From the Guidelines
Treatment of calcaneal spur (heel spur) should begin with conservative measures, including open-backed shoes, orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as these approaches have been shown to be effective in managing symptoms and improving quality of life. According to the American College of Foot and Ankle Surgeons 1, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated).
Conservative Management
Conservative management is the preferred initial treatment strategy for heel spurs, as it can help alleviate symptoms and improve quality of life. This approach typically involves:
- Open-backed shoes to reduce pressure on the area
- Orthoses or heel lifts to provide support and cushioning
- NSAIDs to reduce pain and inflammation
- Decreased activity to allow the inflamed tissue to heal
- Stretching exercises to improve flexibility and reduce strain on the plantar fascia
- Weight loss (if indicated) to reduce pressure on the heel
Additional Treatment Options
If symptoms persist, additional treatment options may be considered, including:
- Local injections of corticosteroids (although not recommended by some studies 1)
- Immobilization with a cast or fixed-ankle walker-type device
- Customized orthotic devices or night splints
- Extracorporeal shock wave therapy for chronic cases
- Surgery to remove the spur (typically considered only after 6-12 months of failed conservative treatment)
It's essential to note that corticosteroid injections are not recommended by some studies 1, and their use should be carefully considered on a case-by-case basis. Additionally, surgery should only be considered after conservative management has failed, as it carries inherent risks and complications. By prioritizing conservative management and carefully selecting additional treatment options, patients with calcaneal spurs can effectively manage their symptoms and improve their quality of life.
From the Research
Treatment Options for Calcaneal Spur (Heel Spur)
The treatment options for calcaneal spur (heel spur) can be categorized into conservative and advanced procedures.
- Conservative therapies include:
- Rest, ice massage, and nonsteroidal anti-inflammatory medications (NSAIDs) 2, 3, 4
- Specific plantar fascia stretching exercises and orthoses 3, 4, 5
- Shoe padding and modifications (e.g., steel shank and anterior rocker bottom) 2, 4
- Foot padding, taping, arch supports, heel cups, custom foot orthoses, night splints, and ultrasound 4
- Advanced procedures include:
- Corticosteroid injections into the heel if symptoms continue 2, 3
- Extracorporeal shock wave therapy (ESWT) if conservative treatment is ineffective 3, 5
- Surgery if conservative treatment is unsuccessful 2, 3
- Magnetic field therapy, which has shown to be effective in pain management for heel spur, similar to ESWT 5
- Platelet-rich plasma injection therapies, which typically provide short-term relief 3