Heel Spur vs Plantar Fasciitis: What's the Difference?
- cmspodiatry
- 6 hours ago
- 5 min read
If you've been told you have a heel spur, or you've searched online because of pain under your heel, you've probably come across the term plantar fasciitis as well. The two conditions are often mentioned together, leading many people to wonder whether they're actually the same thing.
The short answer is no.
A heel spur is a small bony growth that develops on the heel bone, whereas plantar fasciitis is a condition affecting the plantar fascia - the thick band of tissue that supports the arch of your foot. Although they often occur together, they are different conditions, and in many cases, a heel spur isn't actually the cause of the pain.
Understanding the difference is important because the correct diagnosis helps ensure you receive the most appropriate treatment.
What is plantar fasciitis?
Plantar fasciitis is one of the most common causes of heel pain seen by podiatrists.
The plantar fascia is a thick, fibrous band of tissue that runs from the heel bone to the base of the toes. It supports the arch of the foot and helps absorb forces during walking and running.
When this tissue becomes overloaded, tiny areas of damage can develop where it attaches to the heel bone.
What is a heel spur?
A heel spur is a small bony projection that develops on the underside of the heel bone (calcaneus).
It forms gradually over time where the plantar fascia attaches to the heel.
Many people imagine a heel spur as a sharp piece of bone digging into the foot, but this isn't usually the case. In fact, heel spurs are surprisingly common and are frequently discovered by chance on X-rays taken for unrelated reasons.
Many people have a heel spur without ever experiencing heel pain.
What's the difference between a heel spur and plantar fasciitis?
Although they are closely related, they affect different tissues.
Plantar Fasciitis | Heel Spur |
A condition affecting the plantar fascia | A bony growth on the heel bone |
Usually causes pain | Often causes no symptoms |
Involves soft tissue | Involves bone |
Cannot usually be seen on an X-ray | Easily visible on an X-ray |
Usually diagnosed clinically | Often discovered incidentally during imaging |
The important point is that plantar fasciitis causes pain because the plantar fascia becomes irritated or damaged.
A heel spur, on the other hand, is often simply an incidental finding.
Can you have plantar fasciitis without a heel spur?
Yes.
Many people with plantar fasciitis have completely normal X-rays with no evidence of a heel spur.
The diagnosis is usually based on your symptoms and a physical examination rather than imaging.
Can you have a heel spur without plantar fasciitis?
Yes.
This surprises many people.
Research has shown that many adults have heel spurs despite having no heel pain whatsoever.
This is one of the reasons healthcare professionals don't automatically blame a heel spur when someone develops heel pain.
Which one actually causes the pain?
This is probably the question people ask most often.
In the majority of cases, the pain comes from the plantar fascia rather than the heel spur itself.
The heel spur develops gradually over many years as the body responds to repeated strain where the plantar fascia attaches to the heel.
Think of the heel spur as evidence that the area has been under stress rather than the actual source of the pain.
This is why many people continue to have a visible heel spur even after their symptoms have completely resolved.
What are the symptoms of plantar fasciitis?
Typical symptoms include:
Sharp pain underneath the heel.
Pain during the first few steps in the morning.
Pain after sitting for long periods.
Discomfort after standing for long periods.
Pain that eases after walking for a short time before gradually returning.
These symptoms are much more characteristic of plantar fasciitis than of a heel spur.
What are the symptoms of a heel spur?
Many heel spurs produce no symptoms at all.
If symptoms are present, they are often similar to plantar fasciitis because both conditions involve the same area of the heel.
People may experience:
Pain underneath the heel.
Tenderness around the heel.
Pain during walking.
Pain after prolonged standing.
Because the symptoms overlap so closely, it is usually impossible to know whether a heel spur is present without imaging.
How are these conditions diagnosed?
A podiatrist will usually diagnose plantar fasciitis based on:
Your symptoms.
The location of your pain.
Your medical history.
A physical examination.
Imaging is not always necessary.
If an X-ray is taken, it may reveal a heel spur.
However, the presence of a heel spur doesn't necessarily explain the symptoms.
Occasionally, ultrasound or MRI may be recommended if another condition is suspected.
Do heel spurs need to be removed?
In most cases, no.
Because heel spurs often aren't responsible for the pain, removing them rarely forms part of the initial treatment plan.
Surgery is generally considered only after prolonged symptoms that haven't responded to appropriate conservative treatment, and even then, it is relatively uncommon.
How are plantar fasciitis and heel spurs treated?
Fortunately, the treatment for both conditions is often very similar because the focus is usually on reducing strain on the plantar fascia.
Treatment may include:
Supportive footwear
Well-fitting shoes with good cushioning and support can reduce pressure on the heel.
Very flat or unsupportive footwear may make symptoms worse.
Stretching exercises
Stretching the calf muscles and plantar fascia is often recommended.
Consistency is more important than intensity, and improvements usually develop gradually over several weeks.
Strengthening exercises
Strengthening the muscles of the foot and lower leg can improve the foot's ability to tolerate everyday loads.
Insoles or orthoses
Some people benefit from supportive insoles that help redistribute pressure and reduce stress on the plantar fascia.
Activity modification
Reducing activities that aggravate symptoms while remaining as active as possible often helps recovery.
Shockwave therapy
Extracorporeal shockwave therapy may be recommended for persistent plantar fasciitis that hasn't improved with conservative treatment.
Pain relief
Ice and appropriate pain relief may help manage symptoms, particularly after activity.
Always follow the advice of your pharmacist or healthcare professional when using medication.
Can you prevent plantar fasciitis and heel spurs?
Although they can't always be prevented, you can reduce your risk by:
Wearing supportive footwear.
Increasing exercise gradually.
Stretching tight calf muscles.
Maintaining a healthy body weight where appropriate.
Replacing worn-out trainers.
Avoiding sudden increases in walking or running distances.
When should you see a podiatrist?
Arrange an assessment if:
Heel pain lasts longer than two weeks.
Walking becomes uncomfortable.
The pain keeps returning.
Home treatments aren't helping.
You're unsure whether you have plantar fasciitis or another condition.
A podiatrist can identify the underlying cause of your symptoms and recommend an individual treatment plan.
Final thoughts
Although heel spurs and plantar fasciitis are often discussed together, they are not the same condition.
For most people experiencing heel pain, the plantar fascia is the structure responsible for the symptoms, while a heel spur is simply a sign that the area has been under strain over time.
Understanding this difference is reassuring because it explains why many people recover without surgery, even though the heel spur remains.
If your heel pain isn't improving, or you're unsure what's causing it, a podiatrist can provide an accurate diagnosis and recommend the most appropriate treatment to help you get back to comfortable walking.
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