From the Guidelines
Heel spurs are typically treated with conservative measures, including rest, ice application, and over-the-counter pain relievers, with surgery rarely needed and reserved for cases unresponsive to conservative treatment after 6-12 months. The diagnosis of a heel spur, also known as a calcaneal spur, is often associated with plantar fasciitis, and treatment should prioritize reducing pain and inflammation [ 1 ].
Initial Treatment Options
Initial treatment options may include:
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses
- NSAIDs
- Decreased activity
- Stretching exercises
- Weight loss (if indicated)
Additional Treatment Measures
If no improvement occurs after six weeks, additional treatment measures may be considered, including:
- Customized orthotic devices
- Night splinting
- Corticosteroid injections (avoiding the Achilles tendon)
- Casting or use of a fixed-ankle walker-type device during activity
- Referral to a podiatric foot and ankle surgeon for further evaluation and treatment [ 1 ].
Surgery and Other Options
Surgery, such as plantar fasciotomy or resection of the prominent posterior superior aspect of the calcaneus, is rarely needed and reserved for cases unresponsive to conservative treatment after 6-12 months [ 1 ]. Other options, such as extracorporeal shock wave therapy, may also be considered for persistent pain [ 1 ].
Prevention and Management
Heel spurs develop gradually due to chronic strain on foot muscles and ligaments, often associated with plantar fasciitis, and are more common in runners, people who are overweight, or those who wear improper footwear [ 1 ]. Most heel spurs improve with consistent non-surgical treatment within several months, emphasizing the importance of early diagnosis and treatment to prevent long-term morbidity and improve quality of life [ 1 ].
From the Research
Diagnosis of Heel Spur (Calcaneal Spur)
- The diagnosis of heel spur is mostly based on clinical examination, with the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggesting the diagnosis 2.
- Routine imaging studies are not usually necessary but can be used to rule out pathologies or confirm chronic or recalcitrant plantar fasciitis, with the presence of a heel spur on x-ray indicating the condition has been present for at least 6 to 12 months 3.
- A thorough medical history and physical examination are essential to determine the underlying cause of heel pain and to rule out other potential causes 4.
Treatment of Heel Spur (Calcaneal Spur)
- Conservative therapies such as rest, ice, massage, nonsteroidal anti-inflammatory drugs, specific plantar fascia stretching exercises, and orthoses are the preferred initial treatments for heel spur 2, 3.
- Injection therapies using a corticosteroid or platelet-rich plasma may provide short-term relief, while extracorporeal shock wave therapy and surgery may be considered if conservative treatment is ineffective 3.
- Radiotherapy has been shown to be effective in reducing pain in patients with plantar heel spurs, with significant pain reduction observed during and after treatment, and long-term results showing effective pain relief for up to 2 years after treatment 5.
- Preventive measures, such as wearing good quality, suitable shoes with appropriate support for the whole foot, and avoiding activities that aggravate the condition, can help alleviate symptoms and prevent further injury 2, 4.
Treatment Outcomes and Prognostic Factors
- The effectiveness of treatments for heel spur can vary, with some studies showing limited evidence for the effectiveness of certain interventions, such as topical corticosteroid administered by iontophoresis, and conflicting evidence for the effectiveness of low energy extracorporeal shock wave therapy 6.
- Prognostic factors, such as older age and reduction of mechanical heel stress during radiotherapy, may influence treatment outcomes, with older patients and those who avoid heel stress during treatment showing better short-term response to radiotherapy 5.
- The duration of heel pain before treatment may also impact treatment outcomes, with shorter pain history improving long-term results 5.