Plantar Fasciitis vs. For specialized treatment, see our plantar fasciitis treatment Michigan. Heel Spur: What’s the Difference?

Heel pain is one of the most common reasons people visit a podiatrist, and “plantar fasciitis” and “heel spur” are terms that get used interchangeably — even by healthcare providers. In reality, these are distinct conditions that are often related but not the same thing. Understanding the difference has real implications for treatment, because what actually causes your pain determines which intervention will relieve it.

What Is Plantar Fasciitis?

Plantar fasciitis is inflammation and microtearing of the plantar fascia — a thick band of connective tissue that runs from the heel bone (calcaneus) to the base of the toes. It acts like a bowstring, supporting the arch of the foot during standing and walking.

When repetitive tension exceeds the fascia’s tolerance — from overuse, increased activity, poor footwear, or biomechanical factors — microtears develop at the fascial insertion on the heel bone. This triggers an inflammatory response that produces the characteristic stabbing pain.

Classic Plantar Fasciitis Symptoms

• Sharp heel pain with the first steps in the morning (post-static dyskinesia) — the most distinctive feature; during sleep, the fascia contracts; the first steps stretch it abruptly, causing pain
• Pain that improves after “warming up” with walking but may return after prolonged standing or sitting
• Tenderness concentrated at the anteromedial aspect of the heel (the inner front of the heel bone where the fascia attaches)
• Pain that worsens after (not during) exercise
• Gradual onset over weeks to months — not from a single injury

What Is a Heel Spur?

A heel spur (calcaneal spur) is a bony projection that grows from the calcaneus — typically at either the plantar (bottom) surface where the plantar fascia attaches, or the posterior surface where the Achilles tendon inserts.

Plantar heel spurs form through a process called endochondral ossification: chronic tension at the plantar fascia insertion stimulates bone-forming cells (osteoblasts) to lay down calcium deposits along the fascial fibers. Over months to years, these deposits consolidate into a calcified spur visible on X-ray, projecting forward from the calcaneus.

Key Fact: Most Heel Spurs Don’t Cause Pain

Here’s the critical point that surprises most patients: heel spurs are present in approximately 70% of patients with plantar fasciitis — but also in 16–27% of people with no heel pain at all. The spur itself rarely causes the pain. The pain comes from the inflamed plantar fascia at the insertion point. The spur is a radiographic marker of chronic fascial stress, not an independent pain generator in most cases.

This is why surgically removing a heel spur alone — without addressing the plantar fascia — rarely resolves symptoms. And it’s why many people with heel spurs visible on X-ray have no pain whatsoever.

How They’re Related: The Cause-Effect Relationship

The relationship between plantar fasciitis and heel spur is this:

• Plantar fasciitis causes chronic, repetitive tension at the fascial-calcaneal insertion
• Over time, this stress stimulates bony remodeling, producing a heel spur
• The spur is essentially the body’s attempt to strengthen the insertion point under stress
• Once formed, the spur exists even if the fascial inflammation fully resolves
• A heel spur on X-ray means the patient has had (or has) significant plantar fascia strain — but doesn’t mean the fascia is currently inflamed

Posterior Heel Spur (Haglund’s Deformity)

Not all heel spurs are plantar. A posterior heel spur forms at the top-back of the calcaneus where the Achilles tendon inserts. Haglund’s deformity — an enlarged posterior superior calcaneal prominence — causes pain and swelling at the back of the heel, aggravated by rigid-backed shoes (pumps, dress shoes, skates). This is a completely different condition from plantar fasciitis and treated differently.

Diagnosis: How to Tell Which Condition You Have

A podiatrist distinguishes plantar fasciitis from heel spur through clinical examination and imaging:

• Location of maximum tenderness — the anteromedial calcaneal insertion points strongly to plantar fasciitis; posterior pain suggests Achilles/posterior spur pathology
• X-ray — identifies the presence, size, and direction of any bony spur; a lateral foot X-ray is standard
• Diagnostic ultrasound — assesses plantar fascia thickness (>4mm suggests fasciitis), visualizes microtears, and detects associated soft tissue pathology in real time without radiation
• MRI — used when the diagnosis is uncertain or when partial fascial tears or stress fractures need to be excluded

Treatment: Plantar Fasciitis vs. Heel Spur

Because the pain generator in both conditions is the inflamed plantar fascia (not the spur itself), treatment is directed at the fascia:

Conservative Treatment (Both Conditions)

• Calf and plantar fascia stretching — reduces fascial tension at the insertion; most important single intervention
• Night splints — hold the foot in slight dorsiflexion overnight, preventing the fascia from contracting; reduces morning first-step pain significantly
• Supportive footwear — shoes with adequate arch support and heel cushioning; avoid barefoot walking especially in the morning
• Custom orthotics — corrects the biomechanical driver (overpronation, high arch) of excess fascial tension; more effective than OTC insoles for structural contributors
• Anti-inflammatory medications — ibuprofen or naproxen for short-term acute symptom relief
• Activity modification — reduce high-impact activities that stress the insertion

Advanced Treatments

• MLS Laser Therapy — FDA-cleared photobiomodulation; reduces inflammation and stimulates fascial healing at the cellular level; highly effective for chronic plantar fasciitis; typically 6–8 sessions
• Cortisone injection — rapidly reduces acute inflammation; most effective for moderate-to-severe cases; limited to 1–2 injections due to risk of fat pad atrophy
• Shockwave therapy (EPAT) — high-energy sound waves stimulate fascial repair; particularly effective for chronic cases (>6 months duration)
• PRP injection — platelet-rich plasma delivers growth factors directly to the fascial insertion to stimulate healing of chronic microtears

When Is Heel Spur Surgery Necessary?

Fewer than 5% of plantar fasciitis patients require surgery. Surgery — either open or endoscopic plantar fascia release — is considered only when:

• Symptoms have persisted for more than 12 months despite dedicated conservative care
• Multiple advanced treatments (orthotics, laser, shockwave, PRP) have failed
• Activity limitation is severe and quality of life significantly impaired

The heel spur is typically not removed during surgery unless a large spur is directly impinging on soft tissue. Removing the spur without addressing the fascia is ineffective.

Frequently Asked Questions

Persistent heel pain in Southeast Michigan deserves a proper diagnosis — not just rest and anti-inflammatories. Balance Foot & Ankle in Howell and Bloomfield Hills provides on-site digital X-ray, diagnostic ultrasound, MLS laser therapy, and custom orthotics. Dr. Tom Biernacki DPM will identify the exact cause of your heel pain and develop a targeted treatment plan. Request your appointment today.

Medical References & Sources

• American Podiatric Medical Association — Plantar Fasciitis
• PubMed Research — Plantar Fasciitis Treatment Studies
• American Orthopaedic Foot & Ankle Society — Heel Pain

Dr. Tom Biernacki, DPM

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.