Patient Selection Is Everything
Most plantar heel spurs are incidental findings on X-ray and don’t need to be removed. Surgical excision is appropriate for posterior heel spurs (Haglund deformity) causing chronic Achilles insertional pain, and for the small subset of plantar spurs with imaging that clearly correlates the spur with the pain after exhaustive conservative care.
What’s Done
For Haglund deformity: removal of the prominent posterior heel bone, debridement of degenerative Achilles tendon, and reattachment as needed. For plantar spurs: excision through a small medial incision, often combined with selective plantar fascia release.
Recovery
Walking boot for 2–4 weeks, gradual return to regular shoes and activity over 8–12 weeks.