Management of Plantar and Calcaneal Spurs

Initial Conservative Management

The American Academy of Family Physicians recommends using open-backed shoes to reduce pressure on the affected area, particularly for calcaneal spurs 1, 2
The American Academy of Family Physicians suggests considering heel lifts or orthoses to redistribute pressure and provide support 1
For plantar spurs, the American Academy of Family Physicians recommends using appropriately fitting footwear with adequate room for toes (1-2 cm longer than foot) 3
The American Academy of Family Physicians advises avoiding barefoot walking both indoors and outdoors 3
Consider felted foam in combination with appropriate footwear when other offloading devices are not available, as recommended by the American Academy of Family Physicians and the American Diabetes Association 4, 5
Implement activity modification and decreased weight-bearing activities, as recommended by the American Academy of Family Physicians 1
Use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation control, as recommended by the American Academy of Family Physicians 1, 2
Apply stretching exercises targeting the plantar fascia and Achilles tendon, as recommended by the American Academy of Family Physicians 1, 2
Consider weight loss if indicated to reduce pressure on the affected foot, as recommended by the American Academy of Family Physicians 1

For cases not responding to initial measures after 6-8 weeks, consider immobilization, as recommended by the American Academy of Family Physicians 1, 2
Use immobilization cast or fixed-ankle walker-type device to restrict movement and reduce pressure, as recommended by the American Academy of Family Physicians 1
Non-removable knee-high offloading devices may be beneficial, particularly for associated plantar ulcers, as recommended by the American Diabetes Association 4, 6
Consider corticosteroid injections for plantar spurs, as recommended by the American Academy of Family Physicians 1, 2
Bursa injections may be considered for bursitis associated with Haglund's deformity and calcaneal spurs, as recommended by the American Academy of Family Physicians 2

Consider Extracorporeal Shock Wave Therapy (ESWT) for cases not responding to conservative treatment for 2-3 months, as recommended by the American Academy of Family Physicians 1
Surgical options include plantar fasciotomy for plantar spurs, as recommended by the American Academy of Family Physicians 1
Resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa for calcaneal spurs, as recommended by the American Academy of Family Physicians 2

For patients with diabetes and associated plantar spurs, follow specific offloading guidelines to prevent complications, as recommended by the American Diabetes Association 4, 6
In patients with both moderate infection and moderate ischemia, address these issues before focusing on the spur itself, as recommended by the American Diabetes Association 4
Consider calcaneal osteotomy in some patients with bursitis associated with Haglund's deformity and calcaneal spurs, as recommended by the American Academy of Family Physicians 2

If symptoms persist despite 6-8 weeks of appropriate conservative therapy, refer to a podiatric foot and ankle surgeon for evaluation, as other diagnoses may need to be considered, according to the American Academy of Family Physicians 7, 8