No. Many people have a heel spur visible on an X-ray without experiencing any pain. Studies show that heel spurs are present in 85% of painful feet but also in 72% of pain-free feet. The pain is usually caused by plantar fasciitis (inflammation of the fascia) that accompanies the bone spur, not the bone spur itself. Therefore, treatment focuses on the fascia, not just the bone.

No, but they are closely related. Plantar fasciitis is the inflammation of the band of tissue (fascia) that runs from the heel to the toes. A heel spur is a bony growth that develops as a result of chronic tension on the heel bone caused by the fascia. Simply put: fasciitis is the inflammation; the spur is the bone that grows in response to that inflammation. Both are treated simultaneously.

The heel spur itself (the bony protrusion) does not go away without surgery. However, the important thing is that the pain can be completely eliminated without removing the spur. When the plantar fasciitis resolves (with orthotics, stretching, shockwave therapy), the pain subsides even though the spur remains visible on the X-ray. Surgical removal of the spur is only necessary when pain persists despite conservative treatment.

Being overweight is one of the most significant risk factors. Every additional kilogram of body weight increases the load on the heel during walking, which puts more strain on the plantar fascia and promotes the formation of a heel spur. Current clinical guidelines include weight loss as one of the fundamental measures in conservative treatment. A BMI greater than 30 is considered a significant risk factor.

In most cases, no. Approximately 90% of patients improve with conservative treatment (custom insoles, stretching, shockwave therapy). Surgery is reserved for cases that do not respond after 6–12 months of comprehensive conservative treatment. At Clínica San Román, we follow a stepwise protocol to exhaust all non-surgical options before considering surgery.

Yes, extracorporeal shock wave therapy (ESWT) has strong scientific evidence supporting its use in the treatment of chronic plantar fasciitis associated with heel spurs. Between 3 and 5 sessions (one per week) are administered, and studies show an efficacy rate of 65–80% in patients who have not responded to initial conservative treatment. Low-intensity therapy appears to be more effective and better tolerated than high-intensity therapy.

The procedure is performed under local anesthesia of the heel, so you will not feel any pain during the procedure. The postoperative period involves moderate discomfort for the first 5–7 days, which can be managed with oral pain medication (acetaminophen or ibuprofen). The vast majority of patients report that the postoperative pain is significantly less than the chronic pain they had been enduring for months.

Patients can begin walking in postoperative shoes immediately. They usually resume wearing regular shoes after 3 weeks. Sports activities are gradually resumed starting at 6–8 weeks. It is essential to supplement recovery with custom insoles and maintain stretching exercises over the long term to prevent recurrence.

Recurrence of heel spurs after percutaneous surgery is very rare. However, if the factors that caused the heel spur are not addressed (poor biomechanics, being overweight, improper footwear), the plantar fascia may become inflamed again. That is why at Clínica San Román we always include custom insoles and a stretching plan as an essential complement to surgical treatment.

It depends on the severity of the pain. During the acute phase, it is advisable to limit high-impact sports (running, tennis, basketball) and temporarily replace them with low-impact activities (swimming, cycling, elliptical training). With proper conservative treatment (orthotics + stretching), most athletes can resume their usual activities. After percutaneous surgery, a return to sports typically occurs within 6–8 weeks.