From the Guidelines
The initial treatment for a small posterior calcaneal spur should focus on conservative measures, including patient-directed measures such as regular calf-muscle stretching, cryotherapy, over-the-counter heel cushions and arch supports, weight loss (if indicated), activity limitation, and avoidance of flat shoes and barefoot walking, as recommended by the American College of Foot and Ankle Surgeons 1. The goal of these measures is to reduce pain and inflammation, and to prevent further irritation of the heel.
- Key components of the initial treatment include:
- Regular calf-muscle stretching to reduce tension on the Achilles tendon and plantar fascia
- Cryotherapy, such as ice application, to reduce inflammation
- Use of over-the-counter heel cushions and arch supports to redistribute pressure away from the spur
- Weight loss, if indicated, to reduce stress on the heel
- Activity limitation and avoidance of flat shoes and barefoot walking to reduce stress on the heel
- Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to help manage pain and inflammation, as well as padding and strapping of the foot, and corticosteroid injections in appropriate patients 1. It is essential to note that calcaneal spurs themselves are often not the primary source of pain, but rather the inflammation of surrounding soft tissues causes the discomfort.
- Most patients respond well to these conservative measures within 6-8 weeks without requiring more invasive interventions like corticosteroid injections or surgery, as also suggested by another study with similar recommendations 1.
From the Research
Initial Treatment for Small Posterior Calcaneal Spur
The initial treatment for a small posterior calcaneal spur typically involves conservative methods to alleviate pain and reduce inflammation.
- Rest and avoidance of activities that aggravate the condition are often recommended 2.
- Anti-inflammatory medication can be used to reduce pain and inflammation 2.
- Various types of shoe padding and orthotics can help reduce stress on the heel 2.
- In some cases, cortisone injections may be used to reduce inflammation and relieve pain if symptoms persist 2.
Alternative Therapies
Other therapies that have been studied for the treatment of calcaneal spurs include:
- Ultrasound therapy, which has been shown to have significant analgesic efficacy in patients with heel spurs 3.
- Shock wave therapy, which has been found to be effective in reducing pain and inflammation, with some studies suggesting it may be more effective than ultrasound therapy 3, 4.
- Endoscopic treatment, which involves the removal of the calcaneal spur and release of the plantar fascia, has been shown to be effective in treating refractory heel spur syndrome 5, 6.
Important Considerations
It's worth noting that while these treatments can be effective in reducing pain and inflammation, they may not always eliminate the calcaneal spur itself. In some cases, surgery may be necessary if conservative treatment is unsuccessful 2.