What is the treatment for a tiny left plantar calcaneal spur?

Treatment for Tiny Left Plantar Calcaneal Spur

Conservative treatment should be the first-line approach for a tiny left plantar calcaneal spur, including orthoses, NSAIDs, stretching exercises, and appropriate footwear modifications. 1

Initial Conservative Management

• Begin with non-surgical interventions as these are effective for most patients with plantar calcaneal spurs 1:

  • Orthotic devices/heel lifts to reduce pressure on the affected area 1
  • NSAIDs to reduce inflammation and pain 1
  • Stretching exercises targeting the plantar fascia and Achilles tendon 1
  • Open-backed or accommodative footwear to reduce pressure 1
  • Weight loss if indicated 1

• Avoid conventional or standard therapeutic footwear alone as they are insufficient for proper offloading 1

• If other offloading devices are not available, consider felted foam in combination with appropriate footwear 1

Treatment Algorithm

Step 1: Initial 6-8 Week Conservative Treatment

• Implement all initial conservative measures simultaneously 1
• Evaluate response at 6-8 weeks 1
• If improvement occurs, continue treatments until symptoms fully resolve 1

Step 2: If No Improvement After 6-8 Weeks

• Continue initial conservative treatments 1
• Consider immobilization with cast or fixed-ankle walker-type device 1
• Consider corticosteroid injection (avoiding the Achilles tendon) 1

Step 3: If No Improvement After 2-3 Months of Combined Therapy

• Refer to podiatric foot and ankle surgeon for evaluation 1
• Consider additional imaging studies to confirm diagnosis and rule out other conditions 1

Surgical Options (Only After Failed Conservative Treatment)

• Surgery should only be considered after 6 months of failed conservative treatment 2

• Surgical options include:

  • Open heel spur excision 2
  • Arthroscopic treatment of the spur and plantar fasciitis 3, 4
  • Plantar fasciotomy 1

• Surgical outcomes show 79-90% satisfactory results in patients who failed conservative management 3, 2, 5

Important Considerations and Pitfalls

• The plantar calcaneal spur itself may not be the primary source of pain - histologic findings suggest changes within the fascia are often responsible 5
• Radiographic presence of a spur does not always correlate with symptoms 1
• Even after complete surgical excision, spurs may reform without recurrence of symptoms 5
• Surgical complications may include infection, paresthesia, and rarely, recurrence 3, 2
• Recovery time after surgery averages 16 weeks, with maximal improvement often taking longer 2, 5

Special Populations

• For patients with diabetes, follow specific offloading protocols if the spur is associated with an ulcer 1
• In athletes or highly active individuals, consider activity modification and more aggressive early conservative intervention 1