Heel Spur

A heel spur is a small, bony outgrowth made of calcium deposits that develops on the underside or the back of the heel bone (the calcaneus). It usually builds up slowly in response to repeated strain on the foot's ligaments and the plantar fascia, and in many people it causes no symptoms at all — it is often discovered by chance on an X-ray taken for some other reason. One key point is frequently misunderstood: a heel spur and plantar fasciitis are not the same thing. In most cases the source of heel pain is not the spur itself but the surrounding soft tissue. For this reason, treatment relies largely on non-surgical methods and physiotherapy rather than on removing the spur. ^[1][3]

What is a heel spur?

A heel spur, known medically as a calcaneal spur, is a bony projection that extends out from the surface of the heel bone. Cleveland Clinic describes a heel spur as a bony growth that pokes out below the back of the heel bone toward the inside of the foot, and notes that it develops because of stress placed on the foot's ligaments. This projection is in fact a type of bone spur (an osteophyte): it is the foot's example of the body's bone-building response to an area that has been strained for a long time. ^[1][2]

Heel spurs can appear in two main locations, and this distinction matters for understanding the anatomy of the problem. The first is the inferior (plantar) heel spur, which develops on the underside of the heel near where the plantar fascia attaches to the heel bone; this type is usually discussed alongside long-standing plantar fasciitis. The second is the posterior heel spur, which develops at the back of the heel where the Achilles tendon attaches to the bone. Inferior spurs can sit within or just above the plantar fascia, whereas spurs at the Achilles insertion typically form within the fibers of the tendon. The pain pattern and management of these two types can differ to some extent. ^[3]

The most important concept to grasp here is the difference between a bone spur and soft-tissue inflammation. A heel spur is a bony structure — a tangible projection made of calcium that can be seen on an X-ray. Plantar fasciitis, by contrast, is a soft-tissue problem — a painful condition of the plantar fascia, the thick band of tissue running from the heel to the toes, caused by strain and irritation. A heel spur often arises as a consequence of long-standing plantar fasciitis; in other words, the spur is usually not the primary cause of the pain but a sign of the underlying chronic strain. Keeping this distinction clear explains why treatment focuses on relieving the soft tissue rather than on "removing the spur." ^[1][3]

What are the symptoms?

Many people with a heel spur have no symptoms whatsoever. Cleveland Clinic stresses that most people do not realize they have a heel spur until they seek help for heel pain, and that the spur develops quietly over time. Therefore, seeing a heel spur on an X-ray does not necessarily mean it is the cause of the pain — a common point of confusion in clinical practice. ^[1]

When symptoms do occur, the most common complaint is heel pain. With inferior heel spurs, the pain is usually felt on the bottom of the heel, in the area where weight is placed while standing. Many people describe a sharp, stabbing pain with the very first steps after getting out of bed in the morning; this pain may ease after a few steps but can return later in the day when standing up after sitting for a while. This "first-step pain" pattern is actually typical of plantar fasciitis and illustrates why heel spurs and plantar fasciitis are so closely intertwined. Standing for long periods, walking, or moving on hard surfaces can all aggravate the complaint. ^[1][5]

With posterior heel spurs, the pain may be more noticeable at the back of the heel, in the area where footwear meets the heel; these people often report discomfort in shoes with stiff heel counters and sometimes mild swelling. In general, symptoms that may be associated with a heel spur include:

• ·Pain under or behind the heel that appears with pressure
• ·Heel pain that sharpens with the first morning steps or after long rest
• ·Discomfort that increases with prolonged standing during the day
• ·Tenderness when the heel is touched
• ·A sensation of warmth or mild swelling in the heel area in some people

The severity of symptoms is not always proportional to the size of the spur. A large spur may cause no pain at all, while a barely visible growth on imaging may accompany significant symptoms — because the real determinant is the level of strain in the surrounding soft tissue. ^[1][3]

Causes and risk factors

A heel spur develops in response to long-term, repeated strain on the tissues that attach to the heel bone. According to Cleveland Clinic, heel spurs occur when there is stress on the foot's ligaments; the body responds to this continuous pulling and tension with gradual calcium deposition in the strained area, and over time a bony projection forms. In inferior heel spurs, this strain usually concentrates where the plantar fascia attaches to the heel bone; in posterior heel spurs, the attachment of the Achilles tendon comes to the fore. ^[1][3]

