attachment points resulting in acute micro bleeding with secondary calcification and ossification of the soft tissue. Over time these prominences enlarge and can be appreciated on plain film radiographs and clinically with visible and palpable presentation when discussing those of the back of the heel. Commonly these spurs are can be managed conservatively without surgical intervention. Particularly bone spurs associated with the plantar fascia. In both cases, it is believed the pain generator is not the bone spur, but the acutely or chronically inflamed or degenerated connective tissue. Most cases of plantar fascia/heel spur pain resolve with good conservative care of appropriate footwear, arch support or heel cushion, program of stretching and judicious use of anti-inflammatory medication. When surgery is indicated, the bone spur is frequently not addressed and it is simply the plantar fascia that may be partially released or selectively debrided with ultrasound guidance. Posterior heel spurs are a little more challenging and may require removal if they become large enough to interfere with footwear and the counter of the shoe rubbing on the back of the heel. In both cases, anesthesia is frequently afforded with plantar fascia procedure requiring at a minimum local anesthetic to the area and potentially IV sedation. The posterior heel spur being more invasive frequently requires sedation with a regional block or general anesthetic.