Heel Spur Surgery: Everything You Need to Know

Heels spurs can form on both the bottom and back of the heel
Getty Images / Peter Dazeley

Heel spur surgery, also known as a calcaneal spur reduction, is a procedure used to remove painful outgrowths on the heel bone (calcaneus) when conservative therapies fail to provide relief. There are two approaches to the surgery, one that targets inferior spurs on the bottom of the heel and another than targets posterior spurs on the back of the heel.

Heel spur surgery can be highly effective in relieving the pain, inflammation, and swelling caused by heel spurs, but it may take up to three months to fully recover in some cases.

What Is Heel Spur Surgery?

Heel spur surgery describes two different procedures that can be performed as either open surgery (involving a scalpel and large incision) or endoscopic surgery (using "keyhole" incisions with a narrow scope and operating tools).

The surgery most commonly targets spurs that develop near the plantar fascia ligament on the bottom of the foot, but can also be used to remove spurs that develop near the Achilles tendon on the back of the foot.

Heel bone surgery is performed on an outpatient basis, allowing you to return home as soon as the surgery is complete. Depending on the aims of the surgery and other factors, the surgery may involve local, regional, or general anesthesia.

According to research, heel spur surgery is effective in around 69% of cases, with another 25% reporting a moderate improvement of symptoms.

Contraindications

There are few absolute contraindications to heel spur surgery. The surgery should be approached with caution in people with severe bleeding disorders, diabetics with peripheral artery disease, or individuals with a history of deep vein thrombosis (DVT). These relative contraindications need to be assessed on a case-by-case basis.

One absolute contraindication for heel spur surgery is the absence of symptoms. If a spur is accidentally found on an X-ray, it should not be removed just because it is there. Doing so not only exposes the individual to unneeded surgery but may cause serious and potentially permanent injury.

Potential Risks

As with all surgeries, there are risks associated with heel spur surgery, including the use of anesthesia. Common complications include:

  • Temporary or permanent heel pain
  • Temporary or permanent nerve injury (including foot numbness)
  • Acquired pes planus (fallen arches) and flat-footedness
  • Tendinitis (tendon inflammation)
  • Metatarsalgia (pain in the ball of the foot)
  • Foot cramps
  • Foot instability
  • Development of hammertoes or claw toes (due to the contraction of the plantar fascia ligament)
  • Heel fractures

Open vs. Endoscopic Surgery

Complications from heel spur surgery are more common with open surgery, occurring a 3.7-fold increased rate compared to endoscopic surgery. With that said, open surgery is better able to remove the entire spur compared to an endoscopic approach.

Purpose of Heel Spur Surgery

Contrary to what some people think, heel spur surgery is not used because a bone spur is large but rather because a spur is causing refractory (treatment-resistant) pain.

The size or shape of a spur has nothing to do with the incidence of symptoms. Large spurs can often cause no pain, while tiny ones can cause excruciating pain and the extreme loss of mobility. Moreover, in some cases, the pain is not associated with the spur but the condition that gave rise to the spur.

Heel spurs are essentially the abnormal accumulation of calcium, most commonly caused by repetitive foot strain. Repeated injury can lead to changes in the foot as scar tissue develops and calcium released from microfractures and bone degeneration begins to accumulate into bony outgrowths.

When needed, there are two distinct approaches to surgery that are differentiated by the underlying cause and location of a spur. Neither is inherently "better" than the other at improving symptoms, although recovery times tend to be shorter with endoscopic procedures.

Inferior Heel Spur Resection

Inferior heel spurs typically develop in the presence of plantar fasciitis (inflammation of the plantar fascia ligament) and are often referred to as plantar fasciitis bone spurs.

In many cases, the removal spurs will immediately follow plantar fasciotomy (also known as plantar fasciitis release surgery). Once the ligament is partially or fully severed ("released"), the surgeon will remove any large or suspect spurs.

Heel Spur or Ligament Inflammation?

It is important to note that heel spurs associated with plantar fasciitis do not point downward but rather forward towards the toes. So, the pain in the heel is usually not caused by the spur but rather by the persistent inflammation of the ligament at its attachment point at the heel.

Even so, spur removal is performed as a precautionary measure if there is any chance they are causing or contributing to the heel pain. 

Posterior Heel Spur Resection

A less common approach targets posterior heel spurs located near the Achilles tendon at the back of the foot. Posterior heel spurs, also referred to as Achilles bone spurs, generally develop at the point where the tendon attaches to the heel bone. In addition to the heel, it is not uncommon for spurs to develop in the tendon itself.

Because of this, the resection of spurs can become quite complicated. Simple spur on the bone are relatively easy to remove, but those imbedded deep in the Achilles tendon may require the detachment and reattachment of the tendon (referred to as an Achilles tendon repair).

