- A heel spur is a small bony outgrowth on the heel bone, often visible on X-ray.
- Most heel spurs are not painful by themselves — when there is pain, it is usually from plantar fasciitis or another nearby soft-tissue problem.
- Treatment is aimed at the underlying soft-tissue issue, not the spur itself.
- Conservative care — stretching, orthotics, footwear changes — resolves most cases.
- Surgery to remove a spur is rare and only considered after thorough non-surgical care has failed.
What are heel spurs?
A heel spur is a calcium deposit that forms a small bony projection on the bottom (plantar) or back (retrocalcaneal) surface of the heel bone. Heel spurs develop slowly over months and years, usually as a response to ongoing tension or pressure on the heel — often from the plantar fascia pulling repeatedly at its attachment site.
Here's the key thing most people don't realize: heel spurs are very common in people without any heel pain at all, and they are often present in patients whose pain is actually caused by something else entirely. When someone has a heel spur AND heel pain, the spur is usually not the actual problem — the underlying plantar fasciitis or Achilles tendonitis is. Treating the soft-tissue condition typically resolves the pain even though the spur is still there.
At Northwest Extremity Specialists, our approach to heel spurs starts with figuring out what is actually causing the pain. Once we identify the real driver — usually plantar fasciitis — we treat that aggressively with conservative measures. Patients are often relieved to learn that "having a spur" does not mean they need surgery.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
Heel spurs form on the calcaneus, the large bone that makes up the heel of your foot. Plantar heel spurs form on the underside of the calcaneus, at the spot where the plantar fascia attaches. Retrocalcaneal spurs form at the back of the calcaneus where the Achilles tendon attaches. Both develop in response to chronic tension at those attachment points, as the body lays down additional bone to stabilize the area.
What it feels like
Heel spurs themselves usually do not cause noticeable symptoms. When pain is present, it typically comes from the surrounding soft tissue:
- Sharp pain under the heel with the first steps of the day (usually plantar fasciitis)
- Pain at the back of the heel with shoe pressure (retrocalcaneal spur with bursitis)
- A bony, pressure-point feeling at the heel that flares when standing on hard surfaces
- Pain that improves with rest and worsens with activity
- Tenderness when pressing directly over the heel bone in some cases
Why it develops
Heel spurs form gradually in response to long-term mechanical stress. Common contributors:
- Chronic plantar fasciitis causing repeated traction on the heel bone
- Tight calf muscles increasing tension at both attachment points
- Flat feet or high arches that increase fascial strain
- Years of high-impact activity on hard surfaces
- Aging and the natural changes in foot mechanics
- Excess body weight increasing load on the heel
How we diagnose heel spurs
A heel pain workup starts with a careful history and physical exam to identify the actual pain source. On-site digital X-ray is often used to confirm the presence of a spur, but more importantly to rule out other causes of heel pain (stress fracture, cyst). The presence of a spur on X-ray is not by itself a diagnosis — your podiatrist will correlate the imaging with where you actually hurt. Most patients leave the same day with a clear understanding of what is and isn't causing their pain.
Non-surgical care
Treatment is aimed at the underlying soft-tissue condition, not the spur itself. The same conservative measures that treat plantar fasciitis or Achilles tendonitis will resolve heel pain in the presence of a spur:
- Calf and plantar fascia stretching program
- Custom orthotics or heel cups to offload the painful area
- Supportive footwear with adequate heel cushioning
- Night splints in cases with severe morning pain
- Anti-inflammatory medication for short-term flares
- Corticosteroid injection for selected resistant cases
Surgical care
Surgical removal of a heel spur is uncommon and is only considered after a long course (typically 6–12 months) of well-executed conservative treatment has failed AND imaging confirms the spur itself is the source of pain.
- Open or endoscopic heel spur resection
- Plantar fascia release (often combined with spur removal)
- Excision of a retrocalcaneal spur with Haglund's deformity correction
Heel spur surgery typically requires 2–4 weeks of protected weight-bearing in a boot, followed by gradual return to regular shoes and activity over 6–12 weeks.
When to see a specialist
- Heel pain that has persisted more than 2–3 weeks despite rest and over-the-counter measures
- Pain that is changing how you walk
- A heel spur seen on imaging done elsewhere — even if you're not sure it's causing pain
- Recurring heel pain that comes back every time you return to activity
Heel spur evaluation and treatment is handled by any of our board-certified podiatrists across our 8 clinics. For chronic cases that don't respond to first-line care, Dr. Manny Moy (Milwaukie) and Dr. Todd Galle (Wilsonville) bring extensive sports-medicine experience with stubborn heel pain.