What are heel spurs?
A heel spur is a bony protrusion that forms on the sole of the heel, specifically on the underside of the calcaneus bone. It is caused by a build-up of calcium in response to prolonged inflammation of the plantar fascia. Diagnosis is confirmed via X-ray, though the presence of this bony growth does not always correlate with clinical symptoms.
A heel spur is a consequence of chronic plantar fasciitis: inflammation of the connective tissue between the heel and the front of the foot. This ligament-like structure functions as a key support for the arch of the foot, absorbing shock when walking or running.
Plantar fasciitis can be caused by several factors, ranging from overuse to unsuitable footwear or injuries. Prolonged inflammation triggers a physiological response of calcium deposition in the affected area, which eventually develops into a heel spur. However, it is important to note that the presence of a heel spur does not always cause pain. The problem usually starts when the tissues around the spur become inflamed or irritated.
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Heel spur removal treatment
A heel spur is usually only treated if it causes pain. In this case, treatment focuses on relieving plantar fasciitis and reducing inflammation in the affected area.
Conservative Treatments
Initial clinic visits for plantar fascia pain focus on conservative treatments. Our first-line treatment is non-invasive and generally produces excellent results for most patients when followed consistently and diligently.
This conservative approach combines treatments to reduce pain and inflammation, improve foot biomechanics, and promote tissue regeneration. However, it is important for the patient to bear in mind that these treatments do not produce immediate results. A follow-up period of at least six months is generally required to assess the effectiveness of these treatments. Over this duration, we assess symptom progression alongside patient commitment to the guidelines, as consistent application is vital for successful results.
This treatment option follows a step-by-step approach: we always begin with non-invasive measures and, if these don't work, we gradually move on to more invasive treatments. This step-by-step approach avoids unnecessary treatments and allows your body's natural healing process to take its course.
The initial phase usually combines different treatments, such as:
Anti-inflammatory medication
Taken orally or applied topically (creams/gels), to manage pain and swelling.
Applying a cold compress to the affected area
Particularly after physical activity or at the end of the day, which helps to reduce inflammation and provides symptomatic relief.
Physiotherapy
Which may include manual techniques such as deep-tissue massage, joint mobilisation, therapeutic ultrasound.
Specific stretches for the plantar fascia and the calf muscle
Which are essential for relieving tension at the heel insertion and improving tissue elasticity.
Custom-made orthopaedic insoles
With arch support and heel cushioning to correct gait and reduce pressure on the injured areas.
Shockwave therapy
A non-invasive treatment that stimulates the regeneration of damaged tissue through mechanical micro-impacts, improving blood flow and relieving chronic pain.
Strengthening exercises
For the muscles of the foot and leg, aimed at improving stability, distributing weight more effectively, and preventing future relapses.
Footwear assessment
Ensuring that the patient wears suitable shoes with good cushioning and arch support, and without excessive pressure on the heel or arch.
In some cases, if no significant improvement is achieved after several months of conservative treatment, corticosteroid injections may be considered. These injections are effective in relieving severe pain and reducing localised inflammation.
If initial treatments do not provide enough relief, regenerative therapies like bio-regenerative cell injections may be considered to help stimulate the natural repair of damaged tissue.
Should pain persist and functionality fail to improve following the exhaustion of all conservative measures, surgical intervention is considered as a final resort. This decision is made on a case-by-case basis, taking into account the progression of the condition and individual patient needs.
Surgical Procedure
What Does It Involve?
Surgical intervention is considered in cases where plantar fasciitis fails to respond to conservative treatments. This determination is made independently of the presence of a heel spur, as surgical intervention is indicated when inflammation and pain remain persistent despite conservative treatments.
The standard surgical technique entails a total or partial release of the plantar fascia, with the objective of alleviating the tension responsible for the pain. Furthermore, if the patient has a heel spur, this is removed by filing or osteotomy (cutting the bone).
There are two main ways to access the area:
- Traditional open surgery
In this approach, an incision of around 10 centimetres is made on the inner side of the heel. Through this opening, direct access is gained to the plantar fascia and, if the patient has one, the heel spur.
The fascia is then detached, and the bone spur is resected. This technique offers a direct view of the surgical site, but is more invasive. It requires stitches, post-operative care and a longer recovery time. The patient usually needs at least 15 days to walk normally again. There is also a higher risk of swelling, infection, and wound dehiscence (where the wound reopens).
- Minimally invasive surgery (percutaneous with fluoroscopy)
At Clínica Planas, we use a more modern and less invasive technique. This technique uses a 2-millimetre micro-incision to insert specialised instruments guided by fluoroscopy (real-time X-ray).
