Heel Pain Does Not Guarantee a Heel Spur
Myth: The bony spur is the source of pain.
Reality: Most heel pain is due to Plantar Fasciitis, not the spur itself.
In clinic, I heart this concern almost daily: “I have a heel spur—that must be why my heel hurts.”
I understand why patients think this way. Both ideas are intuitive. If you see a bony spike on an X-ray, it feels like that must be the pain generator. However, it misses what we’ve learned from evidence-based medicine over the past few decades.
The Truth About Heel Spurs
When a patient comes in with heel pain and an X-ray report mentioning a “spur,” the conversation often starts with fear. The word itself sounds aggressive—like something sharp digging into soft tissue.
But here’s the key point I explain: Most heel pain is not caused by the spur at all. It’s usually due to Plantar Fasciitis—more accurately described in chronic cases as plantar fasciosis, a degenerative condition of the fascia (fibrous tissue that encases muscle).
The plantar fascia is a thick band of connective tissue that supports the arch and absorbs load when you walk. Over time—especially with repetitive stress, poor load management, or sudden increases in activity—it can develop microtears and degeneration.
That’s what produces the classic symptoms: sharp pain with the first steps in the morning or after rest.
Now here’s where the misconception falls apart: large imaging studies have shown that heel spurs are incredibly common in people with no pain at all.
At the same time, many patients with severe heel pain don’t have a spur. In other words, the presence of a spur doesn’t reliably correlate with symptoms.
What the spur likely represents is chronic traction where the fascia attaches to the heel bone. It’s more of a historical footprint of stress rather than the active source of pain.
This matters because it changes how we treat the condition. If I focus on the spur, I’m treating the wrong thing.
Evidence-based care targets the fascia itself and the mechanical loading environment through strategies like:
- Load management and activity modification
- Load management means resting/reducing high-impact activities as much as possible, with strength training (heel raises) to restore the tissue.
- Activity modification means substituting high-impact for low-impact; think cycling or swimming instead of running
- Stretching (especially calf and plantar fascia-specific)
- Strengthening intrinsic and extrinsic foot muscles
- Footwear adjustments
- Temporary use of shoe inserts when indicated
Surgery to remove a spur, by contrast, is rarely necessary and doesn’t address the underlying pathology in most cases.
So, when I tell patients, “Your spur isn’t the problem,” it’s not dismissive—it’s actually reassuring. It means we can treat this effectively without invasive measures.
Key Takeaways:
- Imaging studies show many people with heel spurs have no pain, while many with pain have no spur.
- Pain correlates more with fascia degeneration (fasciosis) than bone growth