In This Article

• The Key Difference Explained
• What Is a Heel Spur?
• What Is Plantar Fasciitis?
• How They Are Connected
• Symptom Comparison
• How We Diagnose Each Condition
• Treatment: Do You Need Different Approaches?
• The “Heel Spur Surgery” Myth
• Frequently Asked Questions

The Key Difference Between Heel Spurs and Plantar Fasciitis

Heel spurs and plantar fasciitis are two different conditions that frequently occur together, which is why they are so often confused. In our clinic, we see patients every week who come in saying “I have a heel spur” when what they actually have is plantar fasciitis — and the distinction matters for treatment.

Think of it this way: plantar fasciitis is the disease process (inflammation and micro-tearing of the plantar fascia), while a heel spur is sometimes a byproduct of that process (calcium deposits that form in response to chronic tension). Treating the spur without treating the fasciitis is like treating a fever without treating the infection causing it.

What Is a Heel Spur?

A heel spur (calcaneal spur) is a bony protrusion that develops on the underside of the calcaneus (heel bone) where the plantar fascia attaches. These calcium deposits build up gradually over months or years in response to chronic mechanical stress on the plantar fascia attachment point.

Heel spurs can range from a few millimeters to over a centimeter in length. They are visible on standard X-rays as a pointed or shelf-like projection extending forward from the bottom of the heel bone. Here is what surprises most patients: research shows that approximately 10-15% of the general population has heel spurs on X-ray with absolutely no symptoms.

In our experience, we frequently discover heel spurs incidentally on X-rays taken for unrelated reasons. The patient had no idea the spur was there because it was not causing any problems.

What Is Plantar Fasciitis?

Plantar fasciitis is inflammation, micro-tearing, and eventual degeneration of the plantar fascia — the thick band of connective tissue that runs along the bottom of your foot from the heel bone to the base of the toes. It is the most common cause of heel pain, affecting approximately 2 million Americans annually.

The hallmark symptom is sharp, stabbing pain at the bottom of the heel that is worst with the first steps in the morning or after prolonged sitting. The pain typically improves after several minutes of walking as the fascia warms up and stretches, then may return after extended periods on your feet. Read our detailed guide: Why Does My Heel Hurt in the Morning?

How Heel Spurs and Plantar Fasciitis Are Connected

The connection between these two conditions is one of cause and effect — but not in the direction most people assume. Plantar fasciitis can lead to heel spur formation, not the other way around.

When the plantar fascia is chronically inflamed and pulling on its attachment at the heel bone, the body responds by depositing calcium at that stress point — similar to how a callus forms on skin that is repeatedly rubbed. Over time, this calcium buildup develops into a visible spur.

The important clinical implication: about 50% of people with plantar fasciitis have heel spurs, but about 50% do not. And many people with heel spurs have no pain at all. This proves that the spur itself is not what hurts — it is the inflamed, damaged plantar fascia that generates the pain signals.

Symptom Comparison: Heel Spur vs. Plantar Fasciitis

How We Diagnose Each Condition

At Balance Foot & Ankle, a thorough diagnostic workup is essential for developing the right treatment plan. Here is what a typical evaluation includes:

• Physical examination — Palpation of the plantar fascia along its length, with particular attention to the medial calcaneal tubercle (the classic point of maximum tenderness in plantar fasciitis)
• Biomechanical assessment — Evaluating foot structure, arch type, gait pattern, and ankle flexibility to identify contributing factors
• X-rays — Can reveal heel spurs and rule out stress fractures, but cannot directly visualize soft tissue like the plantar fascia
• Diagnostic ultrasound — The gold standard for visualizing plantar fascia thickening (normal is <4mm; fasciitis typically shows >4.5mm). Also detects tears and degeneration
• MRI — Reserved for complex cases or when ultrasound findings are inconclusive

The key diagnostic insight: if you have a heel spur on X-ray AND classic plantar fasciitis symptoms (morning pain, pain after rest, tenderness at the medial heel), the treatment targets the fasciitis — not the spur.

Treatment: Do You Need Different Approaches?

Whether you have plantar fasciitis alone, a heel spur alone, or both together, the treatment approach is remarkably similar — because the treatment targets the soft tissue inflammation and biomechanical dysfunction, not the bony spur.

First-Line Conservative Treatment

• Stretching program — Daily plantar fascia and calf stretches (the towel stretch before bed is essential)
• Custom 3D orthotics — Correct the biomechanical issues driving your fasciitis. Our 3D scanning creates orthotics that precisely match your foot structure
• Supportive footwear — Never go barefoot; wear shoes with arch support and cushioned heels
• Ice and NSAIDs — For acute pain management during flare-ups
• Night splints — Keep the fascia gently stretched while you sleep

Advanced Treatment Options

• EPAT Shockwave Therapy — Acoustic waves stimulate healing in chronically damaged fascia tissue. 80-90% success rate for cases that failed initial conservative care
• MLS Laser Therapy — Reduces inflammation and promotes tissue repair with zero downtime
• Corticosteroid injections — Targeted anti-inflammatory relief for acute flare-ups
• PRP injections — Your body’s own growth factors concentrated to promote fascia healing

The “Heel Spur Surgery” Myth

One of the most persistent myths we encounter is that heel spurs need to be surgically removed. In decades past, surgeons would perform heel spur resection (physically removing the bony spur). We now know this was treating the wrong problem.

Modern evidence shows that when surgery is necessary (fewer than 5-10% of plantar fasciitis cases), the effective procedure is a plantar fascia release — partially releasing the tight fascia to reduce tension on the heel bone. The spur is typically left in place because it is not causing the pain. Patients who undergo fascia release get relief regardless of whether the spur remains.

Read our complete Plantar Fascia Release Recovery Guide for detailed information about what to expect if surgery becomes necessary.

Frequently Asked Questions

Can a heel spur go away on its own?

Heel spurs are permanent bony deposits — they do not dissolve or disappear on their own. However, this is not a problem because the spur itself is rarely the source of pain. When the associated plantar fasciitis is successfully treated, the pain resolves even though the spur remains on X-ray.

Do I need to remove my heel spur?

Almost never. Heel spur removal surgery is rarely performed in modern podiatry because evidence shows it is the inflamed plantar fascia — not the spur — that causes pain. If surgery is ever needed, a plantar fascia release is the procedure of choice, and the spur is left in place.

Can you have plantar fasciitis without a heel spur?

Absolutely. About 50% of people with confirmed plantar fasciitis have no heel spur visible on X-ray. The presence or absence of a spur does not change the diagnosis or treatment approach for plantar fasciitis.

Will orthotics help with a heel spur?

Custom orthotics are one of the most effective long-term treatments because they address the biomechanical forces that caused both the plantar fasciitis and the heel spur to develop. By correcting arch support and redistributing pressure, orthotics reduce tension on the plantar fascia attachment and prevent symptom recurrence.

Sources

1. Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur: Fact or fiction? Foot Ankle Surg. 2012;18(1):39-41.
2. Moroney PJ, et al. The conundrum of calcaneal spurs: do they matter? Foot Ankle Spec. 2014;7(2):95-101.
3. Buchanan BK, Kushner D. Plantar Fasciitis. StatPearls. Updated 2025.
4. Martin RL, et al. Heel pain—plantar fasciitis: Clinical practice guidelines. J Orthop Sports Phys Ther. 2023;53(12):CPG1-CPG39.

Related Articles

• Why Does My Heel Hurt in the Morning?
• Flat Feet Treatment Guide
• Achilles Tendinitis Treatment
• When to See a Podiatrist
• Night Splints for Plantar Fasciitis
• Morton’s Neuroma Guide

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.