Medically Reviewed by
Dr. Peter Hanna, DPM
Board Certified Podiatrist
Heel pain sends more people to a podiatrist than almost any other foot complaint, and two conditions get blamed for it more than anything else: plantar fasciitis and heel spurs. Patients often use the terms as if they mean the same thing. They don’t.
Plantar fasciitis is a soft tissue problem. A heel spur is a bony growth. They tend to show up together, but one doesn’t always cause the other, and knowing which one is behind your pain changes how we treat it. Here’s how to tell them apart, and why the answer matters less than you might expect.
The plantar fascia is a thick band of tissue that runs along the bottom of your foot, connecting your heel bone to your toes. It works like a bowstring, holding up your arch and absorbing shock every time your foot hits the ground.
Plantar fasciitis happens when that band gets overused, overstretched, or strained beyond what it can handle. The tissue swells and irritates the surrounding area, and the result is a sharp or achy pain that tends to concentrate right at the bottom of the heel, where the fascia attaches to the heel bone. It’s the single most common cause of heel pain we see, and roughly one in ten people will deal with it at some point in their life.
We’ve covered the symptom pattern of plantar fasciitis in detail in a separate guide, so this article focuses specifically on how it compares to a heel spur. We also treat plantar fasciitis directly through our plantar fasciitis treatment program, which we’ll get to a bit further down.
A heel spur, also called a calcaneal spur, is a small bony growth that forms on the underside of the heel bone, right around the same spot where the plantar fascia attaches. Unlike plantar fasciitis, it isn’t inflammation or strained tissue. It’s actual new bone, and once it forms, it doesn’t go away on its own.
Heel spurs are common. Somewhere around 15 percent of people have one, whether they know it or not. Many never cause a single symptom, which surprises most patients the first time we mention it. If imaging confirms a spur is part of your case, our heel spur treatment approach still starts with the same conservative steps we use for plantar fasciitis, since that’s usually where the actual pain is coming from.
Here’s where the confusion usually starts. Heel spurs don’t typically cause plantar fasciitis. It tends to work the other way around, and even that relationship is more complicated than a simple cause and effect.
When the plantar fascia stays under repeated stress, the body sometimes responds by laying down extra bone at the point where the fascia pulls on the heel. Over months or years, that buildup becomes a spur. So a spur is often a sign that your plantar fascia has been under strain for a while, not necessarily the reason it hurts right now.
Researchers haven’t fully settled the question either. Some studies point to a spur forming from repeated traction, or pulling, at the fascia’s attachment point. Others suggest it’s more about vertical compression, the kind of stress that builds up from years of walking, standing, and carrying extra weight. Either way, the spur is usually a byproduct of stress on the foot, not the original source of your pain.
Most don’t. This is one of the more surprising facts about heel spurs, and it’s backed by imaging studies going back decades. A lot of people are walking around with a spur on an X-ray they’ll never know about because it has never once bothered them.
When a spur does produce pain, it tends to feel just like plantar fasciitis pain, sharp under the heel, worse with the first few steps of the day. That overlap is exactly why the two conditions get mixed up so often, and why symptoms alone usually can’t tell you which one you’re dealing with.
Plantar fasciitis pain has a fairly recognizable pattern. It’s often worst with your very first steps in the morning or after sitting for a while, eases up once you’ve walked for a few minutes, and then creeps back after you’ve been on your feet for hours or you stand back up after resting.
A painful heel spur mimics that same pattern almost exactly. There isn’t a reliable way to feel the difference between fascia pain and spur pain just by paying attention to how it feels. What sets them apart is what shows up on imaging, not what the pain feels like day to day.
That’s an important point for anyone trying to self diagnose using symptoms alone. If your heel hurts the way we just described, plantar fasciitis is still by far the more likely explanation, with or without a spur involved.
Both conditions center on the same general area, the bottom of the heel, sometimes extending a bit into the arch. Plantar fasciitis pain can also radiate slightly along the length of the fascia toward the ball of the foot, especially after a long day on your feet.
A heel spur, when it’s the source of discomfort, produces a more localized point of tenderness right at the spur itself. Pressing directly on that spot, rather than the broader arch, tends to reproduce the pain more precisely. It’s a subtle distinction, and one we typically confirm with a hands on exam rather than guesswork.
Plantar fasciitis usually develops gradually, from repeated stress rather than a single injury. Standing on your feet all day for work, playing high impact sports, or exercising on hard surfaces like concrete or tile all add up over time.
Footwear plays a bigger role than most people expect. Flip flops, worn out sneakers, and anything without real arch support let the fascia absorb more shock than it should. If you’re not sure whether your everyday shoes are helping or hurting, our guide on running shoes versus walking shoes breaks down what actually supports your foot during different activities.
Certain foot shapes make the fascia work harder too. Both flat feet and unusually high arches change how weight moves across your foot with every step, and that uneven load is a well documented risk factor.
Heel spurs share a lot of the same root causes as plantar fasciitis, since they often form as a response to the same ongoing stress. Extra body weight is one of the strongest links. Some studies have found that people with obesity are roughly five times more likely to have a calcaneal spur than people without it.
Age matters as well. The plantar fascia naturally loses some flexibility over the years, and the fat pad that cushions your heel thins out too, so older adults are more likely to develop a spur even without a major change in activity level. Flat feet also show a stronger connection to spur formation than high arches do.
A smaller number of cases connect to inflammatory conditions like gout, rheumatoid arthritis, or reactive arthritis, which is one more reason heel pain that doesn’t improve deserves a real evaluation rather than months of guessing.
Gender plays a role too, though the research is mixed. A few larger studies have found spurs slightly more common in women overall, while others have found no meaningful difference until after age 50, when footwear habits and hormonal changes may start to matter more.
