Heel Spur Treatment in Michigan | Do You Need Surgery? | Balance Foot

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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Heel spurs are a frequent finding on foot X-rays and a commonly misunderstood diagnosis. Many people believe their heel pain is caused by the spur itself — but the science tells a different story. At Balance Foot & Ankle, our Michigan podiatrists explain the true relationship between heel spurs and heel pain, and provide evidence-based treatment focused on the root cause.

What Is a Heel Spur?

A heel spur (calcaneal spur) is a calcium deposit that forms on the heel bone (calcaneus) in response to chronic tension at a soft tissue attachment. There are two types:

• Inferior (plantar) heel spurs: Form at the attachment of the plantar fascia on the bottom of the heel. Found in approximately 50% of patients with chronic plantar fasciitis — but also in 15–25% of people with zero heel pain. The spur itself is not painful; the inflamed plantar fascia is.
• Posterior heel spurs: Form at the insertion of the Achilles tendon on the back of the heel bone. Associated with Haglund’s deformity and insertional Achilles tendinopathy. Posterior spurs can cause direct irritation when rubbing against shoe counters.

The Spur Doesn’t Cause the Pain — The Fascia Does

Decades of research have confirmed that plantar heel pain is caused by degeneration and micro-tearing of the plantar fascia at its calcaneal origin — not by the bony spur. Removing the spur without addressing the fascia provides no relief. Patients with and without spurs respond equally well to plantar fasciitis treatment. This is why our treatment targets the fascia and its underlying causes, not the radiographic spur.

Conservative Treatment

Over 90% of heel pain cases resolve with non-surgical treatment over 6–12 months. Our protocol includes:

• Stretching: Calf (gastrocnemius and soleus) and plantar fascia stretching before first steps in the morning and after prolonged sitting — the most effective single intervention supported by evidence
• Custom orthotics: Address the biomechanical drivers of plantar fascia overload — overpronation, high arch rigidity, or leg length discrepancy
• Night splints: Maintain the plantar fascia in a stretched position during sleep, preventing the overnight contracture that causes first-step morning pain
• Anti-inflammatory treatment: NSAIDs, ice massage, and corticosteroid injections for acute pain phases
• Activity modification: Reduce high-impact activities; transition to lower-impact alternatives (cycling, swimming)
• Supportive footwear: Adequate cushioning and arch support at all times — barefoot walking on hard surfaces is counterproductive

Advanced Non-Surgical Options

For cases that fail initial conservative treatment (typically after 3–6 months):

• Extracorporeal shockwave therapy (ESWT): Sound wave energy delivered to the calcaneal origin triggers a healing response. Approximately 60–80% of patients who have failed other treatments respond to ESWT. Covered by most Michigan insurance plans after conservative care failure. Painless and requires no recovery time.
• Platelet-rich plasma (PRP) injection: Concentrated growth factors from your own blood are injected into the plantar fascia origin to stimulate healing. Evidence supports 70–80% success rates for chronic plantar fasciitis unresponsive to standard care.
• Physical therapy: Eccentric strengthening, ultrasound therapy, and instrument-assisted soft tissue mobilization (IASTM) address the structural degeneration

Surgical Treatment

Surgery is reserved for the fewer than 5% of patients who fail 12+ months of comprehensive conservative and advanced treatment. Options include:

• Endoscopic plantar fasciotomy: Partial release of the plantar fascia origin through two small portals under endoscopic visualization. No heel spur removal is performed (it is not the source of pain). Rapid recovery, outpatient procedure.
• Open plantar fascia release with calcaneal spur resection: For cases with a large spur causing direct mechanical symptoms or when endoscopic access is limited. The spur is removed only as part of the fascial release, not as the primary target.
• Posterior heel surgery (Haglund’s resection): For insertional Achilles disease with a prominent posterior spur causing shoe irritation and tendinopathy — the posterior bony prominence is removed with or without Achilles tendon debridement.