Several risk factors make this process more likely. Chief among them is a history of plantar fasciitis or long-standing heel pain, because the spur is often a consequence of this chronic strain. Mayo Clinic lists, among the factors that increase the load on the heel, excess weight, occupations that keep you on your feet all day, and foot structure differences such as flat feet or high arches. In addition, older age, tightness in the calf muscles and Achilles tendon, running and jumping on hard surfaces, and the use of worn-out or poorly supportive footwear can all raise the risk. ^[1][5]

Aging and joint wear also play a role in the development of bone spurs. The osteophyte family, of which the heel spur is a member, is most commonly associated with osteoarthritis; calcaneal spurs become more frequent with age and are found at higher rates particularly in people with a history of heel pain or with osteoarthritis. According to studies compiled in StatPearls, a heel spur may be present in roughly half of people with plantar fasciitis; even so, the presence of a spur alone does not explain the pain. These data support viewing a heel spur not as an isolated disease but as an indicator of chronic mechanical load on the foot and of age-related changes. ^[2][4]

How is it diagnosed?

Imaging is the key tool in diagnosing a heel spur, because — as a bony structure — the spur can only be confirmed with imaging. The clinician first takes a detailed history and performs a physical examination: the exact location of the pain, whether it worsens with the first morning steps, which activities trigger it, and where the tenderness in the heel is concentrated are all assessed. This evaluation helps determine whether the pain comes from under the heel or from behind it, and which soft tissue is being strained. ^[1][3]

The most common method for demonstrating the spur itself is an X-ray (radiograph). Bone spurs are clearly visible on X-ray and are often detected incidentally on a film taken for another reason. On a lateral (side) view of the heel, an inferior heel spur can be seen on the underside of the heel bone, and a posterior heel spur at the Achilles attachment region. Cleveland Clinic notes that bone spurs typically show up on imaging and are sometimes a surprise finding on an X-ray taken for a different complaint. ^[1][2]

There is a critical diagnostic distinction here: an X-ray shows the spur, but it does not by itself prove the source of the pain. OrthoInfo (AAOS) explicitly stresses that although many people with plantar fasciitis have a heel spur, spurs are not the cause of plantar fasciitis pain, and the pain can be treated without removing the spur. For this reason, the clinician interprets imaging together with examination findings. In some cases — particularly to look more closely at the soft tissue (the plantar fascia, the Achilles tendon) or to rule out other diagnoses — ultrasound or magnetic resonance imaging (MRI) may be ordered. During diagnosis it is also important to distinguish other causes of heel pain such as Achilles tendinitis, heel fat pad syndrome, stress fracture, and nerve entrapment. ^[3][4]

Treatment options

The guiding principle in treating a heel spur is to prioritize non-surgical (conservative) methods. Cleveland Clinic notes that heel spurs "can't be cured" — that is, the projection itself is not expected to disappear on its own — but that healthcare providers recommend non-surgical treatments to ease the associated symptoms. Although a spur can be removed surgically, this is generally not the first choice, because the real source of the pain is usually not the spur itself but the surrounding soft tissue, and that tissue can be relieved with non-surgical methods. ^[1][3]

The main components of conservative treatment usually include:

• ·Load and activity modification: temporarily reducing activities that clearly increase the pain, such as prolonged standing and running or jumping on hard surfaces. NHS recommends adjusting activity and resting the painful area.
• ·Cold application: applying a cold pack wrapped in a towel to the heel can temporarily reduce pain and discomfort. NHS describes applying an ice pack wrapped in a towel to the painful area for up to 20 minutes.
• ·Suitable footwear and heel support: shoes that cushion the heel and provide good arch support, and where needed a heel pad or insole, can help distribute the load on the heel. Mayo Clinic points to the importance of adequate arch support.
• ·Stretching and exercise: stretching and strengthening exercises targeting the calf muscles, the Achilles tendon, and the plantar fascia are among the strongest components of non-surgical treatment.
• ·Pain management: NHS notes that simple painkillers such as paracetamol may help, while anti-inflammatory medicines should be used on the advice of a doctor or pharmacist because of their possible side effects.

^[1][5][6]

If these steps are not enough, additional options may be considered. Night splints (a support that holds the heel and calf gently stretched overnight, aiming to reduce morning stiffness), custom insoles, and taping are among the approaches that can be added in more stubborn cases. In more recalcitrant cases, a clinician may consider options such as a corticosteroid injection or extracorporeal shockwave therapy (ESWT), which uses high-energy sound waves; NHS likewise notes that steroid injections or shockwave therapy may be offered when exercises and other treatments are not enough. Whether such interventions are appropriate, their balance of benefit and risk, and their dosing must always be decided by a healthcare professional; this content is not a substitute for individual treatment advice. ^[5][6][7]

Surgery (removal of the spur) comes into consideration only in selected cases that have not responded to long-term non-surgical treatment. Mayo Clinic notes that surgical treatment is not often recommended for plantar-fasciitis-related heel problems and is reserved for people who do not respond to conservative treatment. For this reason, most of the treatment journey proceeds with a conservative approach and physiotherapy. ^[5]

How can physiotherapy help?

