Laser treatment for heel spurs: effectiveness and recovery

A heel spur is a bony growth on the underside of the heel bone, often associated with inflammatory and degenerative changes in the plantar fascia. Clinically, it is plantar fasciitis, not the growth itself, that remains the primary cause. Pain typically intensifies with the first steps in the morning and after periods of rest, then increases again in the evening with prolonged activity. Laser treatments are additional, non-invasive methods for reducing pain and accelerating tissue recovery. [1]

The term "laser treatment" encompasses various technologies. In practice, low-intensity photobiomodulation with visible and near-infrared lasers, as well as high-intensity pulsed systems, are used. Both strategies aim to reduce pain and swelling and stimulate reparative processes in the fascia and adjacent soft tissues. The effect is achieved by triggering cascades in the mitochondria, modulating inflammatory mediators, and microcirculation. [2]

Current clinical guidelines for heel pain and plantar fasciitis emphasize that laser therapy should be used as part of a comprehensive program: stretching, manual techniques, taping, orthotics when needed, educational and weight-bearing strategies. Laser therapy is considered a short-term treatment for pain reduction and function improvement, especially in the early stages. [3]

It's important to remember: the goal of treatment is not to "dissolve the spur," but to eliminate pain and restore tissue tolerance to stress. The size of the bone growth correlates poorly with symptoms, so treatment success is assessed based on pain, function, and fascia thickness using ultrasound. [4]

ICD-10 and ICD-11 codes

In clinical practice, either plantar fasciitis, a calcaneal spur, or both conditions are identified if documented. The International Classification of Diseases, Tenth Revision, uses a code for fascial pathology and a separate code for the spur. Both codes may be used in a single episode of illness. [5]

In the International Classification of Diseases, Eleventh Revision, plantar fasciitis is recognized as a distinct entity with the ability to specify lateralization. This facilitates clinical and statistical reporting and the comparability of studies. [6]

Table 1. Codes for plantar fasciitis and heel spurs

Classification	Diagnosis	Code	Note
ICD-10	Plantar fasciitis	M72.2	In some countries it is used as a standard code for the clinic of heel pain in fasciitis.
ICD-10	Calcaneal spur	M77.3	May be indicated together with fasciitis
ICD-11	Plantar fasciitis	FB40.1	Side specifications available: left, right, double-sided

[7]

Epidemiology and clinical context

Plantar fasciitis is one of the leading causes of heel pain in adults. Millions of patients present with complaints annually, and approximately 10 percent of the population experiences symptoms over the course of their lifetime. It is most common in the 40-60 age group, with increased risk among runners and those who perform prolonged static loads. [8]

According to population studies, the proportion of adults with heel pain reaches 11 percent, and it is more common in older women. These data explain the high clinical significance of minimally invasive methods, including laser, as tools for early pain relief and return to activity. [9]

In most cases, the course is benign: with consistent conservative therapy, approximately 80 percent of patients report significant improvement within 12 months. However, some people develop chronic pain, decreased exercise tolerance, sleep disturbances, and limitations in daily activities. In these cases, adding laser therapy to the basic program can accelerate symptom relief. [10]

Associated risk factors include excess body weight, limited ankle dorsiflexion, flat feet, diabetes, and a significant increase in mechanical stress. Correcting these factors increases the effectiveness of any physical or instrumental therapy. [11]

What is laser treatment and how does it work?

Low-intensity laser photobiomodulation uses coherent light in the visible red and near-infrared ranges. These photons are absorbed by mitochondrial enzymes, increasing adenosine triphosphate synthesis, modulating ion channel activity, and reducing levels of pro-inflammatory mediators. This results in reduced pain and swelling, and accelerated tissue metabolism. [12]

High-intensity pulsed systems offer higher peak power and different energy deposition dynamics. With proper protocols, they are also used to reduce pain and improve function, but require strict adherence to parameters and trained personnel. [13]

The key to clinical effectiveness is the dose and geometry of the treatment: wavelength, power, energy density, pulse frequency, duration, and number of application points along the painful areas of the fascia and attachment to the calcaneus. Exceeding the dose does not enhance the effect and may reduce the response due to the biphasic dose-response phenomenon. [14]

Laser therapy is almost always combined with fascial and calf muscle stretching, manual techniques, and exercise therapy. This combination improves short-term pain and function outcomes compared to the use of physical factors alone. [15]

Effectiveness: What do systematic reviews and guidelines say?

