Treatment for Small Left Foot Plantar Spur
Begin with a 6-8 week trial of conservative management including orthotic devices (heel lifts), NSAIDs, plantar fascia and Achilles tendon stretching exercises, and appropriate footwear modifications, as this approach is effective for approximately 90% of patients. 1, 2
Initial Conservative Treatment (First 6-8 Weeks)
Implement all of the following simultaneously 1:
- Orthotic devices: Use heel lifts or cushioned insoles to reduce pressure on the calcaneal spur 1
- NSAIDs: Prescribe to reduce inflammation and pain 1, 3
- Stretching exercises: Target both the plantar fascia and Achilles tendon specifically, as tight Achilles tendon is a biomechanical contributor 1, 2, 4
- Footwear modifications: Use open-backed or accommodative footwear to reduce pressure on the heel 1
- Activity modification: Rest from aggravating activities, particularly in athletes or highly active individuals 1, 3
- Ice massage: Apply to reduce inflammation 5
- Weight loss: Recommend if obesity is present, as this is an associated risk factor 2
Important caveat: Do not use conventional or standard therapeutic footwear alone, as these are insufficient for proper offloading 1. If other offloading devices are unavailable, use felted foam in combination with appropriate footwear 1.
If No Improvement After 6-8 Weeks
Continue all initial conservative measures and add 1:
- Immobilization: Consider a cast or fixed-ankle walker-type device 1
- Corticosteroid injection: Inject into the plantar fascia origin at the medial calcaneal tubercle, carefully avoiding the Achilles tendon 1, 3, 5
- Note: This typically provides short-term relief 5
If No Improvement After 2-3 Months of Combined Therapy
- Refer to podiatric foot and ankle surgeon for evaluation 1
- Consider additional imaging: Confirm diagnosis and rule out other pathologies 1, 5
- Consider advanced therapies: Extracorporeal shock wave therapy, platelet-rich plasma injections, or surgical plantar fascia release may be options for refractory cases 5, 4, 6
Special Considerations
For diabetic patients: If the spur is associated with an ulcer, follow specific offloading protocols per American Diabetes Association guidelines, which may include non-removable knee-high offloading devices 1, 7
Surgical intervention: Open heel spur excision is indicated only after conservative treatment options have been exhausted (typically after 6+ months), with good results (AOFAS score improvement from 56 to 90.4 at one year) but should be reserved as a last resort 6
Natural history: The condition typically resolves with conservative treatment in approximately 90% of patients, though the exact timeline varies 2