Overgrowth of the heel bone due to excessive stretching of the tendon or fascia, resulting in a heel spur. Bone spurs can cause pain at the base of the heel bone. Flat feet (abnormally flat arches and soles) and conditions that keep the Achilles tendon in a constricted state can cause excessive fascial tension, increasing the risk of heel spurs. Bone spurs often cause pain when they develop, especially when walking. Sometimes a bursa develops beneath the spur and becomes inflamed, a condition known as subacromial bursitis, which often produces throbbing pain in the presence of the spur, as well as in the absence of the spur. Sometimes the foot adapts to the spur so gradually that the pain is relieved when the spur grows. On the other hand, painless bone spurs can produce pain from minor injuries caused by sports and other factors. The diagnosis of a heel spur is usually easier to establish after a detailed physical examination. If a bone spur is present, pressure on the central part of the heel bone will produce pain. x-rays can help confirm the diagnosis but often fail to detect a new bone spur. Treatment is mainly to relieve the pain. A mixture of hormones and local anesthetics can be injected directly into the painful area. Elevating the arch with pads or wearing orthopedic shoes can stabilize the heel bone, reduce fascial strain and relieve pain. Most painful heel spurs do not require surgery. Surgery is required to remove the spur only if the pain persists and interferes with walking. However, the outcome of surgery is unpredictable. In some patients, pain persists after surgery.