How should an asymptomatic 11‑year‑old boy with an incidental Achilles (calcaneal) spur be managed?

Management of Asymptomatic Achilles Spur in an 11-Year-Old Boy

No Treatment Required

An asymptomatic calcaneal (Achilles) spur discovered incidentally in an 11-year-old boy requires no treatment or intervention. 1, 2

Clinical Reasoning

Why No Intervention Is Needed

• Calcaneal spurs are frequently asymptomatic—approximately 20% of all calcaneal spurs cause no pain and require no treatment. 1

• Spur size does not correlate with symptoms—even extremely large calcaneal spurs can remain completely asymptomatic, and spur length is not associated with the development of pain or functional impairment. 1

• Radiographic findings in children are often incidental—in pediatric patients with heel pain (calcaneal apophysitis), radiographic findings such as sclerosis, fragmentation, or spurring cannot be used to establish a diagnosis and do not alter management. 2

• The absence of pain indicates no active pathology—pain localized to the posterior-superior heel, tenderness at the Achilles insertion, swelling, or activity-related discomfort would be required to diagnose insertional Achilles tendinopathy, none of which are present in this asymptomatic child. 3

What to Tell the Family

• Reassure the parents that this is a benign incidental finding that does not require treatment, activity restriction, or follow-up imaging. 1, 2

• Explain that the spur itself is not causing harm—it is simply a bony prominence that has formed at the Achilles insertion and is not associated with any disease process in the absence of symptoms. 1

• Advise that the child can continue all normal activities including sports and physical education without any modifications or restrictions. 2

When to Seek Re-evaluation

• Only if symptoms develop should the child return for clinical assessment. Specifically, watch for:
  • Pain at the posterior heel, especially with activity or shoe pressure 3
  • Tenderness when touching the back of the heel 3
  • Swelling, erythema, or warmth at the Achilles insertion 3
  • Limping or refusal to bear weight 4

Common Pitfall to Avoid

• Do not obtain unnecessary follow-up radiographs—repeat imaging in asymptomatic patients provides no clinical benefit and exposes the child to unnecessary radiation. 2

• Do not restrict activities prophylactically—there is no evidence that activity modification prevents symptoms in children with incidental calcaneal spurs. 1, 2

• Do not confuse this with calcaneal apophysitis (Sever disease)—that condition presents with pain during the growth spurt in active children, typically ages 8-14, and is a clinical diagnosis that does not require radiographs. 5, 2