From the Guidelines
Treatment for a prominent heel spur should begin with conservative measures, including rest, ice application, and activity modification to reduce pressure on the affected heel, as well as the use of open-backed shoes, orthoses, and NSAIDs, as recommended by the American College of Foot and Ankle Surgeons 1. The goal of these treatments is to reduce inflammation around the spur, decrease tension on the plantar fascia, and redistribute pressure during weight-bearing activities, allowing the irritated tissues to heal.
- Initial treatment options may include:
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses to redistribute pressure away from the spur
- NSAIDs to manage pain and inflammation
- Decreased activity and weight loss (if indicated)
- Stretching exercises targeting the plantar fascia and Achilles tendon
- If symptoms improve, initial treatments are continued, but if symptoms do not improve within six to eight weeks, other diagnoses may need to be considered, and patients should be referred to a podiatric foot and ankle surgeon 1.
- Local injections of corticosteroids are not recommended as an initial treatment option, but may be considered in particularly acute or refractory cases 1.
- Surgical intervention to remove the spur may be considered if conservative treatments fail after 6-12 months, and may involve resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa, or calcaneal osteotomy to correct calcaneal alignment 1.
From the Research
Treatment Options for Prominent Heel Spur
- Rest, anti-inflammatory medication, and various types of shoe padding are common treatment methods for heel spur syndrome, which includes prominent heel spurs 2
- Cortisone injection into the heel may be considered if symptoms persist, and surgery may be necessary if conservative treatment is unsuccessful 2
- A two-stage mechanical approach using orthotics can also be effective in treating heel spur syndrome, with the first stage focusing on alleviating the cause and effect of the syndrome, and the second stage using a rigid functional orthotic to treat the cause 3
Importance of Accurate Diagnosis
- Accurate diagnosis is crucial in planning a treatment protocol for heel spurs, as it helps to identify underlying medical conditions that may contribute to the symptoms 4
- Differential diagnoses and medical conditions related to heel spurs should be considered when seeking treatment 4
Advanced Treatment Strategies
- Corticosteroid injection is a popular treatment choice for plantar fasciitis, which is often related to heel spurs, and accurate localization of the injected medication is essential for successful resolution of symptoms 5
- A new surgical approach using a plantar midline incision has been proposed, which permits good exposure and eliminates postoperative paresthesias 6