From the Guidelines
Treatment for a plantar spur typically begins with conservative measures, including rest, ice application, and over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-440mg twice daily) to reduce inflammation and pain. The most recent and highest quality study 1 provides guidelines on offloading foot ulcers in persons with diabetes, which can be applied to the treatment of plantar spurs.
Key Conservative Measures:
- 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 inactivity.
- Wearing supportive shoes with cushioned soles and arch support is essential, and custom or over-the-counter orthotic inserts can help redistribute pressure away from the spur.
- Night splints may be beneficial to maintain foot flexibility while sleeping.
- For persistent pain, physical therapy focusing on strengthening foot muscles and improving flexibility is recommended.
- Corticosteroid injections (such as methylprednisolone or triamcinolone) can provide temporary relief for severe cases.
- Weight loss is advised for overweight patients to reduce pressure on the foot.
Surgical Intervention:
Surgery to remove the spur is rarely necessary and only considered when conservative treatments fail after 6-12 months and pain significantly impacts daily activities. The study 1 suggests that surgical offloading interventions, such as Achilles tendon lengthening or metatarsal head resection, may be considered in certain cases. However, these interventions are typically reserved for patients with diabetes and foot ulcers, and may not be directly applicable to the treatment of plantar spurs.
Outcome:
Most plantar spurs improve within 9-12 months with conservative approaches. These treatments work by reducing inflammation around the spur, improving foot biomechanics, and decreasing pressure on the affected area. By prioritizing conservative measures and reserving surgical intervention for severe cases, patients with plantar spurs can expect to achieve significant improvements in morbidity, mortality, and quality of life.
From the Research
Treatment Options for Plantar Spur
The treatment for plantar spur, also known as plantar fasciitis, can vary depending on the individual's risk factors and preferences. Some common treatment options include:
- Rest and stretching exercises to alleviate pain and reduce inflammation 2
- Orthotics, arch supports, and night splints to provide support and stability to the foot 3, 2, 4
- Anti-inflammatory agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to reduce pain and inflammation 3, 2
- Corticosteroid injections to provide short-term pain relief, although the effects may be short-lived and carry risks such as fat pad atrophy and plantar fascia rupture 4, 5
- Ultrasonography-guided focal extracorporeal shock wave therapy for patients with chronic plantar fasciitis 4
- Low-Dye taping (LDT) as a temporary treatment to alleviate pain during the initial waiting period for custom foot orthoses or as an alternative to foot orthoses for patients who may not tolerate the plantar pressures of an orthotic 6
Conservative Management
Conservative management is the primary approach for treating plantar fasciitis, with approximately 90% of patients responding to nonsurgical treatment 3. The goal of conservative management is to reduce pain and inflammation, improve foot function, and prevent further injury. This can be achieved through a combination of the treatment options listed above, tailored to the individual's specific needs and preferences.
Activity Modification
Activity modification is also an important aspect of treating plantar fasciitis, as it can help reduce cyclical repetitive loading of the plantar fascia and alleviate pain 4. This may involve avoiding activities that aggravate the condition, such as running or jumping, and modifying daily activities to reduce stress on the foot.