What a Spur Actually Is
A heel spur is a bony projection that develops where soft tissue (most often the plantar fascia or Achilles) attaches to the heel bone. It forms over time in response to chronic traction on the bone.
The Important Truth
Heel spurs show up on X-ray in roughly half of people with heel pain - and in 15–25% of people with no heel pain at all. The spur itself is rarely what hurts. The inflamed tissue around the attachment is.
When to Treat
Most patients with heel pain and an incidental spur improve completely with treatment of the underlying tendinopathy or fasciitis - without ever touching the spur. Surgical excision is reserved for symptomatic posterior (Haglund-type) spurs and selected refractory cases where imaging clearly correlates the spur with localized pain.
Dr. O’Carroll’s Approach
A careful exam, targeted imaging when needed, and a treatment plan that addresses the actual pain generator - not just the X-ray finding.