From the Guidelines
Treatment for plantar spurs should initially focus on conservative approaches, including the use of open-backed shoes, orthoses, accommodative padding, NSAID therapy, and physical therapy, as these methods can significantly reduce pain and inflammation, improving quality of life. The primary goal is to alleviate symptoms and prevent further irritation of the plantar spur.
Conservative Treatment Options
- Open-backed shoes to reduce pressure on the area
- Orthoses or heel lifts to support the foot and redistribute pressure
- NSAIDs to reduce pain and inflammation
- Accommodative padding for additional support and comfort
- Physical therapy, including stretching exercises, to improve foot mechanics and reduce strain on the plantar fascia
- Weight loss, if indicated, to reduce pressure on the foot
Advanced Treatment Options
For cases where conservative treatment does not provide sufficient relief, corticosteroid injections may be considered, although their use should be judicious and based on the latest clinical guidelines 1. In some instances, immobilization with a cast or a fixed-ankle walker-type device may be necessary. Surgical options, such as the resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa, or calcaneal osteotomy to correct calcaneal alignment, are typically reserved for severe cases that do not respond to conservative management.
Importance of Proper Footwear and Orthotic Support
Proper footwear with good arch support and cushioning is essential in the management of plantar spurs, as it can help redistribute pressure away from the affected area, reducing pain and discomfort. Custom or over-the-counter orthotic inserts can also play a crucial role in managing plantar spurs by providing additional support and cushioning.
Role of Physical Therapy
Physical therapy, focusing on stretching and strengthening exercises for the plantar fascia and Achilles tendon, can be beneficial in managing plantar spurs, typically requiring 2-3 sessions weekly for 4-6 weeks. This approach can help improve foot mechanics, reduce strain on the plantar fascia, and promote healing.
Given the available evidence, the most recent and highest quality study guiding the treatment of plantar spurs emphasizes the importance of initial conservative management, with surgical options considered only after failure of conservative treatments 1.
From the Research
Treatment Options for Plantar Spurs
- Rest, anti-inflammatory medication, and various types of shoe padding are common treatment methods for plantar spurs, as they can help reduce pain and inflammation 2.
- Cortisone injections into the heel may be considered if symptoms persist, and surgery may be necessary if conservative treatment is unsuccessful 2.
- Conservative treatment, such as nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics, corticosteroid injections, casts, physical therapy, ice, and heat, is effective in approximately 90% of patients with plantar fasciitis, a common cause of heel pain associated with plantar spurs 3.
- Extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) injection are also effective treatments for chronic plantar fasciitis, with PRP injection showing more effectiveness at a longer duration 4.
- The use of plantar insoles and stretching exercises focused on the plantar fascia have demonstrated limited evidence of benefit, while corticosteroid injections and iontophoresis with steroids have shown evidence of benefit, although limited and short-term 5.
- Supportive treatments, including plantar fascia-specific stretch, calf stretching, appropriate orthotics, and night dorsiflexion splinting, can alleviate plantar fascia pain, and ultrasonography-guided focal extracorporeal shock wave therapy can be useful for patients with chronic plantar fasciitis 6.
Additional Considerations
- Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase, regardless of the chosen treatment modality 6.
- Local injections of corticosteroids can help with pain relief, but the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture 6.