From the Guidelines
The management of calcaneal spur should begin with conservative treatments, including patient-directed measures such as regular calf-muscle stretching, cryotherapy, over-the-counter heel cushions and arch supports, weight loss (if indicated), activity limitation, and avoidance of flat shoes and barefoot walking, as recommended by the American College of Foot and Ankle Surgeons 1.
Initial Management
The initial management of calcaneal spur includes:
- Regular calf-muscle stretching to reduce pressure on the heel
- Cryotherapy to reduce pain and inflammation
- Over-the-counter heel cushions and arch supports to redistribute pressure away from the spur
- Weight loss (if indicated) to reduce pressure on the heel
- Activity limitation to reduce stress on the heel
- Avoidance of flat shoes and barefoot walking to reduce pressure on the heel
Medical Management
Medical management of calcaneal spur may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
- Padding and strapping of the foot to provide additional support
- Corticosteroid injections (in appropriate patients) to provide temporary relief
Surgical Management
Surgical management of calcaneal spur is typically considered only after 6-12 months of failed conservative treatment, and may include resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa, as well as calcaneal osteotomy to correct calcaneal alignment 1.
Additional Considerations
Additional considerations in the management of calcaneal spur include:
- Proper footwear with adequate arch support and cushioning to reduce pressure on the heel
- Night splints to maintain proper foot positioning during sleep
- Extracorporeal shock wave therapy as a non-invasive option for persistent pain
- Referral to a podiatric foot and ankle surgeon if symptoms do not improve within six to eight weeks 1.
From the Research
Management of Calcaneal Spur
The management of calcaneal spur involves a range of treatment options, including:
- Conservative therapies such as rest, ice massage, nonsteroidal anti-inflammatory drugs, specific plantar fascia stretching exercises, and orthoses 2
- Injection therapies using a corticosteroid or platelet-rich plasma, which typically provide short-term relief 2
- Extracorporeal shock wave therapy and surgery, which may be considered if conservative treatment is ineffective 2, 3
- Preventive measures, such as getting good quality, suitable shoes with the appropriate amount of support for the whole foot 4
- Physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents 4
Treatment Strategies
Treatment strategies for managing heel spurs include:
- Accurate diagnosis and consideration of differential diagnoses and underlying medical conditions that may contribute to the symptoms 5
- Conservative treatments, such as rest, ice, massage, and the use of correct exercise 4
- Advanced procedures, such as corticosteroid injections, extracorporeal shock wave therapy, and radiofrequency thermal lesioning 3
- Surgical intervention, which may be necessary if conservative treatment is unsuccessful 6, 2
Effectiveness of Treatment Options
The effectiveness of different treatment options for chronic plantar fasciitis has been evaluated in several studies, including:
- A retrospective comparative study that found corticosteroid injection, extracorporeal shock wave therapy, and radiofrequency thermal lesioning to be effective in treating chronic plantar heel pain, with corticosteroid injection and radiofrequency thermal lesioning yielding better therapeutic outcomes 3
- A study that found almost all patients respond to conservative nonsurgical therapy, with surgery being the last treatment option if all other treatments have failed 4