The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Foot & Ankle

Heel Spur

Heel spurs are bony growths (enthesophytes) that form on the calcaneus (heel bone) where a tendon or fascia attaches. They are extremely common findings on foot X-rays — but here is the key point that surprises many patients: most heel spurs are completely asymptomatic and are not the true cause of heel pain. At Maryland Orthopedic Specialists, we focus on what is actually causing your pain, not just what shows up on imaging.

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What is heel spur?

A heel spur is a calcaneal enthesophyte — a bony projection that develops in response to repetitive traction stress at a tendon or fascial attachment. Two anatomically distinct types exist: Plantar heel spurs: Located on the inferior (bottom) surface of the calcaneus, at the attachment of the plantar fascia and intrinsic flexor muscles.

A heel spur is a calcaneal enthesophyte — a bony projection that develops in response to repetitive traction stress at a tendon or fascial attachment. Two anatomically distinct types exist:

Plantar heel spurs: Located on the inferior (bottom) surface of the calcaneus, at the attachment of the plantar fascia and intrinsic flexor muscles. These are the spurs most commonly associated with plantar fasciitis. However, radiographic studies consistently show that plantar spurs are present in approximately 50% of patients without plantar fasciitis, and absent in many patients with classic plantar fasciitis. The spur is thus a marker of chronic tensile loading rather than the pain generator — it is the plantar fascia itself that causes pain, not the bony growth.

Posterior heel spurs (Haglund deformity): Located on the posterosuperior calcaneus at the Achilles tendon insertion. The bony prominence can irritate the Achilles tendon insertion and the retrocalcaneal bursa between the tendon and bone. Associated with insertional Achilles tendinopathy and retrocalcaneal bursitis. The Haglund deformity is exacerbated by rigid posterior shoe counters ("pump bump"). This type may be more directly symptomatic than plantar spurs.

Treatment options

Treating heel spur pain means treating the underlying condition — the spur itself rarely requires direct treatment.

Plantar Heel Spur

The approach is identical to plantar fasciitis: stretching, orthotics, supportive footwear, and a corticosteroid injection if needed. The spur does not need to be surgically removed in most cases.

Posterior Heel Spur (Haglund's Deformity)

Open-backed shoes, a heel lift, and Achilles stretching relieve pressure on the posterior heel; surgery to remove the bony prominence is an option for patients who don't improve after conservative care.

Frequently Asked Questions

My X-ray shows a heel spur — is that what's causing my pain?
Almost certainly not in isolation. Heel spurs are found in asymptomatic individuals at the same rate as in those with heel pain. The pain comes from the inflamed plantar fascia or irritated Achilles insertion, not the bone itself. Treating the soft tissues — not the spur — is what resolves symptoms.
Can I just have the spur removed?
Isolated spur resection without addressing the underlying soft-tissue pathology typically fails. If surgery is ever needed, it should address the plantar fascia (release) or Achilles insertion (debridement ± spur resection) comprehensively.
Will the spur grow back after surgery?
If the underlying mechanical stress continues, yes. Appropriate biomechanical management (orthotics, footwear changes, calf stretching) after any procedure reduces recurrence risk.
How long does plantar fasciitis / heel spur pain usually last?
With appropriate treatment, the majority of patients experience significant improvement within three to six months. The condition is self-limiting in many cases, meaning it can resolve on its own, but this process often takes twelve to eighteen months without targeted treatment. A structured program including calf and plantar fascia stretching, supportive footwear, and custom or over-the-counter orthotics accelerates recovery significantly. Persistence with these measures — even after initial improvement — is important to prevent relapse.
What are the surgical options if heel pain does not improve?
Surgery is considered only after six to twelve months of consistent non-surgical treatment have failed to provide adequate relief. The most common procedure is a partial plantar fascia release, in which the tight fascia is partially cut to relieve tension. This is most often performed endoscopically as an outpatient procedure. While effective, surgery carries a small risk of complications including nerve injury or arch flattening, so at MOS we reserve it for truly refractory cases and discuss all risks and expected recovery in detail before proceeding.

Meet the specialists

Gary Feldman, DPM, FACFAS

Gary Feldman, DPM, FACFAS

Podiatry (Foot & Ankle Surgery)

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Related conditions

Plantar FasciitisAchilles Tendinopathy
Medically reviewed by Gary Feldman, DPM, FACFAS, DPM, FACFAS
Last reviewed May 1, 2026

References

  1. Taunton JE, Ryan MB, Clement DB, et al. A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine. 2002;36(2):95–101. doi:10.1136/bjsm.36.2.95
  2. Johansson KJ, Sarimo JJ, Lempainen LL, Laitala-Leinonen T, Orava S. Calcific spurs at the insertion of the Achilles tendon: a clinical and histological study. Muscles Ligaments Tendons Journal. 2012;2(4):273–277.
  3. Haglund P. Über eine seltene Erkrankung der Ferse. Acta Chirurgica Scandinavica. 1928;63:327–339.
  4. OrthoInfo — AAOS. Plantar Fasciitis and Bone Spurs. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs