Heel Spurs: Symptoms, Causes, Treatment & Prevention
A heel spur is a bony growth on the heel bone that often appears alongside long-term plantar-fascia or Achilles-tendon stress. Many heel spurs cause no pain at all, so treatment usually focuses on the irritated soft tissue and the true source of heel pain rather than the X-ray finding itself.
What is a heel spur?
A heel spur, also called a calcaneal spur, is extra bone that develops on the heel bone. It can form where the plantar fascia attaches underneath the heel or near the Achilles tendon attachment at the back of the heel.
On an X-ray, a spur may look like a small shelf or projection of bone. It usually develops gradually in response to long-term mechanical stress at a tendon or fascia attachment rather than appearing suddenly after one ordinary day of walking.
The X-ray finding and the pain are not always the same thing.
AAOS notes that many people with heel spurs have no heel pain. A spur can appear alongside plantar fasciitis or other chronic heel-loading problems, but the surrounding soft tissue is often the more important source of symptoms.
Plantar vs. posterior heel spurs
| Type | Location | Commonly associated with |
|---|---|---|
| Plantar calcaneal spur | Bottom of the heel near the plantar-fascia attachment | Long-standing plantar-fascia stress and plantar heel pain |
| Posterior heel spur | Back of the heel near the Achilles tendon insertion | Insertional Achilles-tendon problems and posterior heel irritation |
Do heel spurs actually cause heel pain?
Sometimes a spur is found in a person with heel pain, but the spur itself is often not the primary pain generator. The American Academy of Orthopaedic Surgeons specifically notes that many people with heel spurs have no pain.
If your pain is worst with the first steps after getting out of bed or after sitting, plantar fasciitis is often the more clinically useful explanation, whether or not an X-ray happens to show a spur.
Other causes of heel pain
- Plantar fasciitis
- Achilles tendinopathy
- Heel-pad irritation or thinning
- Stress fracture of the heel bone
- Bursitis near the back of the heel
- Nerve irritation
- Inflammatory joint disease or gout in the appropriate clinical setting
What causes heel spurs?
Heel spurs are associated with repeated stress where soft tissues attach to the heel bone. They may develop alongside long-standing plantar-fascia tension or Achilles-tendon problems.
Factors that can contribute to chronic heel loading include:
- Repeated running, jumping or long periods of standing
- Sudden increases in training or walking volume
- Tight calf muscles or limited ankle motion
- Foot mechanics that concentrate load on the heel
- Footwear that does not suit the activity or has lost its cushioning
- Higher body weight, which increases mechanical load on the feet
How heel spurs are diagnosed
A clinician should evaluate the pattern of your pain, not just the image. They may examine where the heel is tender, test ankle motion and assess the plantar fascia, Achilles tendon and nearby structures.
An X-ray can show a heel spur and can also help evaluate some other causes of heel pain, including fracture or arthritis. Imaging is not always necessary for a typical case of plantar-fascia pain.
Heel spur treatment
Because pain commonly comes from plantar-fascia or other soft-tissue irritation, initial treatment usually overlaps with conservative heel-pain treatment.
Common first-line measures
- Reduce aggravating load. Temporarily scale back activities that clearly increase heel pain.
- Use ice for symptom relief. Apply a wrapped cold pack for short periods after aggravating activity.
- Stretch the calf and plantar fascia. Improving flexibility can reduce strain around the heel.
- Wear supportive footwear. Appropriate cushioning and support may reduce heel loading.
- Consider heel cups or insoles. These can improve comfort and redistribute pressure for some people.
- Seek professional guidance when pain persists. Physical therapy or other treatment may be appropriate when basic measures are not enough.
Medication and injections
Over-the-counter pain medicines may be appropriate for some people, but they are not safe for everyone. Follow product directions and ask a clinician or pharmacist if you have kidney disease, stomach ulcers, take blood thinners, are pregnant, or have other relevant medical conditions.
Injections and other procedures should be individualized by a clinician. A treatment that temporarily reduces pain does not necessarily remove the spur or correct the underlying mechanical problem.
Shock-wave therapy
Extracorporeal shock-wave therapy may be considered for persistent plantar-fascia pain that has not improved with conservative treatment. It is aimed at the symptomatic tissue rather than simply “breaking up” a heel spur.
Does a heel spur need surgery?
Usually not. Surgery is uncommon and generally considered only after an extended period of appropriate nonsurgical treatment has failed and a specialist has confirmed the structure responsible for the pain.
Depending on the diagnosis, surgery may target plantar-fascia pathology, Achilles insertion problems or another source of symptoms. Removing a radiographic spur alone is not automatically the answer.
Can heel spurs be prevented?
There is no guaranteed way to prevent every heel spur, but reducing repetitive overload may lower the risk of chronic heel problems.
- Increase running and walking volume gradually
- Replace badly worn shoes
- Use footwear appropriate for your activity
- Maintain calf and ankle flexibility
- Address recurring heel or arch pain before it becomes chronic
- If weight management is medically appropriate for you, gradual changes can reduce mechanical load on the feet
When should you see a doctor?
Arrange an evaluation if heel pain persists, keeps returning or is interfering with normal walking despite conservative care.
Seek more prompt care if:
- Pain began after a fall, impact or sudden injury
- You cannot bear weight normally
- There is marked swelling, redness, warmth or fever
- You develop numbness, tingling or weakness
- There is an open wound or skin breakdown
- You have diabetes, neuropathy or significant circulation problems and develop a new foot symptom
Frequently asked questions
Is a heel spur the same as plantar fasciitis?
No. A heel spur is a bony growth seen on imaging. Plantar fasciitis is a painful disorder involving the plantar fascia. They often occur together, but either can exist without the other.
Can you have a heel spur without pain?
Yes. Many heel spurs are incidental findings on X-rays and cause no symptoms.
Can a heel spur disappear?
The bony growth generally remains visible even when symptoms improve. The important treatment goal is relief of the painful tissue and improvement in function, not necessarily making the X-ray look different.
Do orthotics remove heel spurs?
No. Insoles, heel cups and orthotics may reduce strain or redistribute pressure, but they do not remove the bony growth.
Does every painful heel need an X-ray?
No. Many cases of typical plantar-fascia pain can be diagnosed clinically. Imaging may be used when the diagnosis is uncertain, symptoms are unusual or severe, or another condition such as fracture or arthritis needs to be considered.
Medical sources
Related FeetHealth guides
Medical disclaimer: FeetHealth.org provides general educational information and does not diagnose or treat medical conditions. Always seek advice from a qualified healthcare professional for symptoms, diagnosis, medication decisions or treatment. Do not delay urgent care because of information read on this website.