Physiotherapy plays a central role in the non-surgical management of heel-spur-related pain, because the real goal is not to "destroy" the spur but to reduce the strain on the heel bone and improve the load tolerance of the surrounding soft tissue. OrthoInfo notes that doctors may suggest working with a physical therapist on an exercise program focused on stretching the calf muscles and the plantar fascia, and that a physiotherapy program may also include specialized treatments to reduce inflammation around the plantar fascia. Restoring flexibility in the calf muscle, the Achilles tendon, and the plantar fascia is one of the critical steps in relieving heel pain and keeping symptoms from coming back. ^[3]

The 2023 clinical practice guideline for plantar heel pain (JOSPT) supports, with strong evidence, the use of plantar-fascia-specific stretching together with calf (gastrocnemius/soleus) stretching to reduce pain and improve function in both the short and long term. A physiotherapist combines stretching and strengthening exercises, manual therapy techniques, load management and activity planning, and — where appropriate — taping and orthotic advice, according to the individual's situation. The type of exercise, its intensity, and the rate of progression should be individually adjusted to the level of pain, the foot structure, and the person's daily needs. Rather than performing random exercises found online, a professional assessment is both safer and more effective. ^[3][7]

At FizyoArt, we carry out assessment and exercise programs for heel pain and heel-spur-related complaints hands-on, in the home. For orthopedic foot and heel problems, we build an individualized stretching, strengthening, and load-management plan within our in-home orthopedic rehabilitation in Istanbul and in-home orthopedic rehabilitation in Antalya services. For manual techniques aimed at the soft tissue you can make use of in-home manual therapy in Ankara, and for a general assessment with a home exercise program, our in-home physiotherapy in Izmir option. Every program is intended to complement a physician's assessment and is tailored to individual needs. ^[3]

What can be done at home; who is it suitable for, and who not

For mild, recently started complaints related to a heel spur, some adjustments can be made at home and may provide relief for many people. As part of self-care, NHS lists applying a towel-wrapped cold pack to the painful area, wearing shoes that cushion the heel and have good arch support, doing stretching exercises for the calf and plantar fascia, and using simple painkillers where needed. In daily life, avoiding long periods of standing, increasing rest breaks, reducing activities that trigger the pain, and replacing worn-out shoes can also help. These simple measures serve the real goal of relieving the soft tissue. ^[5][6]

That said, self-care is not enough on its own for every situation, and the same program is not suitable for everyone. In the following situations, a professional assessment is needed before self-management:

• ·The pain does not improve, or it worsens, despite one to two weeks of self-care
• ·There is marked swelling, redness, or warmth in the heel
• ·There is significant difficulty bearing weight on the foot, or limping
• ·There is a coexisting condition such as diabetes, a circulation disorder, or loss of sensation (neuropathy)
• ·There is a recent history of injury or a fall
• ·The pain persists at night and at rest

This content is for general information and is not a substitute for an individual diagnosis, dose, or exercise prescription. The correct and safe approach is to seek a professional assessment for persistent or worsening complaints and to personalize the exercise program under expert supervision. ^[5][6]

When should you see a doctor?

Although heel pain is often not a serious condition, certain symptoms call for further assessment. NHS advises talking to a healthcare professional if pain in the heel or foot does not get better on its own within about a week. If the pain has persisted for a long time, is steadily increasing, or clearly limits daily life, a physician's assessment should not be delayed. ^[5][6]

In the case of the following "red flag" symptoms, you should seek medical care without delay:

• ·Sudden, severe heel pain, or pain that appears after an injury
• ·Marked swelling, redness, increased warmth, or pain accompanied by fever in the heel (suspicion of infection)
• ·Pain so severe that you cannot bear weight on or walk on the foot
• ·Numbness, tingling, or loss of sensation in the heel or foot
• ·In people with diabetes, new-onset foot pain, a wound, or a change in color
• ·A sudden "snapping" sensation at the back of the heel, a loud "pop," or an inability to push off onto the toes (suspicion of an Achilles tendon rupture)

Because these symptoms may signal more urgent problems distinct from a heel spur, a professional assessment is essential rather than attempting to self-diagnose. Foot problems should be handled with particular care when conditions such as loss of sensation, a circulation disorder, or diabetes are involved. ^[5][6]

