«Heel spur» is a colloquial term that is misleading. The pain is not caused by the bone growth, but by damage to the plantar fascia — a powerful ligament connecting the heel to the toes of the foot.

The Spur Is Not the Cause of Pain

Radiographic «spur» (calcaneal osteophyte) is found in 50% of people with heel pain. But it is also present in 20% of people without any symptoms. The pain is caused not by the bone, but by chronic microtears and inflammation of the plantar fascia — plantar fasciitis.

What actually helps

  • Stretching the plantar fascia and calf muscles several times a day is the basis of treatment.
  • Footwear with a cushioned heel, insoles and a night splint reduce load on the fascia.
  • Shockwave therapy helps many patients with chronic pain (lasting more than 3–6 months); usually 3–5 sessions are needed.
  • A corticosteroid injection relieves pain quickly, but the effect is temporary, and repeated injections increase the risk of fascia rupture and thinning of the heel fat pad.
  • PRP injections gave a longer-lasting result than corticosteroid in some studies, but the evidence is mixed.
  • Surgery is rarely needed — for persistent pain when several months of proper treatment have not helped.

Why the pain lasts so long

The fascia heals slowly, especially with prolonged standing, running or stiff footwear. In most patients pain decreases markedly within 6–12 months of consistent treatment; more than 90% recover without surgery.

When to see a doctor

If heel pain lasts more than a few weeks, or there is numbness, swelling or pain after an injury, an examination is needed to rule out a stress fracture, nerve entrapment or inflammatory disease. More on the heel spur and plantar fasciitis pages.

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Who it is not suitable for and possible risks

Contraindications

  • Active infection — at the injection site or systemic, with fever.
  • Active cancer or ongoing chemotherapy.
  • Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
  • Pregnancy and breastfeeding — the procedure is usually postponed.
  • A corticosteroid injection into the same area in recent weeks.
  • A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.

Possible risks

  • Pain and swelling at the injection site for 1–3 days.
  • Bruising where blood or fat tissue is taken.
  • Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
  • The effect may be absent or smaller than expected.

If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.

Scientific evidence

Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:

  1. Monto RR. Platelet-rich plasma and plantar fasciitis. Sports Med Arthrosc Rev, 2013.
  2. Lou J et al. Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials. Am J Phys Med Rehabil, 2017.

Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised

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Frequently asked questions

What actually hurts with a heel spur?

Usually the inflamed plantar fascia (plantar fasciitis); the spur itself, a bony projection, is also found in people without pain. That is why the fascia, not the spur, is treated.

Does shockwave therapy help a heel spur?

Yes, for chronic pain lasting over 3 months shockwave therapy is part of the guidelines and helps some patients. The basis of treatment is stretching, insoles and less load.

How long does plantar fasciitis last?

In most people pain eases within 6–12 months of conservative treatment. Surgery is rarely needed — only if treatment has failed for about a year.

How does RegenPAS help organise treatment?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

How much does treatment cost and how long do I need to stay in Munich?

The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.