Heel Spur Treatment
Accurate diagnosis is everything with heel spurs. Most cause no pain at all — so if yours hurts, we find out exactly why and treat the real problem.
What Is a Heel Spur?
A heel spur (calcaneal spur) is a bony growth that forms on the underside or back of the heel bone. These calcium deposits develop gradually over months and years, usually in response to repetitive strain on the plantar fascia or Achilles tendon where they attach to the calcaneus.
Here's what most people don't realise: heel spurs are remarkably common in people with no pain at all. Research consistently shows that around 15–25% of the general population have plantar heel spurs visible on X-ray, yet the majority experience no symptoms whatsoever. This is a critical point, because it means that finding a heel spur on imaging doesn't automatically explain your pain.
There are two distinct types of heel spur, and the distinction matters for treatment:
Plantar heel spurs grow on the underside of the calcaneus, at the origin of the plantar fascia. These are the most common type and are frequently found alongside plantar fasciitis — though the relationship between the two is more complex than simply "the spur causes the pain." Current evidence suggests the spur is a consequence of chronic fascial strain rather than the primary pain generator.
Posterior heel spurs (also called dorsal calcaneal spurs or Haglund's deformity–associated spurs) develop at the back of the heel where the Achilles tendon inserts. These are associated with insertional Achilles tendinopathy and can cause pain when shoes press against the back of the heel.
Classic Symptoms
- Pain on the underside of the heel, particularly with first steps in the morning or after prolonged sitting
- A sharp, stabbing sensation that may ease with movement but returns after rest
- Tenderness when pressing on the centre or inner edge of the heel
- For posterior spurs, a visible bump at the back of the heel with pain from shoe pressure
- Pain that worsens with prolonged standing or walking on hard surfaces
Signs You Need Specialist Assessment
- Your heel pain has lasted longer than four weeks despite rest and over-the-counter treatment
- Pain is affecting your ability to work, exercise, or walk comfortably
- You notice swelling, warmth, or redness around the heel
- The pain came on suddenly after an injury
- You have diabetes, inflammatory arthritis, or peripheral neuropathy — conditions where heel pain can indicate different underlying pathology
Why the Spur Itself Usually Isn't the Problem
This is perhaps the most important thing we explain to patients: in the vast majority of cases, removing or treating the spur itself is unnecessary. The pain comes from the soft tissue pathology surrounding the spur — inflamed plantar fascia, degenerative tendon tissue, fat pad atrophy, or nerve entrapment.
A landmark systematic review by Johal & Milner (2012) found no consistent correlation between the size of a heel spur and the severity of symptoms. Equally, surgical removal of heel spurs alone (without addressing the underlying fasciopathy) has a high recurrence rate. This is why our approach focuses on identifying and treating the true pain source rather than fixating on what appears on an X-ray.
Getting the diagnosis right determines whether your treatment will actually work. Treating plantar fasciitis with a stretching and loading programme is highly effective. Treating a calcaneal stress fracture with stretching is potentially harmful. Treating Baxter's nerve entrapment with shockwave therapy alone is unlikely to resolve it. This is why we use diagnostic ultrasound as a core part of every heel pain assessment.
Conditions that commonly coexist with or mimic heel spurs:
- Plantar fasciitis — The most common association. Thickening and degeneration of the plantar fascia at its calcaneal attachment.
- Plantar fat pad atrophy — Particularly in patients over 50. Thinning of the protective fat pad under the heel.
- Baxter's nerve entrapment — The first branch of the lateral plantar nerve, causing medial heel pain that mimics plantar fasciitis.
- Stress fracture of the calcaneus — A rare but important differential diagnosis.
- Insertional Achilles tendinopathy — For posterior spurs, degeneration at the tendon-bone junction.
- Inflammatory enthesopathy — In conditions like psoriatic arthritis, reactive arthritis, or ankylosing spondylitis.
How We Diagnose Heel Spurs
Diagnostic Ultrasound Scanning
Every heel pain assessment at Lower Limb Clinic includes in-clinic diagnostic ultrasound. This allows us to visualise the plantar fascia, Achilles tendon, fat pad, and surrounding structures in real time — during your first appointment, not weeks later after a separate imaging referral.
