From the Guidelines
Calcaneal spurs should be treated with a combination of 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 reducing symptoms and improving quality of life. The initial treatment approach should focus on reducing pressure on the affected area, managing pain and inflammation, and promoting healing.
- Conservative measures such as open-backed shoes, orthoses, and accommodative padding can help reduce pressure on the heel and alleviate symptoms 1.
- NSAID therapy can be used to manage pain and inflammation, with options including ibuprofen and naproxen.
- Decreased activity, stretching exercises, and weight loss (if indicated) can also help reduce symptoms and promote healing.
- If symptoms persist, referral to a podiatric foot and ankle surgeon may be necessary to consider additional treatment options, such as customized orthotic devices, night splinting, or corticosteroid injections 1.
- Surgery may be considered in rare cases where conservative treatment has failed, but this should only be considered after a thorough evaluation and exploration of other treatment options.
- It is essential to note that local injections of corticosteroids are not recommended as an initial treatment option 1, and other diagnoses should be considered if symptoms do not improve within six to eight weeks.
From the Research
Calcaneal Spur Treatment Options
- Various treatment methods are available for calcaneal spurs, including extracorporeal shock wave therapy (ESWT), pulsed electromagnetic field therapy (PEMFT), corticosteroid injections, and radiofrequency thermal lesioning 2, 3, 4.
- A tier-wise follow-up procedure can be used to administer treatment, where the response to a particular treatment is recorded, and if it does not resolve the spur, the treatment progresses to the next tier 2.
Efficacy of Different Treatments
- ESWT has been shown to be effective in treating calcaneal spurs, with significant decreases in pain and functional capacity 3, 5.
- The addition of PEMFT to ESWT has been found to significantly improve pain and functionality in patients with calcaneal spurs 3.
- Corticosteroid injections and radiofrequency thermal lesioning have also been found to be effective in treating chronic plantar heel pain, with better therapeutic outcomes than ESWT 4.
Factors Affecting Treatment Outcomes
- Previous local steroid injections may negatively affect the result of ESWT 5.
- Body weight and the length of symptoms may also affect the clinical results of ESWT 5.
- Accurate diagnosis and consideration of underlying medical conditions are important in planning treatment protocol 6.