A few groups show up again and again in our exam rooms. Runners and other athletes who ramp up mileage or intensity too quickly put repetitive strain directly on the fascia. People whose jobs keep them standing for most of the day, think retail, healthcare, teaching, and food service, face the same kind of cumulative load.
Most cases we see in adults land between ages 40 and 60, when the fascia has had decades to accumulate wear and the fat pad cushioning the heel has started to thin. Add in extra body weight or unsupportive footwear, and the risk climbs further.
Diagnosis starts with a conversation and a hands on exam. We ask when the pain is worst, whether it eases with walking, and what your daily activity and footwear look like. Then we press along the bottom of your foot to find the exact point of tenderness, which tells us a lot on its own.
An X-ray is the standard next step, mainly to rule out a stress fracture or arthritis and to check whether a spur is present. It’s worth repeating that finding a spur on the image doesn’t automatically mean it’s the source of your pain. We treat the whole picture, not just what shows up on film.
If your case doesn’t fit the usual pattern, we may look at other possibilities, like nerve entrapment or a tendon problem, before settling on a treatment plan. Our podiatry team works through that process with you rather than assuming the first diagnosis is the right one, and we treat the full range of foot and ankle conditions under one roof, including general foot pain that doesn’t fit a textbook description.
The vast majority of heel pain, whether it’s fasciitis, a spur, or both, responds to nonsurgical care. Rest matters more than people expect. Cutting back on the activity that aggravates your heel, even for a week, gives inflamed tissue a real chance to calm down.
Icing the bottom of your foot, supportive shoes or orthotic inserts, and a structured stretching routine for your calf and arch make up the core of most treatment plans. A physical therapist can guide you through stretches that target the fascia specifically, and night splints help address that stubborn first step pain by keeping the fascia gently stretched while you sleep.
Over the counter anti inflammatory medication can help in the short term, though it’s not meant for long term daily use without medical guidance. For most patients, a combination of these steps brings real relief within a few months.
When rest, stretching, and supportive footwear haven’t done enough after a few months, there are additional options worth discussing with your podiatrist. Corticosteroid injections can calm stubborn inflammation, though they’re generally used sparingly since repeated injections can weaken the fascia over time.
Extracorporeal shockwave therapy, which uses sound wave energy to stimulate healing in the tissue, is another option some patients try before considering surgery. Results in the research have been mixed, so we talk through realistic expectations before recommending it rather than presenting it as a guaranteed fix.
Surgery is genuinely rare. More than 90 percent of plantar fasciitis patients improve with nonsurgical treatment, so surgery is typically only considered after roughly a year of consistent conservative care without meaningful progress.
When it is needed, the two most common procedures are a partial release of the plantar fascia to relieve tension, or lengthening the calf muscle to reduce pressure on the fascia during walking. Removing a heel spur on its own is rarely done, since the spur usually isn’t what’s causing the pain in the first place.
If your heel has been bothering you and your appointment is still a few days out, a few general habits can make daily life more comfortable in the meantime. Swapping flip flops or bare feet at home for supportive shoes, even indoors, takes some strain off the fascia.
Rolling a frozen water bottle under your foot for a few minutes at a time can ease swelling, and giving high impact activity a short break helps prevent the irritation from building further before we see you. None of this replaces an actual diagnosis, but it can take the edge off in the short term.
Heel pain that sticks around for more than a week or two, especially if it’s changing how you walk, is worth having looked at rather than waiting out. The same goes for pain paired with swelling, redness, warmth, numbness, or fever, which can point to something beyond routine fasciitis or a spur.
Our podiatry team, including Dr. Peter Hanna, sees this exact combination of symptoms regularly and can usually tell within one visit whether you’re dealing with plantar fasciitis, a heel spur, or both. If you’re ready to get an answer instead of guessing, reach out to our team to schedule an evaluation.
Yes. Heel spurs are common enough that many people have one without ever developing plantar fasciitis or feeling any pain from it at all. The spur and the fascia condition are related but separate.
Almost never. Since most heel spurs don’t cause pain, and even the ones that do usually aren’t the true source of it, treatment focuses on the plantar fascia. Surgical spur removal is uncommon and typically only happens alongside a separate fascia procedure.
Most people see real improvement within a few months of consistent conservative care, though it can take longer depending on how long the fascia was irritated before treatment started. More than 90 percent of patients improve without surgery.
Flat feet change how weight distributes across your foot with every step, which raises your risk for both plantar fasciitis and heel spurs. High arches carry their own version of the same risk, just from a different mechanical pattern.
Not directly. X-rays are good at showing bone, so they can reveal a heel spur or rule out a fracture, but plantar fasciitis itself is a soft tissue condition that’s diagnosed mainly through a physical exam rather than imaging.
Resting the foot, icing the bottom of the heel, and switching to supportive shoes tend to bring the quickest relief while you wait for an evaluation. Stretching the calf and arch regularly helps too, though a proper diagnosis will guide the most effective long term plan.
Cleveland Clinic: Heel Spurs, Symptoms, Causes, and Treatment
Cleveland Clinic: Plantar Fasciitis
American Academy of Orthopaedic Surgeons, OrthoInfo: Plantar Fasciitis and Bone Spurs
National Library of Medicine, PMC: Calcaneal Spurs, A Potentially Debilitating Disorder
Dr. Peter Hanna is a board-certified podiatrist and reconstructive foot & ankle surgeon with over 15 years of experience. He serves as Director of Podiatry at South Florida Multispecialty Medical Group, specializing in complex reconstruction, minimally invasive surgery, and diabetic foot care.
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