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What is a heel spur?
Heel spur (plantar fasciitis) is a degenerative-inflammatory lesion of the plantar fascia at its attachment to the calcaneus. It is often accompanied by bone outgrowth (osteophyte) on the plantar surface of the calcaneus — the actual "spur."
This is the most common cause of heel pain — about 10% of the population experiences this problem during their lifetime. Peak incidence is 40-60 years. In runners, the frequency reaches 10-22%.
What actually hurts?
Contrary to popular belief, the pain is not caused by the "spur" (osteophyte) itself, but by degeneration and microtears of the plantar fascia. 15-25% of people with spurs have no symptoms on X-ray. The correct term is plantar fasciopathy.
Risk factors:
- Excess weight (BMI > 30)
- Prolonged standing (occupation)
- Flat feet or high foot arch
- Long-distance running
- Tight calf muscles and Achilles tendon
- Inappropriate footwear
Facts about heel spurs
- ICD-10: M77.3
- Prevalence: 10% of population
- Peak: 40-60 years
- In runners: 10-22%
- Chronicity: 10-20% without treatment
- Bilateral: up to 30% of cases
Symptoms of heel spurs
Typical presentation
- Sharp heel pain with first steps in the morning
- Pain "as if stepping on a nail"
- Pain decreases after walking around
- Pain worsens by evening
- Tender spot on the heel sole
Progression
- Pain with every step
- Limping, favoring the foot
- Pain at rest
- Overload of the healthy foot
- Secondary knee and low back pain
Chronic form
- Pain for more than 6 months
- Insoles and physical therapy do not help
- Multiple blockades without effect
- Inability to engage in sports
- Limitation of daily activities
Heel spur: treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Well studied, recommended |
| Braces, splints, insoles | Offload and stabilise, reduce pain under load | Moderate evidence |
| Shockwave therapy | A course of 3–5 sessions; helps some patients with chronic pain | Moderate evidence |
| Corticosteroid injection | Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable | Limited or conflicting evidence |
| PRP / CGF | Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown | Limited or conflicting evidence |
| Partial fascia release (rarely) | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In tendinopathies the basis of treatment is graded loading of the tendon: specific exercises over 3–6 months. Shockwave therapy helps some patients. Evidence on PRP is conflicting: there are studies showing benefit in tennis elbow and plantar fasciitis, but no convincing evidence for other tendons. Corticosteroids relieve pain quickly, but the effect is often short, and repeated injections into a tendon are undesirable.
When surgery is discussed. Surgery is discussed for a complete tendon rupture or if pain persists for more than 6–12 months despite proper treatment.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Good to know: diagnosis, self-help, outlook
Why the heel hurts if the “spur” is not to blame
A heel spur is a bony outgrowth seen on X-ray in many people, including those without pain. The pain is usually caused by the inflamed, overloaded plantar fascia that attaches next to it. That is why the fascia is treated, and the spur almost never needs to be removed. Tarsal tunnel syndrome (burning, numbness), a calcaneal stress fracture and Achilles tendon problems cause similar pain.
What you can do yourself
Stretch the plantar fascia and calf muscles several times a day, especially before the first steps in the morning. Wear well-cushioned shoes, use heel cups and avoid walking barefoot on hard floors. Temporarily reduce running and prolonged standing and lose weight if needed.
Outlook and timelines
In most people pain resolves within 6–12 months of conservative treatment, and many notice improvement after a few weeks of regular stretching. Shockwave therapy helps chronic pain. A corticosteroid injection relieves pain briefly and carries a risk of fascia rupture; surgery is rarely discussed.
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:
- Monto RR. Platelet-rich plasma and plantar fasciitis. Sports Med Arthrosc Rev, 2013.
- Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently asked questions about Heel Spur (Plantar Fasciitis) 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.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request