From the Guidelines
To treat pain from a heel spur, start with conservative measures including rest, ice application, and over-the-counter pain medications like ibuprofen or naproxen, as well as wearing supportive shoes with cushioned heels and considering adding heel cups or orthotic inserts. The American College of Foot and Ankle Surgeons recommends initial treatment options such as open-backed shoes, orthoses, accommodative padding, NSAID therapy, weight loss (if indicated), and physical therapy 1. It is essential to note that local injections of corticosteroids are not recommended as an initial treatment option, according to the American College of Foot and Ankle Surgeons 1.
Some key considerations for treating heel spur pain include:
- Wearing supportive shoes with cushioned heels to reduce pressure on the area
- Adding heel cups or orthotic inserts to provide additional support and cushioning
- Stretching calf muscles and plantar fascia several times daily to improve flexibility and reduce tension
- Using over-the-counter pain medications like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) to manage pain and inflammation
- Considering physical therapy focusing on strengthening and stretching exercises for persistent pain
- Avoiding corticosteroid injections as an initial treatment option, as recommended by the American College of Foot and Ankle Surgeons 1
It is crucial to prioritize conservative measures and avoid invasive treatments, such as surgery, unless absolutely necessary and after 6-12 months of unsuccessful conservative treatment. Heel spur pain often stems from inflammation of surrounding tissues rather than the spur itself, which is why anti-inflammatory treatments are effective 1. Most heel spur pain improves within 9-12 months with conservative approaches, and surgery is rarely needed.
From the Research
Treatment Options for Heel Spur
- Rest, ice, massage, and the use of correct exercise are important in helping to recover from heel pain condition 2
- Conservative nonsurgical therapy, including physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, and anti-inflammatory agents, is effective for almost all patients 2, 3
- Cortisone injection into the heel may be considered if symptoms continue 3
- Surgery is the last treatment option if all other treatments have failed, and may involve removal of the heel spur and treatment of plantar fasciitis 3, 4, 5
Surgical Techniques
- Endoscopic treatment of calcaneal spur syndrome is a comprehensive technique 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 4
- A plantar midline incision approach to heel surgery permits good exposure and eliminates postoperative paresthesias 5
Importance of Accurate Diagnosis
- Accurate diagnosis is crucial in planning treatment protocol for heel spurs, and considering differential diagnoses and underlying medical conditions that may contribute to the symptoms is essential 6
- Physicians can help relieve pain and improve the quality of life of affected individuals by considering the diverse aspects of managing heel spurs 6