TLDR: Heel spurs are calcium deposits that form where the plantar fascia attaches to the heel bone. They affect roughly 15 percent of people. Most heel spurs cause no pain at all. When heel pain does happen, it is usually plantar fasciitis, not the spur, that is to blame. More than 90 percent of patients with plantar fasciitis get better within about 10 months using simple, nonsurgical care like stretching and supportive shoes.
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Heel spurs are one of the most misunderstood findings in orthopaedic medicine. In my practice, I see patients who are sure a heel spur on their x-ray explains their heel pain. Most of the time, the real cause is something else. After more than twenty years as a board certified orthopaedic surgeon, I have learned that heel spurs, plantar fasciitis, and heel pain confuse a lot of patients. This guide breaks down what a heel spur is, how it relates to plantar fasciitis, and what actually helps when heel pain will not go away.
What Is a Heel Spur?
A heel spur is a small calcium deposit on the underside of the heel bone. Doctors also call it a calcaneal spur, since the heel bone is called the calcaneus. It forms slowly, often over many months, from ongoing pull where the plantar fascia attaches to that bone.
On an x-ray, a heel spur can stick out by as much as half an inch. That may sound alarming, but most heel spurs cause no symptoms at all. Many patients only learn they have one when an x-ray is taken for a different reason.
Are Heel Spurs and Plantar Fasciitis the Same Thing?
No. Heel spurs and plantar fasciitis are related, but they are not the same condition. Plantar fasciitis is inflammation and small tears in the plantar fascia, a thick band of tissue on the bottom of the foot. A heel spur is a bone growth that can form later, as a reaction to that same ongoing stress.
What Is Plantar Fasciitis?
Plantar fasciitis happens when repeated strain damages the plantar fascia. The body responds with inflammation and pain. It is one of the most common causes of foot pain, and it usually feels like a sharp, stabbing pain with your first steps in the morning or after sitting for a while.
How Are Heel Spurs and Plantar Fasciitis Connected?
Heel spurs often form because of the same stress that causes plantar fasciitis. Over time, the body builds extra bone at that stress point. That extra bone becomes the spur. Plantar fasciitis usually comes first. The heel spur tends to follow as a side effect, not the main problem.
Do Heel Spurs Always Cause Pain?
No, most heel spurs never hurt at all. Many people have a heel spur on x-ray with zero heel pain. That tells us the spur itself is usually not the source of the problem.
Here is what I tell my patients: when heel pain shows up next to a spur, the pain almost always comes from the soft tissue around it, not the bone. That matters, because it changes how we treat you. Removing the spur rarely fixes plantar fasciitis pain, and surgery on the spur alone is rarely needed.
In a smaller number of cases, spur pain can come from something more specific. One example is pressure on a small nerve near the heel, called Baxter’s nerve. As we age, the natural fat pad under the heel also gets thinner. That can make an old spur feel more painful than it used to.
What Does Heel Spur Pain Feel Like?
Most patients describe a sharp, stabbing pain on the bottom of the heel with their first steps in the morning. The pain often eases after a few minutes of walking, then returns after long periods of standing or after a workout. Some patients describe it as a knife or pin sticking into the heel, which later settles into a dull ache. If your pain follows this pattern, plantar fasciitis is almost always the cause, whether or not a spur shows up on x-ray.
What Causes a Heel Spur to Form?
Heel spurs form from repeated strain on the tissues that attach to the heel bone. That strain can come from how you walk, the shoes you wear, or how much time you spend on your feet.
Common Risk Factors for Heel Spurs and Plantar Fasciitis
- Standing or walking a lot on hard floors, common for nurses, teachers, and factory workers
- High impact activity like running, dancing, or jumping sports
- Extra body weight, which adds load to the heel with every step
- Flat feet or high arches, both of which change how force moves through the foot
- Tight calf muscles, which pull harder on the plantar fascia
- Old or unsupportive shoes that do not cushion the heel well
- Age, since the plantar fascia stiffens and the heel fat pad thins over time
How Are Heel Spurs Diagnosed?
