From the Guidelines
Heel spur treatment should initially focus on conservative approaches, including the use of open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss if indicated, as these methods have been shown to be effective in managing symptoms and improving quality of life 1.
Key Considerations
- The primary goal of treatment is to reduce inflammation and alleviate pain, thereby improving morbidity, mortality, and quality of life.
- Conservative treatments, such as rest, ice application, and over-the-counter pain relievers, should be attempted for at least 6-8 weeks before considering more invasive options 1.
- Referral to a podiatric foot and ankle surgeon is appropriate if no improvement occurs after six weeks, and additional treatments may include customized orthotic devices, night splinting, and limited corticosteroid injections 1.
- Surgery is typically considered only as a last resort, after all conservative treatments have been exhausted, and the patient continues to experience persistent pain and limited mobility.
Treatment Options
- Initial treatment measures:
- Open-backed shoes or heel lifts to reduce pressure on the area
- Orthoses to redistribute pressure
- NSAIDs to reduce inflammation and pain
- Decreased activity to avoid exacerbating the condition
- Stretching exercises to improve flexibility and reduce strain on the plantar fascia
- Weight loss, if indicated, to reduce pressure on the heel
- Additional treatments:
- Customized orthotic devices
- Night splinting to maintain a stretched position while sleeping
- Limited corticosteroid injections to reduce inflammation
- Casting or use of a fixed-ankle walker-type device during activity
- Surgical options:
- Plantar fasciotomy
- Extracorporeal shock wave therapy
- Resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa
- Calcaneal osteotomy to correct calcaneal alignment
Important Considerations
- Heel spurs often develop in response to chronic strain on the plantar fascia, so treating the underlying inflammation is key to relieving symptoms 1.
- Neurologic heel pain can occur due to irritation or entrapment of one or more nerves innervating the heel, and may require additional diagnostic and treatment approaches 1.
From the Research
Heel Spur Treatment Options
- Heel spur is a common medical condition that can cause substantial discomfort and reduce the quality of life of the affected patients 2
- 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
Conservative Treatment Strategies
- Treatment should start with stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflammatory drugs 3
- Many standard treatments such as night splints and orthoses have not shown benefit over placebo 3
- The use of an NSAID may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen 4
Advanced Treatment Procedures
- Recalcitrant plantar fasciitis can be treated with injections, extracorporeal shock wave therapy, or surgical procedures, although evidence is lacking 3
- Endoscopic fasciotomy may be required in patients who continue to have pain that limits activity and function despite exhausting nonoperative treatment options 3