What are the treatment options for a bone spur in the foot?

Treatment of Bone Spurs in the Foot

For symptomatic bone spurs (calcaneal spurs) in the foot, begin with conservative management including proper footwear modifications, orthoses, NSAIDs, activity modification, and physical therapy for at least 3-6 months before considering surgical intervention. 1, 2

Conservative Treatment (First-Line)

Conservative therapy should be attempted for a minimum of 3-6 months and includes:

• Footwear modifications: Open-backed shoes to reduce pressure on the affected area, ensuring shoes are properly fitted with 1-2 cm longer than the foot itself 1
• Orthoses and heel lifts: Custom insoles to redistribute pressure and accommodate foot deformities 1, 3
• NSAIDs: For pain and inflammation control 1
• Activity modification: Decreased high-impact activities and weight loss if indicated 1
• Physical therapy: Stretching exercises, particularly for the plantar fascia and Achilles tendon 1, 4
• Accommodative padding: To relieve pressure over bony prominences 1

Important caveat: Avoid corticosteroid injections near the Achilles tendon insertion, as this can lead to tendon rupture 1

When Conservative Treatment Fails

If symptoms persist after 6-8 weeks of conservative management, continue initial treatments and consider:

• Immobilization: Cast or fixed-ankle walker-type device for 2-3 months 1
• Extracorporeal shock wave therapy: As an alternative to surgery 1

Surgical Intervention

Surgery is indicated only after conservative treatment options have been exhausted (typically 6 months to several years of failed conservative therapy). 2, 5

Surgical Options:

Arthroscopic approach (preferred when available):

• Addresses the spur, plantar fasciitis, and adjacent calcaneal periostitis comprehensively 5, 4
• Involves medial 75% plantar fascia release, spur removal, and periosteal debridement 4
• Results in 79-85% excellent outcomes (pain range 0-2) at one-year follow-up 5
• Fewer complications, smaller scars, and tissue-sparing compared to open surgery 5

Open surgical excision:

• Achieves comparable results to arthroscopy with AOFAS scores improving from 56 preoperatively to 90.4 at one year 2
• VAS pain scores decrease from 7 preoperatively to 2 at one year 2
• Provides better visualization and ability to perform additional interventions 2
• Average operative time 35 minutes with minimal complications 2

Surgical Complications:

Reported complications are minimal and include:

• Transient paresthesias (resolve with conservative management) 4
• Superficial wound infections (respond to oral antibiotics) 4
• Rare recurrence of spur formation 2

Treatment Algorithm

1. Initial presentation: Start conservative therapy (footwear, orthoses, NSAIDs, activity modification) 1, 3
2. 6-8 weeks: If no improvement, add immobilization or intensify physical therapy 1
3. 3-6 months: If still symptomatic, consider extracorporeal shock wave therapy or continue conservative measures 1
4. 6+ months of failed conservative therapy: Refer to podiatric foot and ankle surgeon for surgical evaluation 1, 2
5. Surgical decision: Arthroscopic approach preferred when expertise available; open surgery as alternative 5, 4

Critical pitfall: Do not rush to surgery—the condition requires exhaustive conservative treatment first, as surgery carries risks of altered foot biomechanics and potential complications 2, 5