This, in my opinion, is a very poorly treated condition and is a matter of general ignorance as to how to treat biomechanical issues. Injections, physical therapy, or even laser are items to help ease or evaluate the problem but is NOT the primary treatment. A combination of both biomechanical control along with treatment of pain complaints is in order. Fortunately, I have not had to do any surgery on patients over the last 20 years. However, treatment once outlined must be adhered to otherwise recurrence Is certain.
The spur, the picture to the right, looks painful, doesn't it? But the problem really is the soft tissue attachment and the spur is the bones response to constant pulling of the tissue/s on that area. You do not have to remove the spur to provide relief.
If you have been told the problem is due to weight, age, or shock absorption you are being sadly mislead.
For myself this is one in the same as heel spur. With the only difference is the Xray findings. But the issue of cause and effect remain the same as does the treatment. If someone is treating you currently with orthotics and no physical changes are occurring to the orthotic to effect the angles at which your foot moves on the ground it will be useless. Likewise if it is being treated with a soft device it will be useless. Now trust me I will be more than happy that such measures may have worked for you but there is no man made material that can absorb repetative shock and rebound to its original shape. The soft device just becomes a flexable compressed non controlling device.
So The key is addressing biomechanical concerns which unfortunately is an dead art form of medical treatment. This term is used as it is multiple factors that need to be addressed. Which does not mean the person can tolerate what the doctor maybe attempting to control. We handle and explain all these issues.
this can be in combination with the above problems and often times needs to be addressed by itself. Meaning you have been limping on your foot so long that you injure other areas and are essentially with resolving one set of complaints you find yourself feeling a secondary or even tertiary complaint. All of these complaints need to be peeled away layers at a time. This nerve injury can be on the inside or outside of the heel.