Diagnosis and Management of Heel Spurs with Plantar Fasciitis

Diagnosis

Ultrasound has good sensitivity (80%) and specificity (88%) in diagnosing plantar fasciitis compared to MRI, according to the American College of Radiology 2

The American Academy of Family Physicians recommends patient-directed measures including regular calf-muscle and plantar fascia stretching exercises (3-5 times daily) for the initial treatment of heel spurs with plantar fasciitis 3
The American Academy of Family Physicians suggests activity limitation and avoidance of flat shoes and barefoot walking as part of the initial treatment for heel spurs with plantar fasciitis 3
The American Academy of Family Physicians recommends weight loss if indicated as part of the initial treatment for heel spurs with plantar fasciitis 3
The American College of Cardiology is not relevant here, however, the American Academy of Family Physicians recommends referral to a podiatric foot and ankle surgeon if no improvement after 6 weeks of initial treatment for heel spurs with plantar fasciitis 3
Customized orthotic devices may be added to the treatment regimen if no improvement after 6 weeks, as recommended by the American Academy of Family Physicians 3
Limited corticosteroid injections (avoid near Achilles tendon) may be considered if no improvement after 6 weeks, according to the American Academy of Family Physicians and Praxis Medical Insights 1, 3

Avoid local corticosteroid injections near the Achilles tendon due to risk of tendon rupture, as warned by Praxis Medical Insights 1, 4

Overuse of corticosteroid injections can lead to plantar fascia rupture, according to Praxis Medical Insights 4
Complete immobilization can cause muscular atrophy, as noted by Praxis Medical Insights 1
Ignoring symptoms that persist beyond 6-8 weeks should prompt referral to a specialist, according to Praxis Medical Insights 4

Most patients respond to conservative treatment within 6-8 weeks, according to Praxis Medical Insights 1