From the Guidelines
The best treatment for calcaneal spurs is a combination of conservative management options, including open-backed shoes, orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as these methods have been shown to be effective in reducing symptoms and promoting recovery 1.
Initial Treatment Options
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses to provide support and stability
- NSAIDs to reduce pain and inflammation
- Decreased activity to avoid exacerbating the condition
- Stretching exercises to improve flexibility and reduce tension
- Weight loss, if indicated, to reduce pressure on the heel
Advanced Treatment Options
If symptoms persist or worsen, other treatment options may be considered, including:
- Immobilization with a cast or fixed-ankle walker-type device
- Corticosteroid injections, avoiding the Achilles tendon, to reduce inflammation and relieve pain 1
- Physical therapy to improve strength and flexibility
- Surgical intervention, such as resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa, or calcaneal osteotomy to correct calcaneal alignment, may be necessary in severe cases 1
From the Research
Treatment Options for Calcaneal Spurs
The treatment of calcaneal spurs can vary depending on the severity of the condition and the patient's response to conservative therapy. Some studies have investigated the efficacy of different treatment modalities, including:
- Endoscopic treatment: A comprehensive approach to the endoscopic treatment of calcaneal spur syndrome, which involves treatment of the heel spur and plantar fasciitis, as well as adjacent calcaneal periostitis and decompression of the nerve to the abductor digiti quinti 2.
- Arthroscopic treatment: A tissue-sparing and effective approach when conservative therapy has failed, which involves treatment of the spur and plantar fasciitis, as well as adjacent calcaneal periostitis 3.
- Extracorporeal shock wave therapy (ESWT): A non-invasive treatment modality that has been shown to be effective in reducing pain and improving functional capacity in patients with calcaneal spurs 4, 5.
- Low-level laser therapy (LLLT): A non-invasive treatment modality that has been shown to be effective in reducing pain and improving functional capacity in patients with calcaneal spurs, although it may not be superior to ESWT in terms of disability and activity limitation reduction 5.
- Pulsed electromagnetic field therapy (PEMFT): A non-invasive treatment modality that has been shown to be effective in improving pain and functionality in patients with calcaneal spurs when added to ESWT 4.
Comparison of Treatment Modalities
Some studies have compared the efficacy of different treatment modalities for calcaneal spurs, including:
- ESWT vs. LLLT: Both treatment modalities were found to be effective in reducing pain and improving functional capacity, although ESWT may be more effective in reducing disability and activity limitation 5.
- ESWT vs. PEMFT: The addition of PEMFT to ESWT was found to be more effective in improving pain and functionality in patients with calcaneal spurs 4.
Complications and Special Considerations
Some studies have reported complications and special considerations in the treatment of calcaneal spurs, including:
- Fracture of the calcaneal spur: A rare complication that can occur as a result of trauma, which may require rest, elevation, ice pack, and analgesia, as well as application of a back slab for 2-3 weeks 6.
- Infection: A potential complication of surgical treatment, which can be cured with oral antibiotics 2.
- Transient lateral paresthesias: A potential complication of surgical treatment, which can resolve with rest and nonsteroidal inflammatory medications 2.