Plantar fasciitis is often the real problem
Many plantar heel spurs are asymptomatic. The pain is often caused by tearing, thickening, inflammation, and scar tissue in the plantar fascia rather than the spur alone.
Heel pain can come from different problems: plantar fasciitis, a plantar heel spur, Achilles-related posterior heel spurs, or a painful bony prominence that rubs in shoes. The right treatment depends on which structure is actually causing the pain.
Every heel pain case starts with an exam and imaging review. A heel spur on an X-ray does not always mean the spur itself is the cause of pain.
Heel spur surgery is not one single procedure. Dr. Sullivan first identifies whether the pain is coming from chronic plantar fasciitis, a painful plantar heel spur, a posterior heel spur, Achilles-related irritation, or a pump bump that rubs in shoes. The goal is to choose the smallest appropriate procedure for the actual pain source, not simply remove something seen on an X-ray.
Many plantar heel spurs are asymptomatic. The pain is often caused by tearing, thickening, inflammation, and scar tissue in the plantar fascia rather than the spur alone.
A tight Achilles tendon can pull on the back of the heel and create a painful bony prominence. When the problem is mainly bony, a small-incision resection may avoid the long recovery of a traditional open Achilles procedure.
For plantar fasciitis, surgery is generally reserved for chronic symptoms that have lasted more than six months and have not responded to appropriate conservative care or injections.
The phrase “heel spur” can describe more than one condition. A plantar heel spur forms on the bottom of the heel near the plantar fascia. A posterior heel spur forms on the back of the heel near the Achilles tendon. A “pump bump” usually refers to a prominent bone on the back of the heel that rubs against shoes.
These are not all treated the same way. The goal is not simply to remove something seen on an X-ray. The goal is to identify what is painful and choose the smallest procedure that reasonably addresses that problem.
A plantar fascia release, or plantar fasciotomy, can be performed through a percutaneous tiny incision to lengthen the plantar fascia in the proximal part of the arch. This is generally reserved for patients with chronic plantar fasciitis that has lasted more than six months and has not responded to conservative therapies and injections.
When plantar fasciitis becomes chronic, there can be significant plantar scar tissue and thickening of the fascia. Releasing part of the fascia can relax the tension, reduce stress on the injured tissue, and allow that tissue to recover.
The procedure is performed through a very small incision while the area is numb.
Patients are typically allowed protected weight-bearing right away.
There is usually one stitch, commonly removed about one week after surgery.
Many chronic plantar fasciitis patients notice meaningful pain relief early in recovery.
A plantar fascia release can be very effective for the right patient, but it is not the first step for new heel pain. Because the plantar fascia is an important support structure, lengthening it carries risks and should be considered only after a careful evaluation.
Scar tissue is one of the more common expected issues after plantar fascia release. In Dr. Sullivan’s experience, it is usually temporary and better tolerated than the original plantar fascia pain, but it may linger for four to six months while the tissue remodels.
In some cases, the plantar fascia can create a bone spur on the plantar aspect of the calcaneus. If that spur has grown in a way that is truly painful, it can sometimes be shaved down through a tiny incision. Recovery is often very manageable when the problem is a focal painful spur rather than a more complex soft-tissue condition.
The more common heel spur procedure at The Bunion Cure is posterior heel spur resection. This is often related to Achilles tendon tightness pulling on the back of the calcaneus, creating a large bony prominence. In selected patients, Dr. Sullivan can remove the prominent bone through one or two small incisions without detaching and reattaching the Achilles tendon.
This smaller approach is best when the problem is primarily a bony prominence, such as a pump bump that rubs in shoes, and not severe long-standing Achilles tendon disease. If the Achilles tendon has significant calcification, chronic scar tissue, or years of tendon pain, an open procedure with tendon debridement or detachment and reattachment may be more appropriate.
The posterior heel spur procedure usually takes about 30 minutes in the operating room and uses one to two small incisions to remove the prominent bone. Patients are generally placed in a protected weight-bearing walking boot for about four weeks to protect the Achilles tendon area while it calms down.
Most patients tolerate this procedure very well. Many are eager to get out of the boot because the painful shoe-rubbing prominence has been removed, but the boot is still important protection during early healing.
If you have had Achilles tendonitis pain for many years, especially more than five years, or if imaging shows major Achilles calcification and long-term tendon scarring, a small-incision posterior spur resection may not be the right procedure. Those cases may require a more traditional open approach where the Achilles tendon is opened, inspected, debrided, and sometimes detached and reattached.
But if the prominence is mainly bone, you do not have severe Achilles tendon disease, and the problem is a painful bump on the back of the heel that rubs in shoes or high heels, a minimally invasive removal may offer a much easier recovery than the classic open approach.
No. Many plantar heel spurs are not the main pain source. Heel pain may come from plantar fasciitis, scar tissue, Achilles-related irritation, a posterior heel spur, or a painful bony prominence that rubs in shoes.
Plantar fascia release is generally reserved for chronic plantar fasciitis that has lasted more than six months and has not improved with appropriate conservative care or injections.
Many patients are allowed protected weight-bearing right away when the procedure and diagnosis make that appropriate, but the exact walking plan depends on whether the procedure involves the plantar fascia, posterior heel bone, Achilles tendon area, or a more complex open approach.
If there is significant Achilles tendon disease, calcification, chronic scar tissue, or years of tendon pain, a more traditional open procedure may be more appropriate than a small-incision posterior heel spur resection.
Call The Bunion Cure or schedule a consultation so Dr. Sullivan and the medical team can review your symptoms, exam, imaging, and goals.
Clinical content reviewed and approved by Dr. Jordan Sullivan on June 11, 2026.