Last clinically reviewed: April 2026 by Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon

Quick answer: Heel spurs are calcium deposits on the heel bone that are often painless themselves. The pain typically comes from plantar fasciitis—inflammation of the fascia tissue. Over 95% of cases resolve with conservative treatment including stretching, orthotics, and anti-inflammatory therapy. Surgery is rarely needed and reserved for less than 5% of cases.

Contents

• What Is a Heel Spur?
• Symptoms of Heel Spurs
• Causes & Risk Factors
• Diagnosis
• Treatment Options
• When to See a Podiatrist
• The Most Common Mistake We See
• Recommended Products
• Frequently Asked Questions
• The Bottom Line
• Sources

What Is a Heel Spur?

A heel spur is a small bony protrusion that develops on the heel bone (calcaneus). It forms when calcium deposits accumulate at the point where the plantar fascia—a thick band of tissue running along the bottom of your foot—attaches to the heel bone. These spurs are visible on X-ray imaging and are surprisingly common: studies show that about 10% of people with heel pain have heel spurs, yet many people with spurs never experience pain.

Here’s the key distinction: The heel spur itself is usually painless. The pain associated with heel spurs typically comes from plantar fasciitis—inflammation and micro-tears in the plantar fascia tissue. This is a critical point because it changes how we treat you. We don’t treat the spur; we treat the fascia inflammation.

We see heel spurs regularly in our Howell and Bloomfield Hills clinics, and we’ve found that properly diagnosing whether your pain comes from plantar fasciitis, the spur, or a combination of issues is essential for effective treatment. Many patients are surprised to learn that the spur isn’t causing their pain—but that knowledge empowers better treatment decisions.

Symptoms of Heel Spurs

If you have a heel spur with associated plantar fasciitis, you may experience:

• Sharp, stabbing pain on the bottom of your heel, especially toward the back
• First-step pain that’s often worse when you first get out of bed in the morning
• Pain after sitting for extended periods, then worsening when you stand and take the first few steps
• Burning or stabbing sensation that can radiate along the heel
• Mild swelling around the heel area
• Progressive worsening over days or weeks if left untreated
• Pain that intensifies with prolonged walking or standing

Many patients describe the sensation as feeling like they’re “stepping on a nail” or having a sharp stone lodged in their heel. The pain is typically worse in the morning and can improve slightly with movement, only to worsen again later in the day. If your symptoms sound familiar, it’s important to seek professional evaluation rather than self-treating.

Causes & Risk Factors

Heel spurs develop when the plantar fascia is under chronic stress, pulling on the heel bone and causing calcium to accumulate at the attachment point. Common factors that increase your risk include:

• Plantar fascia strain from repetitive stress or overuse
• Prolonged standing or walking, especially on hard surfaces
• Running and high-impact sports, particularly without proper foot support
• Flat feet (pes planus) or high arches (pes cavus) that alter biomechanics
• Poor footwear choices—thin soles, inadequate arch support, or worn-out shoes
• Obesity or weight gain that increases stress on the plantar fascia
• Age-related changes—tissue loses elasticity after age 40
• Tight calf muscles that increase tension through the plantar fascia
• Repetitive microtrauma from occupations requiring standing (teaching, retail, nursing)

The good news: understanding these risk factors means you can take preventive action. Even if you’ve already developed a heel spur, we can address the underlying biomechanical issues driving your pain.

Diagnosis

Proper diagnosis is essential because heel pain can have multiple causes. During your evaluation, we use:

Imaging

X-rays clearly show heel spurs as a bony projection on the heel. Ultrasound helps us assess soft tissue damage to the plantar fascia, inflammation, and thickness—information that X-ray alone cannot provide. This dual imaging approach gives us a complete picture.

Physical Examination

We perform a thorough exam including palpation of the heel, assessment of foot biomechanics, range of motion testing, and evaluation of your gait. We also check for associated conditions.

Differential Diagnosis

Because other conditions can mimic heel spur pain, we rule out:

• Plantar fasciitis (the most common co-diagnosis—95% of heel spur patients have this)
• Stress fracture of the calcaneus
• Tarsal tunnel syndrome (pinched nerve)
• Fat pad atrophy (loss of cushioning tissue)
• Achilles insertional calcific tendinopathy

Treatment Options

We use a conservative-to-surgical treatment ladder. Most patients respond excellently to conservative care, which focuses on reducing plantar fascia inflammation and stress.

