Heel Spurs: What They Are, What They Aren’t, and When They Matter

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

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The Most Misunderstood Finding in Podiatry

Heel spurs — bony prominences visible on X-ray at the plantar calcaneus (bottom of the heel bone) — are among the most misunderstood findings in foot care. Patients are frequently told their heel pain is “from a heel spur,” leading to the intuitive conclusion that removing the spur would remove the pain. The medical reality is considerably more nuanced: heel spurs are common, usually asymptomatic, secondary findings that are a consequence of chronic plantar fascia tension rather than a primary cause of pain. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we take time to explain heel spurs accurately — because understanding the actual pain generator changes how treatment is directed.

What Heel Spurs Actually Are

A plantar heel spur (calcaneal enthesophyte) forms over years as the chronic tension of the plantar fascia at its calcaneal insertion stimulates bone deposition — the body’s attempt to reinforce a stress concentration point. This calcification occurs within the origin of the plantar fascia and flexor digitorum brevis muscle, visible on X-ray as a beak-shaped projection at the anterior-inferior calcaneus. Critically: the spur itself is not what hurts. The spur is inert — it cannot generate pain signals. The pain of plantar fasciitis arises from inflammation and micro-tearing in the plantar fascia itself, not from the bony spur.

The Evidence on Spurs and Pain

Studies examining the relationship between heel spurs and pain consistently find that a significant proportion of people with visible heel spurs on X-ray have no heel pain whatsoever — prevalence of asymptomatic heel spurs approaches 15-20% of adults who have X-rays taken for unrelated reasons. Conversely, many patients with clinically confirmed plantar fasciitis have no visible heel spur on X-ray. The spur correlates with the duration and severity of plantar fascia tension but does not independently predict pain or its severity.

Does the Spur Ever Need to Be Removed?

Surgical removal of the plantar calcaneal spur — when included in plantar fasciitis surgery — adds no benefit to plantar fascia release alone. Studies comparing fascia release with and without spur removal show equivalent outcomes, confirming that the spur itself does not contribute to pain generation. Surgical treatment of plantar fasciitis targets the fascia (release of the plantar fascial insertion) — not the spur. The one exception: a very large spur that mechanically compresses Baxter’s nerve (first branch of the lateral plantar nerve) may contribute to symptoms through nerve entrapment, which is a distinct clinical scenario. Contact Balance Foot & Ankle at (810) 206-1402 for heel pain evaluation focused on identifying the actual pain generator, not just the X-ray finding.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Heel Spurs

Heel spurs are often found incidentally on X-rays and are rarely the true cause of heel pain. At Balance Foot & Ankle, Dr. Tom Biernacki provides accurate diagnosis to determine whether your heel pain is from plantar fasciitis, fat pad atrophy, nerve entrapment, or another cause — and treats the real problem.

Learn About Our Heel Pain Treatment Options | Book Your Appointment | Call (810) 206-1402

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, Zammit GV, Landorf KB, et al. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? J Foot Ankle Res. 2008;1:7.
3. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166(12):1305-1310.

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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.