What are the treatment options for heel spurs?

Treatment Options for Heel Spurs

The most effective initial treatment for heel spurs includes conservative measures such as regular calf-muscle stretching, orthoses, NSAIDs, activity modification, and appropriate footwear for at least 6 weeks before considering more advanced interventions. 1

Initial Conservative Treatment (First 6 Weeks)

Activity Modifications

• Regular plantar fascia and calf muscle stretching exercises
• Weight loss if indicated
• Limitation of aggravating activities
• Avoidance of flat shoes and barefoot walking 1

Orthotic Support

• Medial arch supports
• Over-the-counter heel cushions
• Padding and strapping of the foot
• Open-backed shoes (especially for posterior heel pain) 2, 1

Pain Management

• NSAIDs for pain and inflammation
• Ice massage for acute pain 3

Location-Specific Treatment Approaches

Medial Plantar Heel Pain (Plantar Fasciitis)

• Specific plantar fascia stretching exercises
• Orthoses with medial arch support
• Limited corticosteroid injections may be considered for persistent cases 1, 3

Posterior Heel Pain (Achilles Tendinopathy)

• Heel lifts or orthoses
• Eccentric strength training exercises
• Avoid corticosteroid injections as they increase risk of tendon rupture 2, 1

Lateral Heel Pain (Bursitis with Haglund's Deformity)

• Accommodative padding
• Physical therapy
• Open-backed shoes 2, 1

Persistent Symptoms (After 6-8 Weeks)

If no improvement occurs after 6-8 weeks of conservative treatment:

• Referral to a podiatric foot and ankle surgeon is appropriate
• Consider customized orthotic devices
• Night splinting (for plantar fasciitis)
• Immobilization cast or fixed-ankle walker-type device 2, 1

Advanced Treatment Options (After 2-3 Months)

For cases that fail to respond to conservative measures:

• Extracorporeal shock wave therapy
• Injection therapies (corticosteroid or platelet-rich plasma for plantar fasciitis only) 1, 3

Surgical Intervention (After 6 Months)

Surgery should be reserved for cases that fail to respond to comprehensive conservative treatment after 6 months:

• Plantar fasciotomy for plantar fasciitis
• Resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa for Haglund's deformity 1, 4

Important Considerations

• The presence of a heel spur on x-ray is not thought to be the underlying cause of symptoms and indicates the condition has been present for at least 6-12 months 3
• 90% of patients with heel pain improve with conservative measures 1
• Red flags requiring further investigation include bilateral heel pain, night pain or rest pain, neurological symptoms, and history of trauma 1
• Surgical outcomes are generally good, with significant improvements in pain and function scores, but should only be considered after exhausting conservative options 4

Common Pitfalls to Avoid

1. Rushing to invasive treatments before adequate trial of conservative measures
2. Using corticosteroid injections for Achilles tendinopathy (increases rupture risk)
3. Failing to identify underlying causes such as abnormal foot biomechanics
4. Overlooking red flags that might indicate more serious conditions
5. Not providing adequate time for conservative treatments to work (minimum 6 weeks)