Pre-Operative Evaluation

Heel spur surgery is generally considered a last resort if the pain fails to resolve with conservative treatments. The spurs are most easily detected on X-ray while standing. Even if spurs are identified, every effort should be made to ascertain whether the pain is the result of the spurs or an associated condition.

And, this can be difficult given that the presence of a spur, even a large one, doesn't necessarily mean that it is the cause of the pain. And, this is important to remember given that heel spur surgery is not only difficult to recover from but can cause more problems than it solves if not used appropriately. Insights from an experienced podiatric surgeon or foot and ankle orthopedist is essential to making the correct diagnosis.

Heel spur surgery is often considered when heel spurs are accompanied by severe plantar fasciitis or Achilles tendinitis (both of which may benefit from surgery).

On the other hand, there may be "clues" that cast into doubt the viability of heel spur surgery. One such example is bilateral heel pain, in which the pain in both heels may be the result of systemic diseases or infections rather than any spurs the doctor may find.

To this end, doctors will typically conduct a differential diagnosis to exclude other possible causes before heel spur surgery is recommended. These may include:

The American College of Foot and Ankle Surgeons (ACFAS) recommends heel spur surgery if symptoms fail to resolve with non-surgical treatments after 12 months.

How to Prepare

If heel spur surgery is recommended, you will meet with the surgeon to review the lab and imaging reports and discuss how the operation will be performed. You will also discuss pre-operative and post-operative procedures you need to follow to better ensure the intended result.

Do not hesitate to ask the surgeon why a particular surgery was chosen. While open surgery is associated with a greater risk of complications, there may be reasons why it is a better approach. Keep an open mind, and seek a second opinion if needed.

Location

Heel spur surgery is performed in the operating room of a hospital or specialty surgical center. The operating room will be equipped with standard surgical equipment, including an anesthesia machine, surgical table, an electrocardiogram (ECG) machine to monitor your heart rate, and a mechanical ventilator to deliver supplemental oxygen if needed.

For endoscopic surgery, there will also be a rigid fiberoptic scope called an endoscope that delivers live images to a video monitor. There will also be specialized surgical equipment that can access the foot through tiny incisions.

What to Wear

Depending on the extent and location of the surgery, your foot may be bandaged, placed in an ankle splint or walking boot, or covered with a cast. To accommodate for this, wear baggy shorts or loose-fitting yoga pants that slip easily over the foot. Skirts also work, or you can cut the side seam of an old pair of pants to widen the leg opening.

In addition to changing into a hospital gown, you will be asked to remove contacts, hairpieces, dentures, hearing aids, and tongue or lip piercings prior to the surgery. Leave any valuables at home, including jewelry and watches.

Food and Drink

You will be advised to stop eating at midnight the night before your procedure. On the morning of the surgery, you can take a few small sips of water (not coffee) to take your morning medications. Within four hours of surgery, you should not take food or liquid by mouth.

Medications

Your doctor will advise you to stop taking certain medications that promote bleeding and slow wound healing, including anticoagulants ("blood thinners") and nonsteroidal anti-inflammatory drugs (NSAIDs).

You may need to stop taking certain drugs for anywhere from one day to two weeks before surgery and to discontinue use for up to a week or two after surgery.

Among the drugs commonly avoided prior to surgery:

To avoid drug interactions and complications, always let your doctor know about any medications you are taking, whether they are prescription or over-the-counter.

What to Bring

You will need to bring your driver's license (or some other form of government ID), your insurance card, and an approved form of payment if copay or coinsurance costs are required upfront. (Be sure to call the office beforehand to confirm that they accept your insurance and are in-network providers.)

You will also need to bring someone with you to drive you home and to stay with you for a day or two to help you out and monitor for any adverse symptoms.

What to Expect on the Day of Surgery

Foot specialists called podiatrists can perform heel spur surgery, as can orthopedists (a.k.a. orthopedic surgeons) who have completed a fellowship in foot and joint surgery. Depending on the scope of the operation, the doctor may be accompanied by an anesthesiologist, operating nurse, endoscopic technician, and surgical scrub.

Before the Surgery

Upon your arrival at the hospital or surgical facility, you will register, fill out medical information sheets, and sign consent forms confirming that you understand the aim and risks of the surgery.

You are then led to the back to disrobe and change into a hospital gown. Once changed, a nurse will take your weight, height, vital signs, and a sample of blood to check your blood chemistry.

An intravenous (IV) line is then inserted into a vein in your arm to deliver medications and fluids. (Even if the procedure is performed under local anesthesia, an intravenous sedative is typically used to induce "twilight sleep.")

