatory drugs (NSAIDs), as initial treatment options. Treatment typically begins with these conservative measures, including NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks to reduce pain and inflammation, as recommended by the American College of Foot and Ankle Surgeons 1.
Conservative Treatment
- Physical therapy focusing on stretching exercises for the calf muscles and Achilles tendon should be performed 2-3 times daily, holding each stretch for 30 seconds and repeating 5 times.
- Custom orthotic inserts or heel cups can provide cushioning and reduce pressure on the affected area.
- Extracorporeal shock wave therapy may be beneficial for persistent cases.
- Night splints worn during sleep can prevent morning stiffness.
Surgical Intervention
For severe cases unresponsive to conservative treatment for 6-12 months, surgical intervention may be necessary to remove the bone spurs, as some patients may require calcaneal osteotomy to correct calcaneal alignment 1. These enthesophytes develop due to chronic tension at the tendon-bone junction, causing calcium deposition and bone formation as a protective response to repetitive stress or inflammation, often associated with conditions like Achilles tendinopathy or plantar fasciitis.
Additional Considerations
It is essential to consider other diagnoses if symptoms do not improve within six to eight weeks and refer patients to a podiatric foot and ankle surgeon if necessary 1. Initial treatments are continued, and an immobilization cast or fixed-ankle walker-type device may be added, and bursa injection may be considered 1.
From the Research
Bidirectional Calcaneal Enthesophytes Dorsal Calcaneus
- The presence of calcaneal enthesophytes can be associated with various conditions, including plantar fasciitis and Achilles enthesopathy 2.
- Enthesophytes can be located at different sites, including the dorsal calcaneus, and can be caused by various factors, such as trauma, aging, and certain diseases like spondyloarthritis 3.
- The treatment of calcaneal enthesophytes can involve surgical resection, which can be performed using different techniques, including open and endoscopic approaches 4, 5.
- The choice of treatment depends on the location and size of the enthesophyte, as well as the patient's overall health and medical history.
- Studies have shown that endoscopic treatment of insertional Achilles tendinopathy can be effective in resecting enthesophytes and promoting healing 4.
- Functional lengthening of the Achilles tendon and buried knot technique can also be used to minimize complications and prevent recurrence of the enthesophyte 5.
- The incidence and risk factors of calcaneal enthesophytes have been studied in different populations, including patients with spondyloarthritis and trauma patients 3.
- Radiographic and MR imaging analysis can be used to determine the size and location of enthesophytes, as well as their relationship to surrounding soft tissue structures 6.