Heel bone spurs, once formed, almost never shrink or vanish without intervention. The bony projection that shows up on an X-ray is real, permanent bone, and your body has no reliable mechanism for reabsorbing it. But here is the part that surprises most people: the spur itself is rarely the thing causing your pain. The symptoms associated with a heel spur frequently resolve on their own or with conservative treatment, even though the spur remains exactly where it was. Understanding that distinction changes nearly every decision you make about treating your heel.
Why Heel Spurs Form in the First Place
A calcaneal spur is a small shelf or point of extra bone that grows on the underside of the heel bone (calcaneus), typically at or near the spot where the plantar fascia attaches. For decades, the leading explanation was straightforward: repetitive tugging by the plantar fascia or the small muscles of the foot’s sole irritates the bone surface, which responds by laying down new bone. This “traction theory” made intuitive sense and is still widely cited.
More recently, some researchers proposed an alternative: the spur may actually be the bone’s response to vertical compression rather than horizontal pulling. When you stand and walk, your heel absorbs a large share of your body weight. Under Wolff’s law, bone adapts its structure in response to the loads placed on it. Proponents of this “compression theory” pointed to the vertical alignment of tiny internal struts (trabeculae) inside some spurs as evidence that the force pushing the spur into being came from the ground up, not from the fascia pulling forward.1PubMed Central. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations – Section: Etiology of PCS
A closer look has muddied the picture. A histological study examining both plantar and posterior heel spurs found that the internal struts actually follow a complex pattern with no single predictable orientation, meaning the neat “vertical struts prove vertical force” argument does not hold up well. What the researchers did consistently find, though, was that every spur contained an enthesis of the plantar fascia and pointed in the direction of that tissue, suggesting the fascia does load the spur whenever it is strained during walking or standing.2Scientific Reports. Why heel spurs are traction spurs after all In short, the spur probably forms through a mix of pulling and compressive forces, but either way it represents your skeleton’s attempt to reinforce a stressed area. Once the bone is deposited, it behaves like any other piece of bone: it stays put unless something actively removes it.
The Spur Itself Is Rarely What Hurts
This is the single most important thing to understand about heel spurs, and the reason the question “will it go away?” is slightly misframed. In a large study comparing feet with heel pain to painless feet, spurs were found in about 85% of painful feet but also in roughly 72% of painless feet.3Turkish Journal of Medical Sciences. Do the presence, size, and shape of plantar calcaneal spurs have any significance in terms of pain and treatment outcomes in patients with plantar fasciitis? That means a huge number of people walk around with heel spurs and never feel a thing. If the spur itself were the source of agony, those painless-but-spur-bearing feet would be hard to explain.
Pain in the heel area is more commonly driven by the inflamed plantar fascia, by irritation of the fat pad, or occasionally by nerve entrapment near the heel. The spur is often a bystander, a radiographic souvenir of chronic stress that has been there for years. A separate study examining spur shape and size in patients with plantar fasciitis found that before treatment, neither the spur’s shape nor its size correlated with how bad the symptoms were.4PubMed. Relationship and Classification of Plantar Heel Spurs in Patients With Plantar Fasciitis A small spur can accompany terrible pain, and a large one can accompany none at all.
That said, researchers have identified two distinct types of calcaneal spurs using MRI. Type A spurs sit above the plantar fascia insertion, while Type B spurs grow within the fascia itself. Type B spurs were associated with more severe grades of plantar fasciitis before surgery, suggesting that the spur’s location relative to the soft tissue matters more than its raw size.5PubMed. Classification of Calcaneal Spurs and Their Relationship With Plantar Fasciitis So while the spur is not the main pain generator in most cases, where it sits can influence how much it aggravates the surrounding structures.
Can the Pain Go Away Even Though the Spur Stays?
Yes, and this happens routinely. Most people diagnosed with heel spur-related pain recover with time and conservative measures, yet follow-up X-rays typically show the spur unchanged. The clinical reality is that you are treating the inflammation and mechanical dysfunction around the spur, not the spur itself. When the fascia calms down, when the fat pad recovers, when the nerve irritation settles, the pain fades, and the spur becomes irrelevant.