Frequently Asked Questions

Learn about insurance coverage for foot care on our Insurance & Costs page.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Plantar Fasciitis and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Baxter’s neuropathy. Compressed first branch of lateral plantar nerve — burning medial heel pain rather than first-step sharpness.
• Calcaneal stress fracture. Squeeze test of the heel reproduces pain anywhere; PF is reproduced only at the medial-plantar attachment.
• Heel spur (incidental). Spurs show on X-ray but rarely cause pain on their own — treat the fascia, not the spur.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Stretching aggressively before the fascia warms up. Fix: apply heat or move the foot through gentle circles for 3-5 minutes before your first morning steps, then stretch.

Warning Signs That Need Same-Day Care

Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)

If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your plantar fasciitis, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Frequently Asked Questions

Are heel spurs painful?

Heel spurs themselves are not the primary source of pain in most cases. About 70% of people with plantar fasciitis have a heel spur on X-ray, but heel spurs are also found in 15–20% of asymptomatic adults. The pain comes from plantar fascia inflammation at the heel attachment, not from the spur scraping tissue. This is why removing the spur surgically rarely changes outcomes — the fascia degeneration is the underlying problem that drives the pain.

What’s the difference between a heel spur and plantar fasciitis?

Plantar fasciitis is inflammation and degeneration of the plantar fascia ligament at its heel attachment — the most common cause of heel pain. A heel spur is a bony calcium deposit that forms on the bottom of the heel bone. The two frequently coexist, and the spur forms as the body’s response to chronic fascial tension at the heel. Treating the plantar fasciitis resolves the pain in the vast majority of cases; the spur remains on X-ray but becomes asymptomatic.

Does a heel spur require surgery?

Rarely. Heel spur surgery is indicated only when conservative treatment has failed for 12+ months and the specific spur is confirmed as the pain source — not the fascia. This applies to perhaps 2–3% of heel spur cases. Modern surgical approaches include endoscopic plantar fascia release with spur removal; recovery is 6–8 weeks. In our practice, we counsel strongly against spur removal as an isolated procedure because removing the spur without addressing the underlying fascial pathology produces unpredictable outcomes.

How is a heel spur diagnosed?

X-ray confirms the presence and size of a heel spur. A heel spur appears as a bony projection on the calcaneus (heel bone) visible on a lateral foot X-ray. However, finding a spur on X-ray doesn’t confirm it’s causing symptoms — the clinical examination (point tenderness, gait analysis, response to treatment) is equally important. Ultrasound and MRI are used when soft tissue pathology alongside the spur (fascia thickening, partial tears) needs characterization.

Can heel spurs go away on their own?

Bone doesn’t resorb spontaneously in adults without a pathological process. Once a heel spur forms, it’s permanent — but it becomes asymptomatic in the vast majority of patients who treat the underlying plantar fasciitis. The goal isn’t to eliminate the spur; it’s to resolve the fascial inflammation that made it painful in the first place. When the fascia heals, the spur is still there but no longer provokes a pain response.

What treatments work for heel spur pain?

Treatment is essentially identical to plantar fasciitis treatment: daily stretching (plantar fascia and calf), supportive footwear with heel elevation, custom or OTC orthotics, night splints, and activity modification. For persistent cases: corticosteroid injection, shockwave therapy, and PRP. These target the plantar fascia inflammation, not the spur directly — which is appropriate because the fascia is the pain generator. We start with the least invasive options and escalate based on response.

What is posterior heel spur vs. inferior heel spur?

Inferior (bottom) heel spurs form at the plantar fascia attachment on the bottom of the heel and are associated with plantar fasciitis. Posterior heel spurs form at the Achilles tendon insertion on the back of the heel and are associated with Haglund’s deformity (pump bump) and insertional Achilles tendinopathy — a completely different condition requiring different treatment. Both show up on X-ray but are in distinct anatomical locations; the clinical exam identifies which is causing symptoms.

Does shock wave therapy work for heel spurs?

Extracorporeal shockwave therapy (ESWT) shows 60–75% success rates for chronic plantar fasciitis and heel spur pain that has not responded to 6+ months of conservative care. It delivers acoustic pressure waves that stimulate healing and reduce nerve sensitization. Treatment consists of 3–5 sessions over 3–5 weeks; results appear over 6–12 weeks. It’s non-invasive, requires no anesthesia, and has minimal downtime. We offer ESWT in-office as a step between conservative care and surgery.