Conservative Treatment (First-Line)

Stretching & Physical Therapy

Specific plantar fascia stretches and calf stretches reduce tension and improve tissue healing. Our clinical team can teach you proper technique to do these at home.

Supportive Footwear

We provide specific guidance on shoe selection—looking for adequate arch support, cushioning, and heel support. A small heel lift (0.5–1 inch) can immediately reduce pain by decreasing plantar fascia tension.

Custom Orthotics

We fabricate 3D-scanned custom insoles that correct your specific foot biomechanics, redistribute pressure away from the heel, and provide targeted arch support. This is far more effective than over-the-counter inserts.

Anti-Inflammatory Treatment

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, combined with ice therapy (15–20 minutes, 2–3 times daily), reduce inflammation and pain.

Corticosteroid Injections

For persistent inflammation, ultrasound-guided corticosteroid injections target the exact site of inflammation, providing significant pain relief and allowing aggressive physical therapy.

Night Splints

Worn while sleeping, night splints keep your plantar fascia gently stretched, reducing morning pain and preventing re-injury.

Advanced Conservative Treatment

Extracorporeal Shockwave Therapy (ESWT)

For plantar fasciitis and heel spurs that don’t respond to standard conservative care, ESWT uses acoustic waves to stimulate tissue healing and break up calcifications. This is typically reserved for cases unresponsive to 3+ months of conservative treatment.

Surgical Treatment (Rarely Needed)

Surgery is reserved for the small percentage of patients who fail aggressive conservative care (usually <5%). The procedure involves releasing tension in the plantar fascia and, in rare cases, removing the heel spur itself. Most surgical outcomes are excellent, with patients reporting >80% pain reduction.

To learn more about conservative treatment approaches, see our detailed guide to plantar fasciitis treatment. We also have a comprehensive article on plantar fasciitis to help you understand the condition that usually accompanies heel spurs.

When to See a Podiatrist Immediately

• Heel pain persisting longer than 2 weeks despite home care
• Inability to bear weight on the affected heel
• Numbness or tingling in the foot or heel area
• You have diabetes or neuropathy and develop heel pain (nerve damage risk)
• Signs of infection: redness, warmth, swelling, or drainage
• Rapid worsening of pain over days
• Pain affecting both heels (unusual—may suggest different condition)

Don’t wait. Early intervention leads to faster recovery. Call us at (810) 206-1402 to schedule your evaluation.

The Most Common Mistake We See

Patients often focus their treatment on the heel spur itself—requesting spur removal or obsessing over the X-ray findings. This is exactly backward. The spur isn’t the problem; the plantar fascia inflammation is. Treating the spur without addressing fascia inflammation leaves the underlying condition untreated and guarantees pain will return.

Other Common Mistakes:

• Buying expensive OTC inserts without proper diagnosis. Generic insoles don’t address your specific biomechanical issues. Custom orthotics, tailored to your foot structure, are far more effective and ultimately more cost-efficient.
• Ignoring biomechanical problems. If your flat feet or tight calves caused the spur, those issues must be corrected, or the problem will recur.
• Waiting too long before seeking professional help. The longer plantar fascia inflammation persists, the more likely it becomes chronic. Early intervention means faster recovery.
• Assuming rest alone solves the problem. While rest reduces acute inflammation, you need active treatment—stretching, proper footwear, and possibly orthotics—to achieve lasting relief.

At Balance Foot & Ankle Specialists, we focus treatment on what matters: the plantar fascia. The spur will typically remain on the X-ray indefinitely, but your pain will resolve because we’re treating the actual source of discomfort.

Recommended Products

Compression Socks — Dr. Tom’s Pick

DASS Medical Compression Socks provide graduated compression to improve circulation and reduce swelling. Dr. Tom Biernacki, DPM, recommends these to patients for daytime pain relief and recovery support. Compression helps reduce inflammation and provides gentle support during daily activities.

View on Amazon →

Arch Support Insoles

High-quality arch support insoles provide immediate relief by reducing plantar fascia tension. While custom orthotics are superior, these can provide temporary support. Look for insoles with firm arch support and heel cups.

View on Amazon →

Night Splints

Night splints hold your foot in a dorsiflexed position while sleeping, keeping the plantar fascia stretched and reducing morning pain. This is one of the most effective conservative treatments available.