In addition, EGC leads are attached to your chest to monitor your heart rate, while a pulse oximeter is clamped to your finger to monitor your blood oxygen levels.

During the Surgery

Once you are prepped, you are wheeled into the operating room and administered the appropriate form of anesthesia.

  • If general anesthesia is used, the medications are delivered through the IV line to put you completely to sleep.
  • If regional anesthesia is used, the anesthetic may be injected in the spine (spinal epidural block) or a shallow bundle of nerves behind the knee called the popliteal fossa. An intravenous sedative, also known as monitor anesthesia care (MAC), typically accompanies the regional block.
  • If local anesthesia is used, it is delivered by injection in and around the surgical site. MAC is also commonly used.

For heel spur surgery, you are placed on the surgical table in either a supine (downward-face) or lateral decubitus (sideway-facing) position, depending on how the spurs are best approached.

The surgery is then performed as either an open or endoscopic procedure:

  • Open Reduction: For this procedure, an incision is made either along the bottom of the foot to access a plantar bone spur or down the back of the heel to access an Achilles bone spur. If plantar fasciotomy or Achilles tendon repair is needed, these are performed first. The heel spurs can then be cut away in a secondary procedure, flush to the bone.
  • Endoscopic Reduction: For this procedure, a tiny incision (usually around an inch) is made on the side of the heel to insert the endoscope. A second incision is made to insert a cutting instrument to reduce the spur. Because endoscopic surgery does not remove as much of the spur, it is generally reserved for combination surgeries in which heel spurs are involved.

After the spurs are removed, the incision is closed with sutures or adhesive strips, and the foot is bandaged. An ankle splint, walking boot, or a cast may be used to immobilize the foot and/or ankle if needed.

After the Surgery

After the surgery is complete, you are wheeled into recovery and monitored by a nurse until you awaken. This can take anywhere from 10 minutes for local anesthesia with IV sedation to 45 minutes for general anesthesia. Food and drink are usually provided when you are fully awake.

It is not uncommon to experience pain and discomfort around the surgical site. The doctor will prescribe the appropriate painkillers to take home with you and administer anti-nausea medication if you feel ill from the anesthesia.

Once your vital signs had normalized and you are steady enough to change into your clothes, you can be taken home by a friend or family member.

Recovery

When you arrive home from surgery, you need to relax for the rest of the day with your foot propped on pillows. Do not bathe or shower for the first day. If there is any pain, you can either take Tylenol (acetaminophen), or your doctor may prescribe a short course of an opioid painkiller like Vicodin (hydrocodone plus acetaminophen).

You will need to keep off your feet as much as possible for the first few days. To avoid placing any strain on the foot, your doctor may provide you with a pair of crutches or a hands-free knee crutch.

If there is any pain, bruising, or swelling, you can apply an ice pack to the affected area for no more than 15 minutes several times a day. Do not apply the ice directly to the skin or get the incision wet.

Until the wound is amply healed and the stitches removed, you will need to keep the foot dry. When showering, you can either cover the foot with a plastic bag (secured with a rubber band) or ask your doctor about watertight cast covers available at medical supply stores.

The wound dressing should be changed daily with sterile gauze and an alcohol-free topical antiseptic. Check daily for any abnormal changes in the wound or skin.

When to Call Your Doctor

Call your surgeon if you experience any of the following after undergoing heel spur surgery:

  • Increasing pain, redness, and swelling around the incision site
  • High fever (100.5 F) with chills
  • A yellowish-green ooze from the wound, often foul-smelling
  • Nausea and vomiting
  • Wound dehiscence (an opening incision)

Healing

After seven to 10 days, you will visit your surgeon to have the sutures removed and check on how your wound is healing. An X-ray or CT scan may also be ordered, especially if other procedures were performed.

Based on the findings, the doctor will have a better idea of your prognosis and the appropriate rehabilitation plan. If needed, you may be referred to a physical therapist to oversee the plan.

The duration of rehabilitation varies not only by the surgery used but by your general health and adherence to the treatment program. Broadly speaking, it takes around six weeks to recover plantar heel spur surgery and up to three months for Achilles heel spur surgery with tendon repair.

Most people with office-based jobs can return to work in two weeks with a walking boot or crutches. Those who work on their feet may need to wait for at least four weeks unless their doctor says otherwise.

Coping With Recovery

Your surgeon will want to see you again when it is time to have your cast removed or to step you down from crutches to a walking boot.

As you are gradually stepped down to walking shoes, physical therapy may again be needed to teach you how to walk correctly and how to stretch your arches to compensate for any tissue retraction.

