✅ Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified podiatrist specializing in foot & ankle surgery. View credentials.

The Heel Spur Misconception

Heel spurs are one of the most misunderstood findings in podiatric medicine. The common belief—reinforced by decades of patient conversations and internet searches—is that the bony spur visible on X-ray is the source of heel pain and that removing it will cure the pain. This belief is incorrect, and it leads patients to pursue inappropriate treatments and avoid effective ones.

The reality: heel spurs visible on X-ray are present in approximately 10–15% of the general population. Most of these people have no heel pain whatsoever. Among patients with chronic plantar fasciitis, heel spurs are found in about 50–60% on X-ray. For specialized treatment, see our plantar fasciitis care Michigan. This means many people with plantar fasciitis have no spur, and many people with spurs have no plantar fasciitis. The correlation between heel spur presence and heel pain is weak—the spur is a marker, not the cause.

What Is a Heel Spur?

A heel spur (calcaneal enthesophyte) is a bony outgrowth from the calcaneus (heel bone) at the attachment of either the plantar fascia (inferior spur) or the Achilles tendon (posterior spur). Inferior heel spurs—the type associated with plantar fasciitis—form in the direction of the plantar fascia, pointing forward toward the toes. They represent the bone’s response to chronic mechanical stress at the fascial attachment, laying down new bone in a process called reactive ossification.

The spur is made of cortical bone—the same hard, smooth bone as the rest of the calcaneus. It is not sharp, jagged, or spiky despite how it’s often depicted in patient education diagrams. The soft tissues around the spur are the source of pain when heel spurs are symptomatic—the plantar fascia, fat pad, and periosteum—not the bone itself pressing into the ground with each step.

The Relationship Between Heel Spurs and Plantar Fasciitis

Plantar fasciitis and heel spurs often coexist because they share the same origin. Both result from chronic excessive tension at the plantar fascial insertion on the calcaneus. The repeated pulling of the fascia on the bone stimulates reactive bone formation (the spur) while simultaneously causing microtrauma and degeneration at the fascial insertion (plantar fasciitis/tendinopathy). The heel spur is a consequence of the same process causing plantar fasciitis—not the cause of the pain.

This is why plantar fasciitis treatment works whether or not a heel spur is present. Stretching, orthotics, strengthening, cortisone injection, shockwave therapy, and PRP injection address the fascial pathology—and they work equally well in patients with and without visible heel spurs. Conversely, surgical removal of a heel spur without addressing the fascial pathology typically fails to resolve pain.

When Are Heel Spurs Actually Painful?

In a small subset of cases, the heel spur itself may contribute to pain through direct soft tissue impingement. A very large, irregularly shaped, or unusually positioned spur can irritate the surrounding fat pad, bursa, or nerve branches. In these cases, the spur contributes mechanically to pain and may need to be addressed surgically. However, this is the exception—most heel spur pain is actually plantar fasciitis pain, and treating the fasciitis resolves the symptoms regardless of spur presence.

Effective Treatment: Treat the Fascia, Not the Spur

Because heel pain with a spur is almost always caused by the same pathology as heel pain without a spur (plantar fasciitis and related conditions), the treatment approach is identical regardless of spur presence. The effective treatments are the same: stretching (especially the Achilles-plantar fascia chain and first step morning stretch), custom orthotics with arch support and heel cushioning, footwear modification, cortisone injection, EPAT shockwave therapy for chronic cases, and PRP injection.

These approaches resolve the underlying fascial pathology and inflammation around the spur, eliminating pain. The spur itself remains visible on X-ray after successful treatment—it does not dissolve or disappear—but it causes no symptoms once the surrounding inflammation is resolved.

Heel Spur Surgery: When Is It Needed?

Surgery for heel spurs is rarely needed and rarely appropriate as an isolated procedure. Spur removal (inferior calcaneal exostectomy) performed without plantar fascia release has a poor track record—the recurrence rate of heel pain is high because the underlying fascial pathology wasn’t addressed. When surgery is indicated for heel pain that has failed exhaustive conservative treatment (typically 9–12 months), the procedure typically combines partial plantar fascia release with Baxter’s nerve decompression and, if a very large impinging spur is present, spur reduction. This comprehensive approach addresses all contributing pathology rather than just the bony prominence.

Shockwave therapy and PRP injection have dramatically reduced the need for surgical intervention in plantar fasciitis—even in cases with large heel spurs. These treatments should be exhausted before considering surgical options.

Frequently Asked Questions

Medical References & Sources

• American Podiatric Medical Association — Plantar Fasciitis
• PubMed Research — Heel Spur and Plantar Fasciitis Relationship
• American Orthopaedic Foot & Ankle Society — Heel Pain

Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He treats heel spurs and plantar fasciitis with evidence-based conservative treatment including EPAT shockwave therapy, custom orthotics, and PRP injection.

Heel Spurs — Understanding Causes & Finding Relief

Clinical References

1. Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur: fact or fiction? Foot Ankle Surg. 2012;18(1):39-41.
2. Menz HB et al. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? J Foot Ankle Res. 2008;1(1):7.
3. Tisdel CL et al. Diagnosing and treating plantar fasciitis: a conservative approach to plantar heel pain. Cleve Clin J Med. 1999;66(4):231-235.

Dr. Tom Biernacki, DPM

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.