From the Guidelines
Treatment for a calcaneal enthesophyte, commonly known as a heel spur, should begin with conservative measures including rest, ice application, and over-the-counter NSAIDs like ibuprofen or naproxen for pain and inflammation, as recommended by the American College of Foot and Ankle Surgeons 1.
Initial Treatment
The initial treatment options may include:
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses
- NSAIDs
- Decreased activity
- Stretching exercises
- Weight loss, if indicated These treatments should be continued until symptoms resolve, and if improvement occurs within six to eight weeks, treatments are continued 1.
Additional Treatment Options
For persistent pain, additional treatment options may include:
- Customized orthotic devices
- Night splinting
- A limited number of corticosteroid injections
- Casting, or use of a fixed-ankle walker-type device during activity
- Surgery, such as plantar fasciotomy, may be considered in cases that do not respond to 6-12 months of conservative treatment 1.
Important Considerations
It is essential to note that most heel spurs are asymptomatic and discovered incidentally on X-rays, with pain typically resulting from associated soft tissue inflammation rather than the spur itself 1.
Special Cases
In adolescents, calcaneal apophysitis is a common cause of heel pain, and palliative treatment is almost always successful 1.
Key Takeaways
- Conservative treatment should be the first line of treatment for calcaneal enthesophyte
- Surgery should be reserved for cases that do not respond to 6-12 months of conservative treatment
- Weight loss is recommended for overweight patients to reduce pressure on the heel
- Custom orthotic inserts and physical therapy exercises can provide additional relief 1.
From the Research
Calcaneal Enthesophyte Overview
- Calcaneal enthesophytes are bony growths that occur at the site of tendon or ligament attachment to the calcaneus (heel bone) 2, 3.
- They can be associated with various conditions, including spondyloarthritis, trauma, and osteoarthritis 2, 3.
Risk Factors and Associations
- Advanced age and the presence of spondyloarthritis are risk factors for the development of calcaneal enthesophytes 2.
- Calcaneal enthesophytes are associated with foot osteoarthritis, particularly polyarticular foot OA and OA at specific joints such as the talonavicular and navicular-cuneiform joints 3.
- However, they are not associated with hand osteoarthritis, suggesting a local, biomechanical process rather than a systemic bone-forming process 3.
Treatment Options
- Endoscopic treatment of insertional Achilles tendinopathy, which involves resection of the enthesophyte and posterosuperior calcaneal prominence, is a feasible option 4.
- However, further research is needed to validate this technique and compare it to open surgery 4.
- Conservative therapies, such as orthoses and heel raises, may provide short-term pain relief for conditions like calcaneal apophysitis, but the evidence is limited and further research is needed to establish effective treatment approaches 5.