What is the treatment for calcaneal spurring?

Treatment for Calcaneal Spurring

The treatment for calcaneal spurring should begin with conservative measures including regular stretching exercises, proper footwear, orthotic devices, NSAIDs, and weight loss if indicated, before considering more invasive interventions. 1

Initial Conservative Treatment

• Patient-directed measures should be the first line of treatment, including:

  • Regular calf-muscle and plantar fascia stretching exercises (3-5 times daily) 1
  • Cryotherapy (ice application) for 10-minute periods through a wet towel to reduce pain and inflammation 1
  • Over-the-counter heel cushions and arch supports 2, 1
  • Activity limitation and avoidance of flat shoes and barefoot walking 2
  • Weight loss if indicated 2, 1

• Medication options include:

  • NSAIDs (oral or topical) for pain relief and reducing inflammation 2, 1
  • Padding and strapping of the foot to redistribute pressure 2
  • Corticosteroid injections in appropriate patients (avoiding the Achilles tendon area) 2, 1

Treatment Based on Location of Pain

• For posterior heel pain (suggesting Achilles tendonitis):

  • Open-backed shoes to reduce pressure on the area 2
  • Heel lifts or orthoses 2
  • Decreased activity 2
  • Stretching exercises 2
  • Note: Corticosteroid injections are contraindicated near the Achilles tendon 3, 1

• For lateral heel pain (suggesting Haglund's deformity):

  • Open-backed shoes 2
  • Orthoses and accommodative padding 2
  • NSAIDs 2
  • Physical therapy 2

Secondary Treatment Options (if no improvement after 6 weeks)

• Referral to a podiatric foot and ankle surgeon is appropriate 2, 1
• Additional treatments may include:
  • Customized orthotic devices 2
  • Night splinting 2
  • Limited number of corticosteroid injections 2
  • Casting or use of a fixed-ankle walker-type device during activity 2, 1

Advanced Treatment Options (if no improvement after 2-3 months)

• Continue initial treatment measures 2
• Consider cast immobilization if not previously used 2
• Further options include:
  • Surgery (plantar fasciotomy) 2, 4
  • Endoscopic treatment of calcaneal spur syndrome 5, 6
  • Extracorporeal shock wave therapy 2

Surgical Approaches

• Open heel spur surgery has shown good results with minimum complications, but should only be considered after conservative treatment options have been exhausted 4
• Arthroscopic/endoscopic treatment is a tissue-sparing approach that addresses the spur, plantar fasciitis, and adjacent calcaneal periostitis 5, 6
• Studies have shown significant improvement in pain scores after surgical intervention, with AOFAS scores improving from 56 preoperatively to 90.4 at one year postoperatively 4

Common Pitfalls and Caveats

• Corticosteroid injections should be used judiciously and are contraindicated near the Achilles tendon due to risk of tendon rupture 3, 1
• Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 1
• Most patients respond to conservative treatment within 6-8 weeks 1
• Surgery should only be considered after exhausting conservative treatment options 2, 4

Expected Outcomes

• Most patients with calcaneal spurring respond well to conservative treatment measures 1
• Surgical intervention, when necessary, has shown good to excellent results in pain relief and return to normal activity 5, 6, 4