What Are Heel Spurs? Explained

A heel spur is a bony growth that forms on the underside of the heel bone, most often where the plantar fascia attaches. It is not a disease in itself. It is a structural change that shows up on X-rays, and many people who have one feel nothing at all. The confusion around heel spurs comes from the fact that they are frequently blamed for heel pain that is actually caused by something else.

What Are Heel Spurs and How Do They Form?

Bone responds to mechanical stress. When soft tissue pulls repeatedly on the same spot on a bone, the body can lay down extra calcium there, forming a small bony projection. That is the basic process behind a heel spur.

The plantar fascia is a thick band of connective tissue that runs from the heel bone to the base of the toes. It supports the arch of the foot and absorbs force with every step. At the heel, it attaches to the calcaneus, the large bone at the back of the foot. When that attachment point experiences repeated tension, the periosteum — the thin layer covering bone — can become irritated and eventually ossify. Over months or years, this can produce a spur.

Heel spurs are not sharp shards stabbing into tissue, which is a common mental image. They are typically smooth, horizontal bony outgrowths. They point forward along the bottom of the heel, in the direction the fascia pulls. This matters because it explains why the spur itself is usually not the source of pain.

They can also form at the back of the heel, where the Achilles tendon attaches. These are less common and are sometimes called posterior heel spurs. The mechanism is similar — repeated tension at a tendon or ligament attachment site.

Are Heel Spurs the Same as Plantar Fasciitis?

No. They are two different things that often get confused because they can occur together.

Plantar fasciitis is inflammation or degeneration of the plantar fascia itself. Heel spurs are bony deposits. Research has consistently found that many people with heel spurs have no heel pain, and many people with plantar fasciitis have no visible spur on imaging. A study published in the Journal of Foot and Ankle Research examined imaging findings and found that heel spurs are common in people without any heel pain.

The relationship is more like a shared cause than a direct one. Both can result from the same underlying issue: excessive or repetitive strain on the plantar fascia. The strain may cause tissue damage and pain. The strain may also, over time, contribute to spur formation. But the spur is a byproduct, not necessarily the culprit.

This distinction matters for treatment. If a clinician treats a heel spur as the source of pain, they may recommend surgery to remove it. If the actual problem is plantar fasciitis, removing the spur may not resolve the pain.

What Causes Heel Spurs to Develop?

Anything that increases strain on the plantar fascia or Achilles tendon can contribute to heel spur formation. The causes are mechanical, not dietary or infectious.

• Biomechanical factors: flat feet, high arches, or an abnormal walking pattern that places extra stress on the heel.
• Repetitive activity: running, walking on hard surfaces, or jobs that require prolonged standing.
• Weight: carrying more body weight increases the load on the heel with every step. This is a mechanical relationship, not a judgment.
• Age: spurs become more common with age, likely because cumulative strain adds up over decades.
• Footwear: shoes with poor arch support or worn-out cushioning can alter force distribution.
• Diabetes: some research suggests a higher prevalence of heel spurs in people with diabetes, though the reason is not fully understood and may involve changes in connective tissue.

None of these factors guarantees a spur will form. They increase the likelihood. Many people with all of these risk factors never develop one, and many people with none of them do.

What Do Heel Spurs Feel Like?

Usually nothing. Most heel spurs are found by accident when an X-ray is taken for an unrelated reason.

When heel spurs are associated with pain, the pain is typically described as sharp and located under the heel or slightly forward of it. It is often worst with the first steps in the morning or after sitting for a while. That pattern — pain that is severe on initial movement and then eases — is more characteristic of plantar fasciitis than of a spur itself.

If a spur is large enough or positioned in a way that irritates surrounding tissue, it could theoretically contribute to discomfort. But in clinical practice, the presence or size of a spur on X-ray does not reliably predict whether someone has pain or how severe it is.

Other conditions can cause heel pain that gets attributed to spurs. These include plantar fasciitis, Achilles tendinopathy, stress fractures of the calcaneus, nerve entrapment, and fat pad atrophy. A proper diagnosis matters because the treatments differ.

How Are Heel Spurs Diagnosed?

Heel spurs are diagnosed by imaging. A standard X-ray of the foot will show a bony projection at the calcaneus if one is present. No blood test or physical exam can confirm a spur.

But here is the key point: finding a spur on X-ray does not mean it is the cause of the patient’s pain. A clinician who identifies a spur in someone with heel pain still needs to determine whether the pain is coming from the spur, the plantar fascia, or another structure. That often involves a physical exam, a history of when and how the pain occurs, and sometimes ultrasound or MRI.

Some clinicians use diagnostic ultrasound to look at the plantar fascia directly. Thickening of the fascia is a common finding in plantar fasciitis. This can help distinguish between the two conditions when the picture is unclear.

What Treatments Are Used for Heel Spurs?

Treatment for heel spurs is really treatment for the pain and the underlying mechanical strain, not for the spur itself. Removing the spur is rarely necessary.

Most conservative approaches focus on reducing strain on the plantar fascia and surrounding structures:

• Stretching: calf and plantar fascia stretching exercises are commonly recommended. Some studies support their use for heel pain, though results vary.
• Orthotics: shoe inserts or custom orthotics can change force distribution and reduce strain. Evidence for their effectiveness is mixed but they are widely used.
• Night splints: these hold the foot in a position that keeps the plantar fascia stretched overnight. Some people find them helpful.
• Physical therapy: targeted strengthening and manual therapy may help some patients.
• Anti-inflammatory medications: oral NSAIDs or topical treatments can reduce pain in the short term. They do not change the spur.
• Corticosteroid injections: these can reduce inflammation but carry risks, including plantar fascia rupture and fat pad atrophy. They are generally used sparingly.
• Extracorporeal shock wave therapy: this is used for chronic plantar fasciitis in some cases. Evidence is mixed, and it is not specific to heel spurs.

Surgery to remove a heel spur is uncommon. It is generally considered only when conservative treatment has failed for an extended period and the spur is thought to be contributing to symptoms. Even then, outcomes are not guaranteed, and surgery carries risks including infection, nerve damage, and prolonged recovery.

No clinical guidelines currently recommend removing a heel spur solely because it is visible on an X-ray.

Can Heel Spurs Be Prevented?

There is no proven way to prevent heel spurs. Because they develop gradually in response to mechanical strain, reducing that strain may lower the likelihood, but no study has confirmed that any specific intervention prevents them.

General foot care that supports healthy mechanics may be reasonable: wearing shoes with good support, maintaining a healthy weight, and addressing biomechanical issues early. But these are general measures, not proven prevention strategies for spurs specifically.

If you have heel pain, the more useful question is not whether you have a spur but what is causing the pain. That is what determines treatment.