How is a small plantar spur on the left foot treated?

Treatment of Small Left Plantar Calcaneal Spur

Begin with a 6-8 week trial of combined conservative therapies including orthotic devices (heel lifts), NSAIDs, plantar fascia and Achilles tendon stretching exercises, and appropriate footwear modifications, as this approach successfully resolves symptoms in approximately 90% of patients. 1, 2

Initial Conservative Management (First 6-8 Weeks)

Implement all of the following interventions simultaneously: 1

• Orthotic devices: Use heel lifts or cushioning inserts to reduce pressure on the calcaneal spur 1
• NSAIDs: Prescribe to reduce inflammation and pain at the plantar fascia insertion 1, 3
• Stretching exercises: Target both the plantar fascia and Achilles tendon with specific daily stretching protocols 1, 2
• Footwear modifications: Recommend open-backed or accommodative footwear to reduce direct pressure on the heel 1
• Weight loss: Advise if BMI is elevated, as obesity correlates with worse outcomes and treatment resistance 4
• Activity modification: Limit prolonged standing and barefoot walking during the acute phase 5

Important caveat: Do not use conventional or standard therapeutic footwear alone, as these are insufficient for proper offloading. 1 If specialized offloading devices are unavailable, use felted foam in combination with appropriate footwear. 1

Evaluation at 6-8 Weeks

• If symptoms are improving: Continue all conservative measures until complete resolution 1
• If no improvement: Proceed to Step 2 1

Escalated Conservative Treatment (After 6-8 Weeks Without Improvement)

Continue all initial conservative treatments and add: 1

• Immobilization: Consider a cast or fixed-ankle walker-type device for 2-3 weeks 1
• Corticosteroid injection: Inject into the plantar fascia origin at the calcaneus, carefully avoiding the Achilles tendon 1, 3
  • Note: Corticosteroid injections typically provide short-term relief rather than long-term cure 5

Specialist Referral (After 2-3 Months of Failed Conservative Treatment)

• Refer to podiatric foot and ankle surgeon for evaluation if symptoms persist despite combined conservative therapy 1
• Additional imaging: Consider MRI or ultrasound to confirm diagnosis and exclude other pathology such as plantar fascia tears, stress fractures, or nerve entrapment 1
• Surgical options: Endoscopic partial plantar fasciotomy may be considered for therapy-resistant cases, with success rates showing pain resolution in most patients within one month post-operatively 4

Key Clinical Pearls

• Radiographic presence of a heel spur does not correlate with symptom severity and indicates the condition has been present for at least 6-12 months 1, 5
• The heel spur itself is not the primary pain generator; rather, plantar fasciitis (degenerative process at the fascia origin) causes the symptoms 2, 5
• Obesity significantly impacts treatment success: Patients with BMI >30 kg/m² have higher failure rates with both conservative and surgical treatment 4
• Natural history favors resolution: approximately 90% of patients improve with conservative treatment, though the timeline varies from weeks to months 2