Educational purposes only. This article is intended as general health information and does not constitute medical advice. It is not a substitute for professional diagnosis or treatment. If you are experiencing heel or foot pain, please consult a qualified physical therapist, podiatrist, or medical professional before commencing any exercise programme.
One of the most common sources of confusion in heel pain management is the relationship between heel spurs and plantar fasciitis. Patients come in having been told by an imaging report that they have a heel spur and understandably assume that the spur is the problem, that a bony growth is stabbing into their foot with every step. The reality is considerably more reassuring, and understanding it is important for making good decisions about treatment.
What Is a Heel Spur?
A heel spur, technically called a calcaneal enthesophyte, is a bony growth that forms at the attachment point of the plantar fascia on the underside of the heel bone (calcaneus). It develops over time in response to repeated tensile stress at the fascia-bone interface. The body lays down new bone tissue in response to chronic loading, resulting in a bony prominence that shows up clearly on X-ray.
Heel spurs are extremely common. Research consistently demonstrates they are found in a substantial proportion of adults who have no heel pain whatsoever, studies have reported prevalence of approximately 11–16% in the general adult population, increasing with age. These spurs are often completely asymptomatic. The presence of a spur on imaging does not, by itself, explain pain.
Why the Spur Is Usually Not the Source of Pain
It is the plantar fascia itself, and specifically the degenerated, sensitised tissue at its calcaneal insertion, that generates pain in the vast majority of heel pain cases. The bony spur is a secondary finding, a sign that the enthesis has been under prolonged stress, but it is not typically the pain generator.
This is supported by the fact that treatment targeting the plantar fascia, progressive strengthening, load management, physical therapy, resolves pain in the overwhelming majority of cases without any intervention directed at the spur itself. Ultrasound and MRI studies have further clarified the picture: pain correlates much more strongly with plantar fascia thickness, changes in fascia echogenicity, and neovascularisation at the insertion than with the presence or size of a bony spur.
The Diagnostic Confusion and Why It Matters
The conflation of heel spurs and plantar fasciitis has real consequences for treatment decisions. Patients told they have a "spur" sometimes become fearful of activity, believing they are walking on a bony spike. This fear-avoidance leads to reduced loading, which weakens the foot musculature and delays recovery. Others pursue treatments, including surgical spur removal, that are rarely indicated and do not reliably resolve pain because the fascia pathology remains unaddressed.
It is worth noting that in the rare cases where surgery for heel pain is considered, modern procedures focus on releasing or debriding the plantar fascia at its insertion, not on removing the spur. The spur is typically left intact because it is not the problem.
What About Posterior Heel Spurs?
It's worth distinguishing calcaneal spurs at the plantar fascia insertion, what most people mean when they say "heel spur", from posterior calcaneal spurs or Haglund's deformity, which occur at the Achilles tendon insertion at the back of the heel. These are a separate entity associated with Achilles tendinopathy and have a different clinical presentation. If your pain is at the back of the heel rather than the underside, the diagnosis and management pathway is different, and worth discussing with your physical therapist or podiatrist.
Treatment: The Same Regardless of the Spur
Here is the practical takeaway: whether or not a heel spur is present on your X-ray, the treatment for plantar heel pain is the same. The evidence base points clearly toward progressive loading as the most effective intervention. High-load heel raise exercises, performed regularly over weeks to months, have been shown in multiple randomised controlled trials to produce superior outcomes to stretching, orthotics, or passive treatments alone.
Progressive loading stimulates the plantar fascia and surrounding structures to remodel, improves the organisation of collagen fibres, and builds the load-bearing capacity of the entire posterior kinetic chain. The tissue becomes better equipped to handle the demands placed on it, and pain resolves as a result.
A Heel Spur Is Not a Reason to Avoid Activity
If you've been given a heel spur diagnosis and told to rest, avoid exercise, or consider surgery, it is worth getting a second opinion from a physical therapist who specialises in musculoskeletal conditions. In the vast majority of cases, a graded return to activity combined with a progressive strengthening programme is both safe and the most effective path to recovery.
The Fasciitis Fighter ROUND 2 was developed by a physical therapist to make evidence-based heel raise strengthening accessible and progressive at home, addressing the plantar fascia pathology that is, in almost every case, the actual source of your pain.