Quick summary (TL;DR)

• ·A heel spur is a bony projection (an osteophyte) made of calcium deposits that develops on the underside or the back of the heel bone. ^[1][2]
• ·It is different from plantar fasciitis: the spur is a bony structure visible on X-ray, while plantar fasciitis is soft-tissue inflammation of the plantar fascia. The spur is often a consequence of long-standing plantar fasciitis, not the primary cause of pain. ^[1][3]
• ·It causes no symptoms in many people and is found incidentally on an X-ray taken for another reason. Seeing a spur on X-ray does not prove that it is the source of the pain. ^[1][3]
• ·The most common symptom is heel pain, which can sharpen especially with the first morning steps and after long sitting. ^[1][5]
• ·Diagnosis is made with history, examination, and X-ray; ultrasound or MRI may be used when needed to evaluate the soft tissue. ^[1][3]
• ·Treatment prioritizes non-surgical methods: activity modification, cold application, suitable footwear and support, stretching and strengthening exercises, and physiotherapy. Surgery is reserved, rarely, for recalcitrant cases. ^[1][3][5]
• ·Physiotherapy helps reduce pain and prevent recurrence through a stretching and strengthening program targeting the calf and plantar fascia. ^[3][7]
• ·This content is for general information and is not a substitute for an individual diagnosis, dose, or treatment advice. Persistent pain requires a physician's assessment.

Frequently Asked Questions

Are a heel spur and plantar fasciitis the same thing?

No, they are not the same. A heel spur is a bony projection that develops on the heel bone and is visible on X-ray; plantar fasciitis is a soft-tissue problem caused by strain and irritation of the plantar fascia, which runs from the bottom of the heel to the toes. The two often occur together and can cause similar pain; however, in most cases the heel spur is a consequence of long-standing plantar fasciitis, and the real source of the pain is usually the soft tissue. ^[1][3]

Will a heel spur go away or disappear on its own?

The bony projection itself is not expected to disappear on its own; Cleveland Clinic notes that heel spurs "can't be cured." The good news, however, is this: the real goal is not to destroy the spur. By relieving the surrounding soft tissue, the pain can decrease markedly in most people and the spur can remain silent. In other words, even after the pain resolves, the spur may still be seen on an X-ray. ^[1][3]

Is surgery always required for a heel spur?

No. Treatment prioritizes non-surgical methods. Surgery comes into consideration only in selected cases that have not responded to long-term non-surgical treatment. Mayo Clinic notes that surgery is not often recommended for plantar-fasciitis-related heel problems and is reserved for those who do not respond to conservative treatment. ^[1][5]

My X-ray showed a heel spur — is that why I have pain?

Not necessarily. Seeing a spur on X-ray is common and is also found in many people who have no pain. OrthoInfo stresses that although many people with plantar fasciitis have a spur, the spur is not the cause of the pain, and the pain can be treated without removing the spur. For this reason, the clinician interprets the X-ray together with examination findings. ^[3]

Which exercises are recommended for a heel spur?

In general, stretching and strengthening exercises targeting the calf muscles, the Achilles tendon, and the plantar fascia stand out; the 2023 clinical guideline supports plantar fascia and calf stretching with strong evidence. However, the type, intensity, and progression of exercise should be tailored to the individual. This article does not provide a specific exercise prescription; for the right program, a physiotherapist's assessment is recommended. ^[3][7]

Should I apply cold or heat for heel spur pain?

NHS recommends applying a towel-wrapped cold pack (for example, an ice pack) to the painful heel area for up to 20 minutes, provided the skin is protected. Because which approach suits you may depend on the nature of the complaint and your other health conditions, consulting a healthcare professional is the safest approach if you are unsure. ^[5][6]

Can heel spur pain come back after it resolves?

Heel pain can recur if the underlying strain persists. To reduce recurrence, it helps to wear suitable footwear, maintain flexibility in the calf and plantar fascia, manage weight, increase activity gradually, and avoid overloading on hard surfaces. For recurrent complaints, it is advisable to review your foot-strike pattern and exercise program. ^[5][7]

What is the difference between a heel spur and Achilles tendinitis?

A posterior heel spur is a bony projection that develops where the Achilles tendon attaches to the heel bone, whereas Achilles tendinitis concerns pain and strain in the tendon itself. The two can occur in the same area and may coexist; however, their assessment and treatment approaches can differ. If there is a sudden snapping sensation at the back of the heel or an inability to push off onto the toes, an urgent assessment for a tendon rupture is needed. ^[3]