Normal plantar fascia thickness measures approximately 3–4mm on ultrasound. In plantar fasciitis, the fascia typically thickens to 5mm or beyond, often with areas of hypoechoic (darker) degeneration visible within the tissue. We can also identify fascial tears, bursitis, fat pad changes, and assess blood flow using Power Doppler imaging — increased vascularity (neovascularisation) is a marker of active tissue pathology and helps guide treatment decisions.
Ultrasound also identifies conditions that X-rays miss entirely: early stress reactions in the calcaneus, soft tissue masses, plantar fibromatosis (Ledderhose disease), and retrocalcaneal bursitis behind the heel.
Pressure Plate Gait Analysis
We use in-floor pressure plate technology to map exactly how forces distribute through your feet during standing and walking. This reveals asymmetries and abnormal loading patterns that contribute to chronic heel pain — such as excessive medial heel loading, late-phase forefoot overload, or compensatory gait patterns you may not be aware of.
This data directly informs orthotic prescription. Rather than using a generic arch support, we design orthoses based on your actual force distribution, targeting the specific mechanical factors driving your symptoms.
Clinical Biomechanical Assessment
A detailed assessment of foot and ankle range of motion, lower limb alignment, muscle strength, and functional movement. We assess dorsiflexion range at the ankle (tightness in the calf complex is one of the strongest risk factors for plantar fasciopathy), rearfoot motion, midfoot stability, and hip and knee alignment. This gives us the full biomechanical picture — not just what's happening at the heel, but why.
Treatment Options
Our treatment approach is guided by diagnosis. What we recommend for plantar fasciitis with heel spur is different from what we recommend for fat pad atrophy, Baxter's neuropathy, or insertional Achilles tendinopathy.
Progressive Loading Programme
For plantar fasciopathy, the strongest evidence supports progressive loading — beginning with isometric calf raises, progressing through isotonic loading, and building toward functional demands. The Rathleff protocol (high-load strength training) has shown superior outcomes to traditional stretching alone.
Focused Shockwave Therapy (ESWT)
NICE-approved for recalcitrant heel pain. We typically deliver 3–6 sessions at weekly intervals. Shockwave promotes neovascularisation and tissue remodelling in degenerative fascia — essentially restarting the healing process in tissue stuck in a chronic degenerative cycle.
Custom Foot Orthoses
Designed using pressure plate data and 3D foot scanning, manufactured in-house via Réalta Labs using selective laser sintering (SLS) 3D printing. Incorporating targeted heel cushioning, calibrated arch support, and forefoot modifications based on gait analysis.
Corticosteroid Injection Therapy
For severe, acute plantar fasciopathy that hasn't responded to conservative measures. Performed under real-time ultrasound guidance. Injection creates a window for rehabilitation — we always combine it with a structured loading programme.
Heel Padding and Offloading
For fat pad atrophy (common in patients over 50), cushioning and offloading strategies are more appropriate than loading programmes. Silicone heel cups, viscoelastic cushioning in orthotics, and footwear modification can dramatically reduce symptoms.
Footwear Guidance
Specific, evidence-based footwear advice including heel-to-toe drop, sole stiffness, cushioning properties, and fit. For posterior heel spurs, shoe modification or heel-tab adjustment can eliminate the friction driving symptoms.
Common Causes and Risk Factors
Heel spurs develop in response to chronic mechanical stress. The bone remodels and deposits calcium at the point of maximum fascial or tendinous tension — a process that occurs over months to years.
Age & Body Composition
Age over 40 (fat pad naturally loses thickness and elasticity). High body mass index increases compressive load through the heel with every step.
Occupation & Activity
Prolonged standing or walking on hard surfaces. Rapid increases in training volume or intensity in runners and athletes.
Biomechanical Factors
Tight calf muscles (reduced ankle dorsiflexion below 10 degrees is strongly associated with plantar fasciopathy). Pes planus (flat feet) or pes cavus (high-arched feet) — both alter fascial loading patterns.
Systemic Conditions
Inflammatory conditions such as psoriatic arthritis, reactive arthritis, or ankylosing spondylitis can drive enthesopathic spur formation.
