What is the treatment for a calcaneal spur?

Treatment for Calcaneal Spur

The most effective treatment for calcaneal spur includes a combination of conservative measures such as appropriate footwear, orthoses, NSAIDs, stretching exercises, and weight loss if indicated, with surgical intervention reserved for cases that fail to respond after 6-8 weeks of appropriate conservative management. 1, 2

Diagnosis and Assessment

• Calcaneal spurs are bony outgrowths from the calcaneal tuberosity that can cause heel pain, often associated with plantar fasciitis 3
• Pain location helps determine the specific condition:
  • Posterior heel pain suggests Achilles tendonitis or bursitis 2
  • Lateral heel pain may indicate Haglund's deformity 2
  • Diffuse heel pain could suggest stress fracture 2
  • Pain relieved when walking barefoot but worsened by shoes suggests Haglund's deformity or bursitis 2

Conservative Treatment Options

First-Line Treatments

• Rest and activity modification to prevent ongoing damage and reduce pain 1
• Appropriate footwear selection:
  • Open-backed shoes to reduce pressure on the affected area 1
  • Shoes with proper fit, width, and cushioning 1
• Orthotic devices:
  • Heel lifts or cushions to redistribute weight and reduce pressure 1, 2
  • Custom or over-the-counter arch supports 2

Pain Management

• NSAIDs (oral or topical) for pain relief and reducing inflammation 1
• Cryotherapy (ice application) for 10-minute periods through a wet towel to reduce pain and swelling 1
• Avoid corticosteroid injections near the Achilles tendon due to risk of tendon rupture 1, 2

Exercise and Physical Therapy

• Stretching exercises for the plantar fascia and Achilles tendon 1
• Eccentric exercises have proven beneficial for tendinopathies 1
• Weight loss if indicated to reduce pressure on the heel 1, 2

When Conservative Treatment Fails

• If no improvement occurs within 6-8 weeks of appropriate conservative treatment, referral to a podiatric foot and ankle surgeon is recommended 1, 2
• Additional treatment options may include:
  • Immobilization with a cast or fixed-ankle walker-type device 1
  • Advanced imaging studies (MRI, ultrasound) to confirm diagnosis and rule out other conditions 1, 2

Surgical Options

• Surgery should only be considered after failure of conservative measures for at least 6 months 4
• Surgical approaches include:
  • Open surgical excision of the heel spur 4
  • Arthroscopic treatment, which addresses the spur, plantar fasciitis, and adjacent calcaneal periostitis 5, 6
• Surgical outcomes are generally good with significant pain reduction reported in most studies 5, 6, 4

Common Pitfalls and Caveats

• Corticosteroid injections should be used judiciously and are contraindicated near the Achilles tendon 2
• Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 1
• Overdebridement of hyperkeratotic tissue can make underlying skin susceptible to increased tenderness 1
• Patients should be advised that recovery from surgical intervention typically takes several months 4