This percutaneous approach involves filing down the bone spur and performing a partial or complete release of the plantar fascia with a specialised scalpel. The decision to perform a partial or complete release depends on the extent of the condition and the patient’s individual circumstances.
The primary advantage of this technique is the quick recovery: being minimally invasive, it requires only a single stitch, no immobilisation, and allows for walking on the day of the operation.
Postoperative pain is reduced significantly. Additionally, there is a much lower risk of complications, including infections and bruising.
In most cases, on the day of the operation, the patient can wear padded shoes with a heel-relieving insole, allowing them to gradually resume their daily activities. The procedure takes approximately 20 minutes.
Preoperative Care
Before undergoing surgery, the patient must carefully follow the specialist’s instructions to properly prepare the affected area and minimise the risk of complications, both during and after the procedure.
Preoperative preparation for this percutaneous procedure follows standard outpatient protocols. These include a full medical check-up, comprising blood tests and an assessment of the patient's general state of health. We would also recommend refraining from smoking in the days leading up to the surgery. Additionally, it is essential to stop taking anticoagulants at least 10 days before the procedure, always under medical supervision, to minimise the risk of bleeding.
The procedure is carried out under local anaesthetic and mild sedation, which ensures that the patient remains relaxed and pain-free throughout the procedure.
Postoperative Care and Recovery
Recovery following percutaneous surgery is very straightforward and involves virtually no significant restrictions. Contingent upon the patient’s wellbeing, athletic activities may be resumed at their discretion, provided the return to exercise is incremental. Physical activity is clinically beneficial, as it facilitates physiological gliding of the fascia and alleviates tension within the treated region.
Patients can walk and resume their normal daily activities from the very first day, as the postoperative swelling subsides. To protect the treated area, it is best to avoid baths or showers for the first 48 hours. Should you experience any minor discomfort, you may take a painkiller as prescribed by your doctor.
Symptoms
The symptoms of plantar fasciitis include:
- Severe pain in the sole of the foot, particularly in the mornings, easing with physical activity.
- Possible swelling during the acute phase.
- Pain localised in the heel, which can be confirmed by an X-ray or ultrasound scan.
- A burning sensation or sharp pains in the sole, particularly after prolonged periods of inactivity.
- Tenderness when pressure is applied to the affected area.
Causes and risk factors
Being Overweight
Being overweight increases pressure on the heel and inflammation of the plantar fascia.
Unsuitable Footwear and Lack of Physical Fitness
Walking long distances when you are not used to it, particularly when wearing flip-flops or shoes that lack proper support, can put strain on the soles of your feet and cause them to become overloaded.
Sports-Related Strain
Heel spurs are a common problem among athletes who engage in very intense training without taking sufficient rest, thereby overloading the fascia.
Ageing
It also occurs in older patients because, over time, the connective tissue loses its elasticity and the fascia becomes stiff, leading to inflammation in the area.
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F.A.Q.
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Can it come back?
If the bone spur is removed surgically, it will not return. However, if the problem is plantar fasciitis and it is not treated properly, the symptoms may return.
Conservative treatments may not always work, which is why surgical methods are available. The most effective of these is fascia release, which resolves the problem once and for all. -
When can I start walking again?
Percutaneous surgery offers a major advantage: a much faster recovery. Unlike traditional surgery, the patient can walk again almost immediately after the procedure. We recommend wearing a padded bandage on your heel for the first two or three days to provide essential protection to the treated area. After that, patients can wear comfortable trainers, preferably with a padded insole in the heel, to cushion their step and aid recovery. As the swelling subsides, the patient will be able to gradually resume wearing any type of footwear, provided it does not cause discomfort.
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When can I get back to work?
The timeline for returning to work varies according to the physical demands of the patient’s job. In the case of sedentary work, such as office-based tasks, patients can usually return to work within 2 or 3 days of the procedure, provided they feel comfortable and ready to do so. However, for jobs involving physical exertion or constant movement, the recovery time may be slightly longer. In such cases, return-to-work timelines are assessed individually, though typically remain short due to the minimally invasive nature of percutaneous surgery.
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When can I resume sporting activities?
Return-to-sport timelines are determined by the patient’s healing progress and the impact level of their activities. Some patients may resume light activities, such as brisk walking, 15 days after the procedure. High-impact sports that involve demands such as running or jumping typically require a recovery period of three to four weeks before the patient can safely return.
Recovery is typically swift, though the timeline should be customised to suit the patient's personal healing rate.