From the Guidelines
Heel spurs should be initially treated with conservative measures, including open-backed shoes, orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as these methods have been shown to be effective in managing symptoms and improving quality of life. The American College of Foot and Ankle Surgeons recommends initial treatment options such as open-backed shoes, orthoses, and NSAIDs, as well as decreased activity, stretching exercises, and weight loss (if indicated) 1.
Key Treatment Considerations
- Open-backed shoes to reduce pressure on the area
- Orthoses or heel lifts to support the foot
- NSAIDs to manage pain and inflammation
- Decreased activity to reduce strain on the foot
- Stretching exercises to improve flexibility and reduce tension
- Weight loss, if indicated, to reduce pressure on the foot
Additional Treatment Options
If symptoms persist, additional treatment options may be considered, such as corticosteroid injections, casting, or use of a fixed-ankle walker-type device during activity 1. However, local injections of corticosteroids are not recommended as an initial treatment option.
Referral to a Specialist
If no improvement occurs after six weeks, referral to a podiatric foot and ankle surgeon is appropriate, and further options such as surgery or extracorporeal shock wave therapy may be considered 1. It is essential to continue initial treatment measures and explore other diagnoses if symptoms do not improve within six to eight weeks.
Patient-Directed Measures
Patient-directed measures, such as regular calf-muscle stretching, cryotherapy, over-the-counter heel cushions and arch supports, and avoidance of flat shoes and barefoot walking, can also be beneficial in managing heel spur symptoms 1. A comprehensive treatment plan that incorporates these measures can help improve symptoms and quality of life for patients with heel spurs.
From the Research
Definition and Symptoms of Heel Spur
- Heel spur is a common medical condition that can cause substantial discomfort and reduce the quality of life of the affected patients 2.
- The primary symptom of heel spurs is pain in the plantar surface of the heel 3.
Diagnosis and Treatment
- When seeking treatment for a heel spur, it is essential to consider the differential diagnoses and underlying medical conditions that may contribute to the symptoms 2.
- A staged approach seems to yield the best results in treatment of this common condition, including avoidance of wearing flat shoes and walking barefoot, use of over-the-counter arch supports and heel cushions, regular stretching of the calf muscles, and nonsteroidal anti-inflammatory drug therapy 4.
- Steroid injection may lead to lower heel pain visual analogue scores in the short-term, but the evidence is of low quality and the potential benefit is diminished when data are restricted to placebo-controlled trials 5.
- Surgical plantar fasciotomy, cast immobilization, and extracorporeal shockwave therapy are generally recommended as late-stage therapy for resistant cases 4.
Treatment Options
- Treatment strategies for managing heel spurs include preventive measures, conservative treatments, and more advanced procedures 2.
- Endoscopic treatment of calcaneal spur syndrome is a comprehensive approach that 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 6.
- Injected corticosteroids may be used to treat plantar heel pain, but the evidence for their effectiveness is of low quality and further research is needed to establish their benefits and harms 5.