Updated clinical guidelines for heel pain indicate that low-level laser therapy can be used to reduce pain in the short term in both acute and chronic conditions. The strength of the recommendation has been upgraded to "moderately strong" after reviewing new randomized trials and meta-analyses. [16]

Meta-analyses show pain reduction and improved functional outcomes in the weeks and months following a course of low-intensity photobiomodulation. When compared with shockwave therapy, short-term pain reduction is often unnoticeable, and both methods are superior to placebo. Given the limited availability of large, long-term studies, the long-term effects require further clarification. [17]

High-intensity laser systems demonstrate comparable pain and function improvements to shockwave therapy in chronic conditions, according to randomized trials. The choice between approaches is often determined by availability, tolerability, and clinical experience. [18]

When compared with glucocorticosteroid injections, shockwave therapy generally shows better medium-term results, while injections carry risks of heel fat pad atrophy and fascial rupture. This indirectly increases interest in non-invasive pain relief options, including laser. [19]

Table 2. Effectiveness of methods for chronic plantar fasciitis

Method	Effect on pain in the next 6-12 weeks	Effect on function	Features of the evidence base
Low-intensity photobiomodulation	Reduction in pain as measured by a visual analogue scale by a clinically significant amount	Improvement of questionnaire functions in a short period of time	Several meta-analyses show superiority over control, long-term data are limited
High-intensity pulsed systems	Comparable to shock wave therapy	Similar dynamics according to questionnaires	Several randomized trials, dose standardization needed
Shock wave therapy	Above steroid injections for up to 3 months	Functional improvement	Strong basis for chronic course
Glucocorticosteroid injections	Fast pain relief for a short period	Limited effect on function	The risks of fat pad atrophy and fascial rupture are described in the literature.

[20]

Types of laser techniques and dosage parameters

Low-intensity photobiomodulation typically uses wavelengths between 780 and 860 nanometers and between 630 and 680 nanometers. Recommended minimum energy densities for application points for fasciitis are approximately 2-4 joules per cm² per point, with treatment of multiple zones in the projection of the fascia and its attachments. The number of sessions often varies from 6 to 12, with a frequency of 2-3 times per week. [21]

High-intensity pulsed systems (e.g., 1064 nanometers) employ high peak power with controlled energy load and pulse structure. Clinical protocols combine plantar scanning with targeted treatment of the most painful points, while adhering to total energy limits per session. [22]

It's important to adhere to the concept of an "optimal dose window": too little energy may have no effect, while too much energy may reduce tissue response. This is why studies record wavelength, power, energy density, pulse frequency, duration, and number of points. [23]

The choice of parameters depends on the thickness of the soft tissues of the heel, the severity of the pain, and the stage of the process. For high pain sensitivity, start with more gentle doses and increase them as hyperalgesia decreases. [24]

Table 3. Typical parameters of laser therapy for plantar fasciitis

Technology	Wavelength	Energy density per point	Number of points	Session duration	Well
Low-intensity photobiomodulation	780−860 nanometers or 630−680 nanometers	2−4 joules per cm²	4-8 along the fascia and attachment area	8-12 minutes	6-12 procedures 2-3 times a week
High Intensity Pulse System	1064 nanometers	Clinically equivalent total energy according to device protocol	Scanning plus targeting zones	6-10 minutes	4-8 procedures 1-2 times a week

[25]

Who is laser indicated for and who is not?

Indications include acute and chronic pain associated with plantar fasciitis with an inadequate response to basic non-pharmacological measures. Laser therapy is particularly appropriate for patients with high pain sensitivity, where exercise therapy and stretching are limited by pain. [26]

Relative contraindications are typical for photobiomodulation: do not irradiate the eyes, avoid direct treatment of active malignant tumors, avoid exposure to the abdomen during pregnancy, and exercise caution in cases of photosensitivity. The use of protective eyewear is mandatory for both patients and staff. [27]

Medical lasers themselves are regulated devices with clearly defined beam hazard classes. They are not household gadgets, but professional equipment that must be used by trained professionals in compliance with safety protocols. [28]

The vast majority of patients tolerate the procedures well. A slight reactive increase in pain is often noted during the first day, but this resolves on its own. This is not a complication, but a predictable response to tissue stimulation. [29]

Table 4. Safety and contraindications

Paragraph	Details
Eye protection	Always use protective glasses for the patient and staff
Tumors	Do not irradiate areas of active tumors without specific oncological indications.
Pregnancy	Do not treat the abdominal area; treatment of the foot is decided individually.
Photosensitivity	Consider photosensitizing medications and conditions
Emitter class	Comply with the requirements for devices of the corresponding class and safety protocol

[30]

