Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
| Type | Location | Associated Condition | Causes Pain? | Treatment |
|---|---|---|---|---|
| Inferior heel spur (plantar) | Inferior calcaneus at plantar fascia origin | Plantar fasciitis (seen in ~50% of cases) | No — fascia inflammation is the pain source, not the spur | Treat plantar fasciitis: stretching, orthotics, ESWT |
| Posterior heel spur (Haglund deformity) | Posterior-superior calcaneus at Achilles insertion | Insertional Achilles tendinopathy | Yes — bony prominence impinges Achilles tendon | Heel lifts; wide heel shoes; Achilles stretching; ESWT; surgery |
| Retrocalcaneal bursitis spur | Posterior calcaneus at retrocalcaneal bursa | Bursitis between Achilles and calcaneus | Yes — inflamed bursa between spur and tendon | Injection into bursa; padding; surgery (bursectomy + spur removal) |
| Treatment | Targets | Evidence | Expected Outcome | Notes |
|---|---|---|---|---|
| Plantar fascia + calf stretching | Plantar fasciitis (underlying cause) | Level I | 60-75% improvement with consistent stretching | Must address fascia, not the spur |
| Custom orthotics | Biomechanical cause of fasciitis / Haglund loading | Level II | Reduces recurrence; long-term management | Heel cup for plantar; heel lift for Haglund |
| ESWT (shockwave therapy) | Plantar fasciitis; insertional Achilles; Haglund | Level I | 70-85% improvement at 12 weeks | May partially remodel spur over time; treats underlying pathology |
| Corticosteroid injection | Plantar fasciitis; retrocalcaneal bursitis | Level II | 2-4 months relief; 60-70% respond | Avoid direct Achilles injection; fascia atrophy risk |
| Heel spur surgical removal (exostectomy) | Haglund deformity (posterior spur); insertional Achilles | Level II-III | Good outcomes when combined with Achilles debridement | NOT indicated for inferior heel spur alone — spur is not the pain source |
| Endoscopic plantar fascia release | Plantar fasciitis refractory to all conservative care | Level II | 70-80% success; less risk than open | Spur NOT routinely removed — unnecessary |
Quick answer: Treatment for heel spur causes treatment surgery follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (810) 206-1402.
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
![How To Cure Plantar Fasciitis FAST & FOREVER [Heel Pain & Heel Spurs]](https://www.michiganfootdoctors.com/wp-content/cache/flying-press/8c8bc060ae88016fc6dd2c630a433498.jpg)
Watch: How To Cure Plantar Fasciitis FAST & FOREVER [Heel Pain & Heel Spurs] — MichiganFootDoctors YouTube
A heel spur is a bony protrusion (osteophyte) that forms on the calcaneus (heel bone), typically at the attachment of the plantar fascia on the bottom of the heel (inferior calcaneal spur) or at the Achilles tendon attachment on the back of the heel (posterior calcaneal spur). Heel spurs are found in approximately 15% of the general population but are present in 50-70% of patients with plantar fasciitis.
The most important clinical decision with Heel Spur Causes Treatment Surgery isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
The most important clinical decision with Heel Spur Causes Treatment Surgery isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Do Heel Spurs Cause Pain?
This is one of the most common misconceptions in podiatry: heel spurs do NOT directly cause pain in most cases. Studies show that people with and without pain have heel spurs at similar rates. The pain associated with heel spurs comes from the associated soft tissue inflammation — plantar fasciitis on the bottom, or retrocalcaneal bursitis at the back of the heel. The spur forms because of chronic traction on the fascia or Achilles, not the other way around.
Symptoms
Bottom heel spurs: Sharp, stabbing pain on the bottom of the heel, worst with the first steps in the morning or after rest — the classic presentation of plantar fasciitis. Posterior heel spurs: Pain and swelling at the back of the heel, worse with shoe pressure and Achilles loading — consistent with insertional Achilles tendinopathy and retrocalcaneal bursitis.
Conservative Treatment
Plantar fascia stretching, calf muscle stretching, custom orthotics with heel cup and arch support, anti-inflammatory medications, corticosteroid injections, and physical therapy address the soft tissue inflammation without touching the spur. These measures resolve symptoms in 80-90% of patients within 6-12 months.
Surgical Options
Endoscopic plantar fasciotomy with or without spur removal is effective for refractory plantar heel pain. Posterior heel debridement with Haglund’s resection addresses the posterior spur and bursitis when conservative care fails. Outcomes are excellent in appropriately selected patients after 6+ months of conservative management.
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✅ Pros / Benefits
- Conservative treatment resolves symptoms in 80-90% of patients
- Surgery not required in most cases
- Multiple non-surgical options available
- Custom orthotics highly effective for long-term symptom control
❌ Cons / Risks
- Full conservative treatment takes 6-12 months
- Surgery reserved for refractory cases after 6+ months
- Spur removal without addressing underlying plantar fasciitis often leads to recurrence
- Patients frequently disappointed to learn the spur itself is not the main problem
Dr. Tom Biernacki’s Recommendation
Heel spurs are probably the most misunderstood condition I see. Patients come in convinced the spur needs to be removed — and I have to explain that it is the associated plantar fasciitis that is causing their pain, and that treating the fascitis (not the spur) is the solution. In over 80% of cases, we do not need surgery. Proper conservative treatment works remarkably well.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Will my heel spur get bigger over time?
Heel spurs typically remain stable once formed. They do not continuously grow unless the traction forces causing their formation persist.
Can I see a heel spur on an X-ray?
Yes — heel spurs are visible on plain X-rays. However, as noted above, the presence of a spur does not determine whether it is causing symptoms.
Can heel spurs be dissolved or treated without surgery?
No — bony spurs cannot be dissolved with medications. They can only be addressed surgically. However, since the spur itself usually does not cause pain, this is rarely necessary.
Is there a difference between heel spur syndrome and plantar fasciitis?
Heel spur syndrome is plantar fasciitis associated with an X-ray finding of a calcaneal spur. The treatment is the same — the spur does not change the management.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.