Diagnosis starts with a hands on exam. I check where it hurts, how your foot moves, and whether your pain pattern fits plantar fasciitis, a stress fracture, nerve irritation, or something else.
An x-ray can confirm a heel spur and rule out other bone problems, like a stress fracture. Since heel spurs do not cause plantar fasciitis pain, finding one on x-ray usually does not change the treatment plan. MRI or ultrasound is rarely needed. I reserve those for cases where the diagnosis is unclear or nerve involvement is suspected.
I also ask about occupation and daily habits during this visit. Jobs that involve long hours on your feet, especially on concrete or tile, are a common thread in patients with stubborn heel pain. Knowing that history helps guide which changes will make the biggest difference for you.
How Do You Treat a Heel Spur?
Treatment targets the plantar fascia and soft tissue, not the spur itself. The good news: most patients get much better without surgery.
Conservative, Nonsurgical Treatment Options
In my practice, I start almost every patient with the same basics:
- Stretching the calf and plantar fascia, best done first thing in the morning
- Supportive shoes with good arch support and cushioned soles
- Activity changes, cutting back on high impact exercise while healing
- Ice on the bottom of the heel for 15 to 20 minutes at a time
- Over the counter pain relievers, used short term and only as right for you
- Night splints, which keep the plantar fascia gently stretched while you sleep
- Orthotics or heel cups, which cushion the heel and support the arch all day
Most patients feel real relief within a few months of steady stretching and better shoes. If pain sticks around, physical therapy or a cortisone shot can help calm things down further.
When Is Surgery Considered for a Heel Spur?
Surgery is only for the small number of patients who do not improve after 9 to 12 months of real effort with nonsurgical care. The procedure usually releases the plantar fascia to ease tension. A large spur can be removed at the same time, but spur removal alone is rarely the goal.
Like any surgery, there are risks to weigh, including nerve irritation, a longer recovery, and in rare cases pain that does not fully go away. That is why surgery stays a last resort, not a first step.
When Should You See an Orthopaedic Surgeon for Heel Pain?
See a doctor if heel pain has lasted more than two to three weeks despite rest, stretching, and better shoes. Also get checked sooner if you notice numbness, tingling, swelling, or pain that started suddenly after an injury. Those signs point toward something other than plantar fasciitis.
An early, accurate diagnosis makes treatment work better and saves you months of guessing.
Key Takeaways on Heel Spurs and Plantar Fasciitis
- A heel spur is a calcium deposit on the heel bone. Most heel spurs never cause pain.
- Heel pain is usually caused by plantar fasciitis, not the spur itself.
- Risk factors overlap for both conditions: standing a lot, extra weight, tight calves, and worn out shoes.
- More than 90 percent of patients improve with simple, nonsurgical care.
- Surgery is reserved for the small number who do not improve after months of nonsurgical treatment.
This article is for general orthopaedic education. It is not a substitute for an in person exam. Every patient is different, so treatment should always be guided by your own orthopaedic surgeon or healthcare provider.
Ready to Get Your Heel Pain Evaluated?
If heel pain has lingered for more than a few weeks, an accurate diagnosis is the fastest path to relief. Schedule a visit with Dr. Calendine at the Bone and Joint Institute of Tennessee.
Bone and Joint Institute of Tennessee
3000 Edward Curd Lane, Franklin, TN 37067
Phone: (615) 791-2630
References (Held Pending Dr. Calendine’s Sign Off)
The statistics and clinical claims above come from peer reviewed and professional society sources. They are listed here pending Dr. Calendine’s review before this section is published.
- American Academy of Orthopaedic Surgeons, OrthoInfo: Plantar Fasciitis and Bone Spurs
- Cleveland Clinic: Heel Spurs
- WebMD: Heel Spurs and Plantar Fasciitis
- Sajja S, Elahi N, Ganti L. Plantar Fasciitis With a Calcaneal Spur. Cureus. 2023;15(12):e51242.