During the recovery period, it is not unusual to feel pain and aggravation as you challenge muscles and tissues that have laid dormant for weeks. With persistence and adherence to your rehabilitation plan, you will recover. Support from family and friends also helps.

During follow-up appointments, your doctor will want to check for improvements in your symptoms. Not everyone who undergoes heel spur surgery experience the complete resolution of symptoms, but many do.

If you still have pain, inflammation, and swelling after rehabilitation, let your doctor know. In some cases, revision surgery may be needed. At other times, further investigations may be needed to explore other possible explanations for your symptoms.

A Word From Verywell

Surgery is a less common treatment for heel spurs but one that may be necessary if nothing else is able to relieve the pain and loss of mobility. Even so, heel spur surgery (like certain back or neck surgeries) is considered a last resort rather than a "quick fix."

Before seeking heel spur surgery, ask your doctor if all treatment options have been explored, including therapeutic ultrasound and extracorporeal shockwave therapy (ESWT). At the same time, ask yourself if you have been adherent to your doctor's treatment recommendations, including routine exercise, weight loss, and the consistent use of night splints and orthotics.

By committing to a holistic, non-surgical treatment plan, you may find that your heel spur symptoms resolve on their own. In fact, more than 90% of people with heel spurs experience spontaneous recovery without surgery.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Johansson KJ, Sarimo JJ, Lempainen LL, Laitala-Leinonen T, Orava SY. Calcific spurs at the insertion of the Achilles tendon: a clinical and histological study. Muscles Ligaments Tendons J. 2012;2(4):273-7.

  2. Meyr AJ, Mirmiran R, Naldo J, Sachs BD, Shibuya N. American College of Foot and Ankle Surgeons clinical consensus statement: Perioperative management. J Foot Ankle Surg. 2017;56(2):336-56. doi:10.1053/j.jfas.2016.10.016

  3. Apóstol-González S, Herrera J, Herrera I. Calcaneus fractures as a complication of the percutaneous treatment of plantar fasciitis. Case report. Acta Ortop Mex. 2014;28(2):134-6.

  4. Fallat LM, Cox JT, Chahal R, Morrison P, Kish J. A retrospective comparison of percutaneous plantar fasciotomy and open plantar fasciotomy with heel spur resectionJ Foot Ankle Surg. 2013;52(3):288-90. doi:10.1053/j.jfas.2012.10.005

  5. Monteagudo M, De albornoz PM, Gutierrez B, Tabuenca J, Álvarez I. Plantar fasciopathy: A current concepts review. EFORT Open Rev. 2018;3(8):485-93. doi:10.1302/2058-5241.3.170080

  6. Kirkpatrick J, Yassaie O, Mirjalili SA. The plantar calcaneal spur: A review of anatomy, histology, etiology and key associations. J Anat. 2017;230(6):743-51. doi:10.1111/joa.12607

  7. Toumi H, Davies R, Mazor M, et al. Changes in prevalence of calcaneal spurs in men & women: A random population from a trauma clinicBMC Musculoskelet Disord. 2014;15:87. 2014 Mar 15. doi:10.1186/1471-2474-15-87

  8. Wong SH, Chiu KY, Yan CH. Review article: Osteophytes. J Orthop Surg (Hong Kong). 2016;24(3):403-10. doi:10.1177/1602400327

  9. Elengard T, Karlsson J, Silbernagel KG. Aspects of treatment for posterior heel pain in young athletes. Open Access J Sports Med. 2010;1:223-32. doi:10.2147/OAJSM.S15413

  10. Yi TI, Lee GE, Seo IS, Huh WS, Yoon TH, Kim BR. Clinical characteristics of the causes of plantar heel pain. Ann Rehabil Med. 2011;35(4):507-13. doi:10.5535/arm.2011.35.4.507

  11. Davies G. Regional anaesthesia and antithrombotic drugs. Contin Educ Anaesth Crit Care Pain. 2012 Feb;12(1):11-6. doi:10.1093/bjaceaccp/mkr046

  12. Lui TH. Endoscopic calcaneoplasty and Achilles tendoscopy with the patient in supine position. Arthrosc Tech. 2016;5(6):e1475-9. doi:10.1016/j.eats.2016.08.027

  13. Nery C, Raduan F, Mansur N, Baunfeld D, Del Buono A, Maffulli N. Endoscopic approach for plantar fasciopathy: a long-term retrospective study. Int Orthop. 2013;37(6):1151-6. doi:10.1007/s00264-013-1847-z

  14. Lim S, Yeap E, Lim Y, Yazid M. Outcome of calcaneoplasty in insertional Achilles tendinopathy. Malays Orthop J. 2012;6(SupplA):28-34. doi:10.5704/MOJ.1211.007