Comparison with alternatives and combinations

Laser therapy is not a substitute for a quality program of therapeutic exercise and stretching. A combination of methods provides the best short-term results in terms of pain and function. For chronic pain, shockwave therapy is an alternative for some patients, as meta-analyses demonstrate convincing results and are superior to glucocorticosteroid injections in terms of medium-term pain relief. [31]

Glucocorticosteroid injections can quickly reduce pain, but carry risks of heel fat pad atrophy and fascial rupture, especially with repeated injections or improper technique. Therefore, they are not considered a first-line treatment for most patients. [32]

In several studies, high-intensity laser systems have demonstrated comparable efficacy to shockwave therapy, allowing for a choice based on availability, tolerability, and patient preference. Low-intensity photobiomodulation provides statistically significant, clinically measurable pain relief over the next few weeks. [33]

Table 5. When to choose what

Situation	Preferred approach
High pain sensitivity limiting exercise	Add laser to stretching and manual techniques
Ineffectiveness of the initial program after 4-6 weeks	Consider high-intensity laser or shockwave therapy
Risk of complications with injections	Give priority to non-invasive methods

[34]

What does a rational treatment protocol look like?

The classic low-intensity regimen involves treating 4-8 points in the projection of the fascia and attachment to the calcaneus, with an energy density of 2-4 joules per cm² per point, a session lasting 8-12 minutes, and a course of 6-12 treatments performed 2-3 times per week. At the same time, the patient performs stretching of the fascia and calf muscles, as well as foot strength exercises. [35]

The high-intensity option uses a pulsed mode with control of the total energy delivered per session, combining scanning and treatment of trigger zones. The course is shorter: 4-8 treatments, 1-2 times per week. The exact number depends on the device and tolerance. [36]

A review of the load is essential: a temporary reduction in the total number of steps per day, limitation of prolonged static standing, rational footwear with good cushioning and, if necessary, orthoses as part of an overall program, and not as the only method. [37]

Table 6. Example of a step-by-step plan for 6 weeks

Weeks	Procedures	Home program
1-2	Laser 2-3 times a week, manual techniques	Stretching the fascia and calf muscles 2-3 times a day, monitoring the step load
3-4	Continuation of laser, connection of taping according to indications	Foot muscle strength exercises every other day, shoe recommendations
5-6	Evaluation of the effect, decision to continue or change the method	Gradual return to previous activity, prevention

[38]

Safety, possible reactions and monitoring

The most common reaction is a brief increase in pain for several hours after the session, which does not require intervention. A sensation of warmth and slight tissue swelling are sometimes noted, but these resolve on their own. If eye protection and protocols are followed, the risk to the eyes is minimal. [39]

Directing the beam toward the eyes is strictly prohibited. If a malignant tumor is present in the intended treatment area, the decision to use photobiomodulation is made on an individual basis; direct treatment of the tumor area is generally avoided. During pregnancy, the abdomen is not irradiated; treatment of the feet is decided on an individual basis in consultation with a physician. [40]

Medical devices must be approved by the FDA and used by trained personnel. This reduces the likelihood of dosing errors and improves the reproducibility of results. [41]

Table 7. Security algorithm before each session

Step	Examination
1	Glasses on the patient and staff
2	Update on contraindications and medications with photosensitivity
3	Calibration of parameters according to protocol and pain sensitivity
4	Marking and processing of points, precise control of total energy
5	Brief instructions on possible sensations after the session

[42]

What to expect for the patient: timeframes and criteria for success

Over the next 2-6 weeks, it's reasonable to expect a decrease in pain with the first steps and an increase in distance without worsening symptoms. As pain sensitivity decreases, increase the intensity of the exercises. For lasting results, it's critical to continue the stretching and strengthening program. [43]

If there is no significant progress after 6-8 weeks, consideration is given to changing parameters, switching to a high-intensity protocol, or alternatives, such as shock wave therapy. Higher-level interventions, including injections and surgical measures, are reserved for cases of persistent pain after conservative options have been exhausted. [44]

Table 8. Performance indicators

Indicator	Target dynamics by 6 weeks
Pain when taking first steps	A clinically significant reduction in pain scores
Function by questionnaires	Improvement in scores on validated foot scales
Fascia thickness by ultrasound	A downward trend in chronic course
Load tolerance	Increase in standing time and walking distance without exacerbation

[45]

Frequently asked questions

Does the laser remove the bone spur? No, the goal is to reduce pain and restore function. The bone spur may persist even after symptoms have completely resolved. [46]

Is laser treatment alone possible? Not recommended. Best results are achieved with a combination of stretching, manual techniques, and proper load management. [47]

Is laser dangerous? When protocols are followed and eye protection is used, the procedure is safe for the vast majority of patients. [48]