Heel spur vs. plantar fasciitis: What’s the difference and how to treat it

Although these terms are often used interchangeably to describe the same condition (pain under the heel bone), the pain is often complex, and a specific diagnosis like heel spur or plantar fasciitis isn't always possible or entirely accurate.

This article explains the difference between these two conditions, why a specific diagnosis isn't necessary for effective recovery, and how to treat it effectively.

What's the difference between a heel spur and plantar fasciitis

Why "plantar heel pain" is a more accurate term

Research indicates that when people experience heel pain, their scans usually reveal a combination of “injuries” and changes to their heel bone (calcaneus) and plantar fascia.

These changes typically involve:

• A thickening of the plantar fascia, and
• A thinning of the fat pad under the heel bone, and
• Less often a heel spur.

Since multiple structures can contribute to this type of heel pain, experts recommend using the term "plantar heel pain" instead of specific terms like "plantar fasciitis" or "heel spur" for a more accurate diagnosis.

A closer look at heel spurs

Heel spurs appear on x-rays as bony points in the area where the plantar fascia attaches to the heel bone.

What do heel spurs look like?

In an x-ray, a heel spur appears as a tiny, pointed piece of bone on the underside of the heel bone.

What causes heel spurs?

Your body constantly renews its bone tissue, like with your fingernails and hair. It also responds to pressure and stress by depositing more bone cells in that area to make it stronger.

When new bone cells are laid down, they occasionally form a bone spur – a small, often pointy nodule or bump formed by a collection of excess bony tissue.

Bone spurs can form in any area of the body where there is too much pressure (or repetitive stress) on a bone.

Heel spurs are bone spurs that specifically develop where the plantar fascia connects to the heel bone.

The current understanding suggests that heel spurs occur when an overloaded plantar fascia pulls excessively on its attachment to the heel bone.

Poor movement patterns due to muscle weakness may cause your plantar fascia to become overloaded.

Your plantar fascia can become overloaded for various reasons, including:

• Weak foot and ankle muscles
• Excessive pronation (rolling in of the foot) when walking and running
• Poor core and hip muscle strength and control
• Wearing hard or unsupportive shoes
• Walking on hard surfaces like concrete
• Increasing sports or walking intensity and volume too quickly

What does a heel spur feel like?

Research indicates heel spurs are often not painful, contrary to popular belief.

Years ago, when experts first identified bone spurs on scans, heel spurs looked particularly painful, and doctors assumed they were the main reason for a person’s heel pain.

However, recent studies show that these little bony outgrowths also occur in people without any heel pain.

For instance, when people with foot pain have their feet scanned, heel spurs are often found in both feet, yet they only experience pain in one.

Also, when you recover from heel pain, the heel spur remains – casting even more doubt on whether heel spurs cause any symptoms.

So, it isn’t clear what heel spurs feel like precisely and if or how they contribute to pain.

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Can heel spurs go away?

No, heel spurs are permanent. However, they usually don't cause pain (as discussed above), so there's no need to be concerned if you have one.

It is possible to fully recover from heel pain (and remain pain-free) even if you have a heel spur.

Do you need surgery to remove the heel spur?

No, studies indicate that removing a heel spur doesn't improve surgical outcomes.

That means you may still have heel pain even if you have surgery to remove a heel spur.

Understanding plantar fasciitis better

When you’re diagnosed with plantar fasciitis, it typically suggests a plantar fascia injury is the cause of your pain, but it's important to recognize this may be oversimplified.

The diagnosis of plantar fasciitis suggests an injury to the plantar fascia.

Although plantar fasciitis is a common cause of heel pain, it might not be the only contributor to the discomfort.

Here's what makes it a little more complex:

1. The causes of plantar fascia overload (and flare-ups) and the factors leading to heel spur growth are similar. In some cases, a heel spur might also contribute to your pain.
2. Additionally, your heel bone fat pad (which cushions your heel bone) could be irritated and play a role in the pain you feel under your heel when you’re standing or walking.

The good news is that treatment is the same regardless of the structures involved.

Treatment for heel spurs and plantar fasciitis is the same

In a previous article, we discussed the 5 best home treatments you can use to treat plantar fasciitis, but these also work well for heel spurs and include:

1. Relative rest

Briefly, relative rest involves reducing your physical activities to a level that doesn’t worsen your pain, giving your injury a chance to heal, and allowing your pain to settle.

Supportive shoes and insoles can reduce plantar heel pain by supporting your foot and cushioning the heel.

2. Supportive shoes, orthotics or insoles, plantar fascia taping

By wearing supportive shoes, using orthotic inserts, and taping, you support your feet better and help relieve excess pressure on them, which can reduce heel pain.

3. Physiotherapy exercises

If muscle weakness or tightness contributed to your plantar fascia overload and heel spur development, you can reduce pain and prevent it from worsening with targeted exercises that:

1. Strengthen your intrinsic foot and ankle muscles
2. Strengthen your plantar fascia
3. Strengthen your hip and leg muscles and improve your movement control
4. Stretch your plantar fascia and other leg muscles

Whether you have heel pain from a heel spur or plantar fasciitis, the best way to ease it is with a combination of these treatments tailored to your unique injury and circumstances.

Exakt Health is here to help you recover from heel pain without the stress of not knowing what to do or how to do it correctly. We provide straightforward advice and customized rehab plans, all in a convenient app that’s easy to access and use.

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Conclusion

The key points to remember from this article are:

1. Heel spurs are often painless and don't necessarily indicate a problem.
2. Plantar fasciitis and heel spurs are typically associated with one another or other issues in the foot, like fat pad irritation.
3. A better term for the heel spur and plantar fasciitis pain is "plantar heel pain" – because pinpointing a single structure causing the pain is difficult in most cases.
4. The right combination of treatments tailored to you is the most effective approach for managing plantar heel pain.
5. Always incorporate relative rest and exercises; Add supportive shoes, orthotics, or taping if and when you feel it helps.

The Exakt Health app streamlines your injury recovery by offering easy access to expert advice and guidance tailored to your feedback. Download the app today and get simple and effective treatment plans for a hassle-free rehab experience.

Evidence-based rehab plan for heel pain

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