A heel spur is a small bony growth under the heel bone. However, most heel spur pain comes from irritated soft tissues such as the plantar fascia rather than the spur itself. Treatment usually focuses on reducing tissue irritation, improving foot strength, supporting your heel, and managing load so you can walk more comfortably.

Heel spur pain is a common cause of heel pain, especially with your first few steps in the morning. Heel spurs often occur alongside plantar fasciitis, and both problems can make walking, work, and sport uncomfortable.

At PhysioWorks, our Brisbane physiotherapists assess plantar heel pain, walking mechanics, calf tightness, footwear, and training loads. Treatment aims to reduce irritation, improve foot and calf strength, and help you return to comfortable daily activity.

What Is a Heel Spur?

A heel spur is a small bony growth that forms on the underside of the heel bone. Many people have a heel spur without symptoms, and when pain occurs, it usually relates more to irritated soft tissues such as the plantar fascia than to the spur itself.

Heel spurs are also called calcaneal spurs. On an X-ray, they may look like a hook or spike projecting forward from the heel bone. Even so, the scan finding alone does not explain how painful your heel is or how much it affects walking.

This is why a heel spur assessment should look beyond the scan. Your physiotherapist will also consider plantar fascia irritation, calf tightness, ankle mobility, load tolerance, and other causes of foot pain or heel pain.

Heel Spur vs Plantar Fasciitis

Heel spurs and plantar fasciitis are closely linked, but they are not exactly the same thing. A heel spur is the bony change seen on imaging, while plantar fasciitis refers to irritation of the plantar fascia and nearby tissues that often causes the pain.

If your symptoms sit more within the plantar fascia pattern, you may also benefit from reading our guide to plantar fasciitis.

What Causes Heel Spur Pain?

Heel spur pain usually develops after repeated overload through the plantar fascia and nearby heel tissues. The spur may form over time, but pain is more likely when the surrounding fascia, fat pad, or attachment tissues become irritated.

Common contributors include:

• Sudden increases in walking, running, or standing time
• Hard surfaces and unsupportive or worn-out shoes
• Flat feet, high arches, or altered foot mechanics
• Tight calf muscles and limited ankle dorsiflexion
• Higher body weight or pregnancy increasing heel load
• Work demands that keep you on your feet for long periods
• Other health issues affecting tissue tolerance, such as arthritis or diabetes

Heel spur pain often overlaps with plantar fasciitis. It may also need to be distinguished from retrocalcaneal bursitis, Achilles tendinopathy, or other local tissue irritation around the heel.

Common Symptoms of Heel Spurs

Heel spur symptoms usually involve pain under the heel rather than pain at the back of the heel. The pattern often matches plantar heel pain, with soreness that is worst when you first get moving and improves once the tissues warm up.

• Sharp or stabbing pain under the heel
• Morning first-step pain
• Pain after rest, especially after sitting
• Tenderness on the underside of the heel
• Increased pain with prolonged walking or standing
• Discomfort walking barefoot on tiles or concrete

Typical Heel Spur Pain Pattern

Heel spur pain often follows a predictable plantar heel pain pattern. Symptoms are commonly worst with the first few steps in the morning or after rest, improve slightly once the tissues warm up, then become sore again after prolonged walking or standing.

Children and teenagers with heel pain may have Sever’s disease rather than a heel spur. Age, activity level, and examination findings help separate these problems.

How Is Heel Spur Pain Diagnosed?

Heel spur pain is usually diagnosed through your symptom history and a physical examination. A physiotherapist will assess where the pain is, what loads aggravate it, how your foot moves, and whether another heel condition is a better fit.

Your assessment may include foot posture, walking pattern, calf flexibility, ankle mobility, footwear, and recent training or workload changes. In many cases, imaging is not needed early. If symptoms persist or the diagnosis is unclear, your doctor may request an X-ray, ultrasound, or MRI.

Imaging can show a calcaneal spur, plantar fascia thickening, or nearby tissue changes. Yet scans can also show a heel spur in people with no pain at all. For that reason, your examination findings matter more than the size of the spur alone. For general consumer advice, Healthdirect also provides a helpful overview of heel pain.

How Do You Treat Heel Spurs?

Heel spur treatment usually works best when it targets pain relief, load management, foot support, and progressive strengthening. Most people improve without surgery when the irritated tissues are calmed and the foot is helped to tolerate daily loads better.