One of the most striking demonstrations of this comes from research on extracorporeal shockwave therapy (ESWT). In a study of over a hundred patients, shockwave treatment produced excellent pain relief in about two-thirds of cases, with another 16% getting at least a 50% reduction in pain. Yet when post-treatment X-rays were compared to pre-treatment images, no patient had a significant reduction in spur size. A small number showed minor changes in the spur’s angle or dimensions, and one patient’s spur actually fractured, but those radiographic changes did not correlate with who felt better and who did not.6PubMed. Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes The pain resolved; the spur did not.
A different shockwave study, focused specifically on overweight and obese patients, did report a measurable decrease in spur length alongside pain improvement after treatment.7PubMed. Extracorporeal shock-wave therapy effectively reduces calcaneal spur length and spur-related pain in overweight and obese patients Whether this reflected true bone resorption or measurement variability is debated, and it is the exception rather than the rule in the literature. The general pattern holds: pain improvement and spur disappearance are separate phenomena, and it is overwhelmingly the former that happens.
Conservative Treatments That Help
Because the goal is resolving pain rather than erasing the spur, the treatment toolbox is surprisingly low-tech. A review of randomized controlled trials on plantar fasciitis treatments recommended starting with inexpensive, patient-centered approaches: stretching, over-the-counter orthotic insoles, and patient education about the condition’s natural course.8PubMed Central. Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials Night splints, which hold the foot in a slightly stretched position while you sleep, have also been studied, though results are mixed across trials.
Footwear matters more than many people expect. A randomized controlled trial tested both customized insoles and minimalist flexible shoes in women with calcaneal spurs and found that both approaches significantly reduced pain after six months, improved function scores, and increased walking distance.9PubMed Central. Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial The mechanism in both cases was probably a combination of redistributing pressure under the heel and reducing excessive foot pronation. Foot pronation decreased in both groups over the study period, which takes load off the plantar fascia insertion where the spur lives.
The practical message is that many people will recover within several months by consistently stretching their calves and plantar fascia, wearing supportive shoes or insoles, and avoiding activities that hammer the heel. The spur will still be there on an X-ray years later, but if it isn’t causing symptoms, that becomes a curiosity rather than a problem.
Corticosteroid Injections and Their Limits
Steroid injections into the heel are a common escalation when stretching and insoles aren’t enough. A review of placebo-controlled trials found that corticosteroid injections consistently reduce pain compared to placebo, sometimes outperforming other treatment options. The catch is that the relief tends to be short-lived, typically lasting four to twelve weeks, and the injections carry a small risk of plantar fascia rupture.10PubMed Central. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis
A more recent comparison of corticosteroid injections against standard conservative treatment found no statistically significant difference in favorable outcomes between the two groups. About 41% of patients who received injections had good results, compared to roughly 31% of those who got conservative care alone.11PubMed Central. Comparison of corticosteroid injections and conservative treatments for heel spurs The gap was not large enough to reach significance, which suggests that injections may buy time and comfort but are not dramatically superior to consistent conservative management. They make the most sense as a bridge: easing pain enough to let you do the stretching and rehab that produces longer-lasting improvement.
When Surgery Enters the Picture
Surgery for heel spurs is genuinely rare and reserved for people who have tried everything else for many months without improvement. The most common procedure is a partial release of the plantar fascia, sometimes combined with excision (physical removal) of the spur. You might assume that cutting out the spur would be the whole point of surgery, but the evidence suggests otherwise.
A study comparing outcomes in patients who had plantar fascia surgery with spur excision versus fascia surgery without spur excision found something counterintuitive: removing the spur was associated with a significant delay in symptom resolution and a longer time before patients could bear weight in shoes. Complication rates and the need for follow-up treatment were similar between the two groups.12PubMed. The effect of plantar calcaneal spur excision on plantar fascia surgery outcomes In other words, adding spur removal to the surgery made recovery slower without making the outcome better. This reinforces the broader theme: the spur is mostly an innocent bystander, and aggressively targeting it may create more disruption in the heel than it solves.
Surgeons today generally focus on releasing tension in the fascia and decompressing any entrapped nerves rather than chiseling out the spur. When a spur is removed, it is usually because it is in a position where it mechanically interferes with the surgical approach or clearly irritates a nerve.
