From the Guidelines
Treatment for calcaneal spur should initially focus on conservative measures, including open-backed shoes, orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as these approaches can effectively manage symptoms and improve quality of life. When considering treatment options for calcaneal spurs, it's essential to prioritize approaches that minimize morbidity, mortality, and enhance the patient's quality of life.
Conservative Treatment
- Open-backed shoes to reduce pressure on the area
- Orthoses or heel lifts to provide support and cushioning
- NSAIDs for pain and inflammation management
- Decreased activity to avoid exacerbating the condition
- Stretching exercises to improve flexibility and reduce tension in the plantar fascia and Achilles tendon
- Weight loss, if indicated, to reduce pressure on the heel
These conservative measures are recommended as the first line of treatment, as they are generally effective in managing symptoms and can be implemented with minimal risk of adverse effects, as suggested by 1 and further supported by 1.
Surgical Intervention
Surgical intervention, such as the resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa, may be considered for patients who do not respond to conservative measures after 6-12 months, as noted in 1. However, surgery should be reserved for persistent cases due to the associated risks, including infection and nerve damage. It's crucial to address the underlying cause of heel pain, which is often plantar fasciitis rather than the calcaneal spur itself, and to focus on treating inflammation and biomechanical issues to achieve the best outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Treatment Options for Calcaneal Spur
The treatment options for calcaneal spur include:
- Conservative treatment methods such as rest, anti-inflammatory medication, and various types of shoe padding 2
- Cortisone injection into the heel if symptoms continue 2
- Surgery if conservative treatment is unsuccessful 2, 3, 4, 5, 6
Surgical Treatment
Surgical treatment options include:
- Endoscopic treatment of calcaneal spur syndrome, which involves treatment of the heel spur and plantar fasciitis, as well as adjacent calcaneal periostitis 3, 4
- Open heel spur surgery, which involves excision of the calcaneal spur and provides a better view of the surgical wound, allowing for additional interventions in the region under visual control 6
- Arthroscopic treatment, which is a tissue-sparing and effective approach when conservative therapy has failed 3, 4
Postoperative Care and Results
Postoperative care and results vary depending on the surgical approach used. Studies have reported:
- Good to excellent results at 3 months postoperatively in all patients with regard to pain relief and return to normal activity 3
- Average AOFAS score of 89.8 at 6 months postoperatively and 90.4 at one year after open heel spur surgery 6
- Average VAS score of 2 at 6 months postoperatively and 2 at one year after open heel spur surgery 6
- Complications such as superficial wound infections, transient lateral paresthesias, and recurrence of heel spur have been reported 3, 4, 6