Most heel spurs don’t need to be physically removed. The bony growth itself usually isn’t the source of your pain. Instead, the inflamed soft tissue around it is what hurts, and treating that inflammation resolves symptoms in the vast majority of cases without surgery. About 90% of people with heel spur pain improve with conservative treatments alone, and surgical removal is reserved for the small percentage who don’t respond after 6 to 12 months of consistent effort.
What a Heel Spur Actually Is
A heel spur is a bony projection that forms on the calcaneus, the large bone at the back of your foot. These growths are triangular, made of fibrocartilage, and vary in size. They’re classified as small (5 mm or less) or large (over 5 mm), and they can point downward, outward, or curve into a hook shape. Spurs larger than 5 mm and those with a horizontal or hooked shape tend to cause more pain.
How they form is still debated. One theory suggests that chronic pulling of the plantar fascia on the heel bone causes inflammation and gradual bone buildup at the attachment point. A competing theory points to repetitive vertical compression, essentially tiny stress fractures in the tissue, with the spur forming as a protective response. The second theory is supported by the fact that surgically removed spurs often grow back, and tissue samples from the site don’t typically show signs of inflammation.
This is important context for anyone searching “how to remove a heel spur.” Even when the spur is cut away, it can reform. That’s why treatment focuses on the surrounding tissue rather than the spur itself.
Who Gets Heel Spurs
Obesity is the single strongest risk factor. In one study of older adults, 45% of obese participants had heel spurs compared to just 9% of those who were not obese. Being obese made someone nearly seven times more likely to have a spur. Other independent risk factors include osteoarthritis (about 2.6 times the risk) and a history of heel pain (about 4.6 times the risk). Footwear, occupation, and physical activity level also play a role in determining whether a spur becomes painful.
Stretching and Strengthening Exercises
Targeted exercises are one of the most effective first-line treatments. A clinical trial with two-year follow-up found that plantar fascia-specific stretching improved outcomes in patients with chronic symptoms. The goal is to reduce tension on the heel attachment point and improve flexibility in the calf and foot.
Start with a plantar fascia massage: sit down, place a small ball or frozen water bottle under your foot, and slowly roll it from just below the ball of your foot to just before your heel. The frozen bottle doubles as an ice treatment. Do 10 slow rolls per foot, two sets, once daily.
Heel raises build strength in the muscles that support your arch. Stand with the balls of your feet on the edge of a step, heels hanging off. Slowly lower your heels below the step’s edge until you feel a gentle calf stretch, then rise up onto the balls of your feet. Move slowly and hold a railing for balance.
Other commonly recommended exercises include calf wall stretches, toe curls (gripping a towel with your toes), marble pickups, and resistance band work for the foot and ankle. Consistency matters more than intensity. Daily stretching for several weeks is typically needed before you notice meaningful improvement.
Orthotics and Supportive Devices
Custom orthotic inserts, heel cups, and arch supports work by redistributing pressure away from the spur and cushioning the heel. They also help correct alignment issues that increase strain on the plantar fascia. Over-the-counter heel cups are a reasonable starting point, but custom-molded orthotics from a podiatrist provide more targeted support if off-the-shelf options don’t help. Night splints, which hold your foot in a gently stretched position while you sleep, can also reduce that sharp first-step-in-the-morning pain by preventing the plantar fascia from tightening overnight.
Shock Wave Therapy
Extracorporeal shock wave therapy (ESWT) uses focused pressure waves directed at the painful area. It’s thought to work by clearing inflammatory debris and stimulating new blood vessel growth, which promotes healing. This is typically offered when stretching, orthotics, and rest haven’t worked after several months.
Results are encouraging. In one clinical study, 72% of treated heels were rated “excellent” four weeks after a course of five sessions, and 92% of patients reported being pain free at the four-week follow-up. Average pain scores dropped from 9.2 out of 10 before treatment to 3.4 after four weeks. Longer-term studies from other research groups have shown 80% satisfactory results at six months, with 94% of patients reporting complete or near-complete pain resolution. The main side effect is increased local pain during the procedure itself, which typically subsides within 30 minutes.
Injection Treatments
When pain persists despite conservative care, injections offer another option before considering surgery. The two main choices are corticosteroid injections and platelet-rich plasma (PRP) injections, which use a concentrated sample of your own blood’s healing components.
Both reduce pain, but a systematic review of randomized controlled trials covering hundreds of patients found that PRP outperformed corticosteroids at every time point measured. The advantage was modest at one to three months but grew substantially over time. By six months, PRP patients had meaningfully better pain scores. By 12 months, the gap widened further, and functional scores (how well people could walk and bear weight) were dramatically better in the PRP group. At 24 months, the PRP advantage in function still held.
Corticosteroid injections provide faster initial relief but tend to lose effectiveness. PRP takes longer to kick in but delivers more durable results. PRP is also less likely to cause tissue weakening, a known risk with repeated steroid injections near the heel’s fat pad.
When Surgery Becomes an Option
Surgery is considered only after at least 6 to 12 months of failed conservative treatment. The procedure involves physically cutting away the bony spur from the calcaneus. It can be done through open surgery, with a small incision, or arthroscopically, using a tiny camera and instruments inserted through even smaller cuts.
A study comparing the two approaches found that open surgery achieved results comparable to arthroscopy but with fewer complications. Open surgery provides a better view of the area, allows the surgeon to address other nearby issues during the same procedure, involves less radiation exposure, and costs less. The resulting scar is minimal and similar in size to arthroscopic scars.
Recovery from spur removal typically involves several weeks of limited weight-bearing, followed by gradual return to normal activity. One thing to keep in mind: because the spur formed in response to mechanical stress that may still be present, spurs can grow back after excision. Continuing with orthotics, stretching, and weight management after surgery helps reduce that risk.
Reducing Your Risk of Recurrence
Since obesity carries nearly seven times the risk, reaching or maintaining a healthy weight is the single most impactful thing you can do. Supportive footwear with adequate arch support and cushioning reduces the repetitive compression that drives spur formation. If you spend long hours standing on hard surfaces, cushioned mats or insoles make a real difference. Keeping your calf muscles and plantar fascia flexible through daily stretching helps distribute force more evenly across the foot, reducing the strain at the heel where spurs develop.