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 Township, 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

More questions patients ask

What causes heel pain?

Heel pain most commonly results from plantar fasciitis (inflammation of the plantar fascia ligament), which accounts for approximately 80% of cases. Other causes include Achilles tendinitis, heel spurs, stress fractures, Baxter's nerve entrapment, and fat pad atrophy. Dr. Biernacki performs a thorough biomechanical evaluation to identify the precise cause. Call 810-206-1402 for a same-day appointment.

How long does plantar fasciitis take to heal?

With proper treatment, most plantar fasciitis cases improve within 6-12 weeks. Conservative treatments include custom orthotics, stretching protocols, physical therapy, and corticosteroid injections. For persistent cases beyond 6 months, Dr. Biernacki offers advanced options including shockwave therapy and minimally invasive procedures with 90%+ success rates.

Should I see a podiatrist for heel pain?

Yes. A board-certified podiatrist like Dr. Biernacki can accurately diagnose the cause of heel pain using X-rays and diagnostic ultrasound, ruling out stress fractures and other serious conditions. Self-treatment with over-the-counter insoles often delays proper treatment and can worsen the condition. Early intervention leads to faster recovery.

Still have a question about coverage or cost? Book online and we will check your benefits before your visit: Book in Howell · Book in Bloomfield Township. Prefer to talk it through first? Call (810) 206-1402.