View on Amazon →

Heel Cups

Gel or foam heel cups cushion the heel and reduce direct pressure on tender areas. They’re inexpensive, easy to use, and provide immediate comfort. Many patients use these in combination with other treatments.

View on Amazon →

Frequently Asked Questions

Do heel spurs cause heel pain?

Not directly. The spur itself is usually painless. Pain comes from plantar fasciitis—inflammation of the fascia tissue—which often develops alongside the spur. About 90% of heel spur patients also have plantar fasciitis. Treatment targets the fascia inflammation, not the spur itself.

What does a heel spur look like on X-ray?

On an X-ray, a heel spur appears as a small, pointed bony projection extending from the heel bone (calcaneus), usually at the point where the plantar fascia attaches. It typically looks like a small hook or spur, which is how it got its name. The size of the spur on X-ray doesn’t correlate with pain severity.

How are heel spurs treated?

Most cases respond to conservative treatment: stretching, custom orthotics, night splints, NSAIDs, ice therapy, corticosteroid injections, and proper footwear. Advanced cases may benefit from shockwave therapy (ESWT). Surgery is reserved for the <5% of cases that fail conservative treatment after 3+ months.

Can heel spurs go away on their own?

The bony spur itself doesn’t go away—it’s permanent. However, the pain associated with heel spurs almost always resolves with proper conservative treatment. Once plantar fascia inflammation is controlled, you’ll be pain-free even though the spur remains visible on X-ray.

How long does heel spur treatment take?

Most patients notice significant improvement within 2–6 weeks of consistent conservative treatment. Full resolution typically takes 8–12 weeks. The timeline depends on the severity of inflammation, your compliance with treatment, and whether you have other contributing factors like biomechanical issues or ongoing overuse.

Does insurance cover heel spur treatment?

Most insurance plans cover conservative treatment for heel spurs, including office visits, X-rays, and initial treatment. Coverage for custom orthotics and corticosteroid injections varies. Coverage for advanced treatments like ESWT or surgery may require prior authorization. Contact your insurance provider or our office for specific coverage details.

When should I see a podiatrist for a heel spur?

You should schedule an appointment if you have persistent heel pain lasting >2 weeks, pain affecting your daily activities, or symptoms worsening over time. Early professional evaluation prevents the condition from becoming chronic and allows for more effective treatment. Call us at (810) 206-1402 to book an appointment.

Do heel spurs require surgery?

No. Less than 5% of heel spur cases require surgery. The vast majority—over 95%—resolve completely with conservative treatment including stretching, orthotics, anti-inflammatory therapy, and time. Surgery is only considered after aggressive conservative care fails.

The Bottom Line

Heel spurs are common, usually benign, and highly treatable. While the bony spur itself is permanent, the pain associated with it—typically caused by plantar fasciitis—resolves in the vast majority of cases with conservative treatment. The key is early diagnosis, understanding that the spur isn’t the problem (the fascia inflammation is), and committing to a comprehensive treatment plan that includes stretching, supportive footwear, and possibly orthotics or injections. If conservative care fails after 3+ months, advanced treatments like shockwave therapy or surgery are available, though they’re rarely needed. Don’t let heel pain linger—early intervention at Balance Foot & Ankle Specialists means faster recovery and return to pain-free walking.

Sources

This article is based on peer-reviewed clinical research and current best practices in podiatric medicine:

1. Goff JD, Crawford R. “Diagnosis and treatment of plantar fasciitis.” American Family Physician. 2011 Sep 15;84(6):676-682. PubMed
2. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. “Risk factors for plantar fasciitis: a matched case-control study.” Journal of Bone and Joint Surgery. 2003 May;85(5):872-877. PubMed
3. Garaghe AM, Walsh E. “Plantar fasciitis: a review of the literature.” Foot & Ankle Specialist. 2013 Dec;6(6):444-454. PubMed
4. Ball LM, Shurtz MJ, Pruss A, Bowers JA, Perez VL. “Extracorporeal shockwave therapy for plantar fasciitis: a systematic review.” Current Reviews in Musculoskeletal Medicine. 2022 Apr;15(2):141-150. PubMed
5. Neufeld SK, Cerrato R. “Plantar fasciitis: evaluation and treatment.” Journal of the American Academy of Orthopaedic Surgeons. 2015 Jun;23(6):392-393. PubMed

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