Risk Factors That Keep Spurs Growing
If you already have a heel spur, you cannot will it away, but you can address the conditions that encouraged it to form. Research on patients with type 2 diabetes found that those who also had calcaneal spurs had significantly higher rates of peripheral neuropathy, were older on average, and had higher body mass index compared to diabetic patients without spurs.13Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi. Increased Calcaneal Spur Frequency in Patients with Obesity and Type-2 Diabetes Mellitus Each of those risk factors has a plausible mechanical pathway: extra body weight increases the compressive and tensile load on the calcaneus with every step, neuropathy may alter gait patterns and foot mechanics in ways that concentrate stress, and aging reduces the shock-absorbing capacity of the heel’s fat pad.
Occupations that involve prolonged standing on hard surfaces, running and jumping sports, and flat or unsupportive footwear are also commonly implicated. None of these guarantees a spur, but they all push the heel toward the kind of repetitive overload that triggers the bone-forming response described earlier. Managing your weight, wearing appropriate shoes, and treating underlying metabolic conditions won’t dissolve an existing spur, but they can reduce the chronic irritation of the surrounding tissues and lower the chance that the spur keeps growing or that new ones form.
Imaging and What It Actually Tells You
If you are diagnosed with a heel spur, chances are it showed up on a plain X-ray. X-rays are cheap and widely available, and they do a fine job of revealing bony outgrowths. What they cannot do well is assess the soft tissue that is almost certainly the actual source of your pain. Ultrasound and MRI are far better at evaluating the plantar fascia itself and are considered first- and second-line imaging tools for plantar fascia disorders, respectively.14PubMed Central. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging
This matters because an X-ray that shows a spur can give you (and sometimes your doctor) the false impression that the spur is the diagnosis. In reality, the spur is a finding, not necessarily a diagnosis. The clinical question should be: what is inflamed, thickened, or entrapped around the spur? Answering that usually requires ultrasound or MRI, which can show fascia thickening, edema in the fat pad, fluid collections, or partial tears. If your pain is not responding to initial treatment, pushing for soft-tissue imaging can change the management plan in ways that an X-ray alone never would.
Systemic Conditions That Mimic or Worsen the Problem
Not all heel spurs are the product of simple mechanical overuse. Inflammatory conditions in the spondyloarthritis family, which includes ankylosing spondylitis and psoriatic arthritis, are characterized by disproportionate inflammation at entheses, the exact spots where tendons and ligaments anchor to bone.15JAMA Internal Medicine. Spondyloarthritis and Enthesopathy: Current Concepts in Rheumatology The plantar fascia’s attachment to the calcaneus is a classic enthesis site. In someone with an underlying inflammatory disease, a heel spur may represent an enthesophyte driven by systemic inflammation rather than local mechanical stress alone.
This distinction matters for treatment. If the spur and surrounding pain are part of a systemic inflammatory process, stretching and insoles will have limited benefit. Disease-modifying medications targeting the underlying inflammatory condition become the priority. If you have bilateral heel pain, morning stiffness lasting more than 30 minutes, pain that worsens with rest rather than activity, or a family history of inflammatory arthritis, it is worth raising these with your doctor rather than assuming you simply have garden-variety plantar fasciitis.
How Heel Pain Alters the Way You Walk
Even while the spur itself sits quietly in the bone, the pain it is associated with can create a cascade of secondary problems through altered gait. A systematic review of walking patterns in people with plantar heel pain found moderate to strong evidence of decreased loading under the heel during the initial ground-strike phase, exactly what you would expect from someone unconsciously protecting a painful heel. To compensate, these individuals shifted weight toward the midfoot and forefoot, spending more time loading those areas and generating higher forces there.16PubMed. Gait deviations associated with plantar heel pain: A systematic review
Over weeks and months, this compensation pattern can overwork structures that were never designed to absorb heel-level forces. Midfoot pain, metatarsal stress reactions, Achilles tendon strain, and even knee or hip discomfort can follow. Some people develop an awkward limp that loads the opposite leg unevenly, setting off problems on that side too. Treating heel spur-related pain early and consistently is not just about the heel: it is about preventing a chain of compensatory injuries that can become their own chronic issue. Returning to a normal heel-strike gait pattern as quickly as possible, through a combination of pain management, stretching, and appropriate footwear, short-circuits that cascade before it takes hold.