What to Expect at Your First Appointment
Detailed history
5 minDuration, aggravating factors, previous treatments, and impact on daily activities.
Clinical examination
5–10 minFoot, ankle, and lower limb examination including range of motion and muscle strength testing.
Diagnostic ultrasound
10 minScanning the plantar fascia, fat pad, and surrounding structures. Images shown to you in real time.
Pressure plate gait analysis
5 minForce distribution mapping during walking to identify biomechanical contributors.
Diagnosis & treatment plan
5 minClear explanation of your diagnosis with a personalised treatment plan, timelines, and expected outcomes.
Total appointment time: approximately 45–60 minutes. Most patients leave with a clear diagnosis and treatment already started — not a vague recommendation to "rest and see how it goes."
Recovery and Prognosis
The prognosis for heel spur–related pain is excellent with appropriate treatment. Around 90% of plantar fasciopathy resolves with conservative (non-surgical) management. The key factors that influence recovery time include how long you've had symptoms before seeking treatment, accuracy of diagnosis, compliance with loading programmes, and addressing underlying biomechanical factors through orthotics and footwear.
Typical timelines: acute plantar fasciitis with early intervention — 6–12 weeks. Chronic plantar fasciopathy (over 6 months) — 12–24 weeks. Fat pad atrophy — ongoing management. Insertional Achilles tendinopathy with posterior heel spurs — 12–24 weeks with progressive loading.
We monitor progress with repeat ultrasound scanning, tracking measurable changes in fascial thickness, echogenicity, and vascularity alongside your subjective pain scores. This means treatment decisions are based on objective tissue changes, not guesswork.
Your Clinicians
Paul McMullan BSc(Hons) MSc FRCPSGlasg MRCPod — Lead clinician with nearly 15 years of specialist experience in lower limb musculoskeletal conditions. Currently completing an MSc in Podiatric Sports Medicine at Queen Mary University of London. Fellow of the Royal College of Physicians and Surgeons of Glasgow. Experienced in diagnostic ultrasound, injection therapy, shockwave therapy, and biomechanical assessment.
Darren Costello BSc(Hons) MSc PGCert — MSc Sports and Exercise Medicine, postgraduate certificate from Brunel University in lower limb musculoskeletal assessment. Specialist interest in biomechanical analysis and orthotic therapy for chronic heel conditions.
Why Patients Choose Lower Limb Clinic
Diagnostic ultrasound in every heel pain assessment
No separate imaging referral needed.
Treatment guided by what we see on ultrasound
Not just what patients describe.
Custom orthoses manufactured in-house
Using 3D printing technology for precision fit.
Shockwave therapy available
For chronic cases that haven't responded to standard treatment.
MSc-qualified clinicians
With specialist training in musculoskeletal lower limb conditions.
HCPC registered, Royal College members
Fellowship of the Royal College of Physicians and Surgeons of Glasgow.
Frequently Asked Questions
Common questions about Heel Spurs at Lower Limb Clinic.
Find Your Nearest Clinic
Get Heel Spurs at our clinic, conveniently located in East Belfast
Lisburn Road Clinic
385 Lisburn Road, BT9 7EP
Ormeau Road Clinic
373 Ormeau Road, BT7 3GP
Newcastle Clinic
1 Shimna Road, BT33 0AS
We serve patients from across Belfast and Northern Ireland including East Belfast, South Belfast, Lisburn, Bangor, Holywood, Newtownards, Dundonald, Carryduff, Hillsborough, and Comber.
Get Expert Treatment
- Same-week appointments available
- No GP referral needed
- MSc-qualified specialists
Related Conditions
Find Your Nearest Clinic
Get Heel Spurs at our clinic, conveniently located in East Belfast
Lisburn Road Clinic
385 Lisburn Road, BT9 7EP
Ormeau Road Clinic
373 Ormeau Road, BT7 3GP
Newcastle Clinic
1 Shimna Road, BT33 0AS
We serve patients from across Belfast and Northern Ireland including East Belfast, South Belfast, Lisburn, Bangor, Holywood, Newtownards, Dundonald, Carryduff, Hillsborough, and Comber.