What is the treatment for a plantar surface calcaneal spur?

Treatment for Plantar Surface Calcaneal Spur

Conservative treatment is the first-line approach for plantar surface calcaneal spurs, with 90% of patients improving without requiring surgery. 1

Non-Pharmacological Interventions (First-Line)

• Regular stretching exercises:

  • Stretch calf muscles and plantar fascia daily 1
  • Focus on strengthening intrinsic foot muscles
  • Improve ankle mobility through eccentric exercises 1

• Footwear modifications:

  • Use properly fitting footwear with adequate support 1
  • Consider shoe inserts with cushioning properties
  • Implement custom or over-the-counter orthotics to correct biomechanical issues 1

• Physical modalities:

  • Apply ice through a wet towel for 10-minute periods (cryotherapy) 1
  • Use external supports like night splints 1
  • Consider transcutaneous electrical nerve stimulation (TENS) for pain relief 1

Pharmacological Interventions

• Oral medications:

  • Use NSAIDs for short-term pain relief 1
  • Consider celecoxib as a non-selective NSAID alternative
  • Use paracetamol as an alternative to NSAIDs 1

• Injection therapy:

  • Consider local glucocorticoid injections if first-line treatments fail
  • Use corticosteroid injections with caution due to potential risks of plantar fascia rupture and fat pad atrophy 1, 2

Advanced Interventions

• Minimally invasive treatments:

  • Consider platelet-rich plasma injections or therapeutic ultrasound for refractory cases 2
  • Botulinum toxin injections may help relax calf muscles and decrease stress on the plantar fascia 2

• Surgical options:

  • Reserve surgery for patients who have failed 3-6 months of conservative therapy 1
  • Consider plantar fasciotomy (endoscopic approach preferred) after exhausting all non-operative options 1, 3
  • Open heel spur surgery can be effective with minimal complications but should only be considered after conservative treatment failure 4

Treatment Timeline and Referral

• Evaluate response to treatment every 4-6 weeks 1
• Refer to a foot specialist if no improvement occurs after six weeks of conservative treatment 1
• Be aware that complete resolution may take 3-6 months even with appropriate conservative management 2

Special Considerations

• For patients with diabetes:

  • Perform more frequent foot examinations
  • Evaluate for peripheral arterial disease and neuropathy
  • Advise never to walk barefoot, in socks only, or in thin-soled slippers 1

• Common pitfalls to avoid:

  • Relying solely on corticosteroid injections without addressing biomechanical factors
  • Rushing to surgical intervention before adequate trial of conservative measures
  • Neglecting the importance of proper footwear and stretching exercises
  • Failing to recognize that radiographic presence of a heel spur doesn't always correlate with symptoms

Remember that while a calcaneal spur may be visible on imaging, the pain often stems from associated plantar fasciitis rather than the spur itself. Treatment should target both the inflammatory process and the biomechanical factors contributing to the condition.