Short-Term Pain Relief

• Modify aggravating activities while symptoms settle
• Use ice after activity if the heel feels reactive
• Trial heel cushions or heel cups to reduce local pressure
• Use hands-on therapy or joint mobilisation when helpful

Stretching and Strengthening

Exercise is one of the most important parts of recovery. Your physiotherapist may prescribe calf stretches, plantar fascia stretches, calf strengthening, and foot control work such as active foot posture correction exercises.

Taping, Bracing, and Footwear

Mechanical support can reduce strain through the sore heel. Depending on your presentation, your physiotherapist may recommend taping, a heel cup, supportive footwear, or orthotics.

You can also review our heel braces and supports if you want home support options that match your treatment plan.

Adjunct Treatments

If symptoms stay stubborn, other options may be discussed. These can include shockwave therapy, dry needling, or injections coordinated with your doctor. Surgery is rarely needed and is usually considered only after a long period of strong conservative care.

Load Management for Heel Spur Pain

Load management is a key part of heel spur recovery. In simple terms, it means reducing the loads that irritate your heel, then rebuilding your tolerance in a gradual way so the tissues can cope better over time.

This often means avoiding a sudden jump in walking, running, standing, or barefoot time while your heel is sensitive. It does not always mean full rest. Instead, your physiotherapist will usually guide a safer activity level that keeps you moving without repeatedly flaring the pain.

• Reduce aggravating load during painful flare-ups
• Keep moving within a tolerable range
• Rebuild calf, foot, and walking tolerance gradually
• Progress activity in small steps rather than big jumps

If you return to full activity too quickly, heel pain can settle for a few days and then flare again. Good load management helps prevent that boom-and-bust pattern.

How Long Does Heel Spur Pain Take to Settle?

Heel spur pain may settle within a few weeks when the irritation is mild and the main loading factors are changed early. More persistent cases often take a few months, especially when the heel has been sore for a long time or walking demands remain high.

Consistent rehabilitation matters. The best results usually come from a combination of load modification, exercise, supportive footwear, and a progressive return to activity.

Why Does Heel Spur Pain Keep Coming Back?

Heel spur pain often returns when the underlying load problem has not been fixed. The pain may calm down temporarily, but it can flare again if foot strength, calf capacity, footwear, or daily loading patterns have not improved enough.

Common reasons for recurring heel spur pain include:

• Returning to long walks or running too quickly
• Continuing to wear worn-out or unsupportive shoes
• Not restoring calf strength and ankle mobility
• Stopping exercises too early once the pain eases
• Ignoring contributing factors such as work demands or body weight changes

This is one reason a structured physiotherapy program often works better than relying only on rest, passive treatment, or a scan result.

Can You Prevent Heel Spur Pain Returning?

You can reduce the risk of flare-ups by keeping the calf and foot strong, improving ankle flexibility, and wearing shoes with enough support for your daily activity. Gradual load progression also matters, especially if you are increasing work hours on your feet or returning to running.

• Keep up calf and foot strengthening
• Maintain flexibility through the calf and plantar fascia
• Replace worn-out shoes before they lose support
• Increase walking or running loads gradually
• Address recurring foot mechanics or training errors early

When Should You Seek Help for Heel Spur Pain?

You should seek help for heel spur pain if it lasts more than a couple of weeks, keeps returning, or makes walking difficult. Early physiotherapy can clarify the diagnosis, reduce the risk of persistent pain, and help you follow a more effective plan.

• Pain lasts longer than two weeks
• Morning pain is severe or you are limping
• You cannot increase walking, work, or sport comfortably
• You are unsure whether it is a heel spur, plantar fasciitis, or another condition

What to Do Next

If your heel pain is not settling, do not rely on the X-ray finding alone. A heel spur often sits alongside soft tissue overload, and the best treatment plan depends on your movement, loading pattern, footwear, and daily demands.

Book a physiotherapy assessment at your nearest PhysioWorks clinic. We can identify the main driver of your pain and guide the next steps for walking, work, exercise, and long-term recovery.

Heel Spur FAQs

Are heel spurs always painful?

No. Many people have a heel spur on X-ray without symptoms. When pain is present, the irritated plantar fascia or nearby heel tissues are often more important than the bony spur itself.

Do heel spurs go away?

The spur often remains visible on imaging, but your pain can still settle fully. Treatment aims to calm the irritated tissues and improve function rather than remove the spur.

Can I keep walking with a heel spur?

Usually yes, but your walking volume may need to be reduced at first. Supportive footwear, taping, heel cups, and a guided exercise plan often help you stay active more comfortably.

Will I need surgery for a heel spur?

Surgery is uncommon. Most people improve with physiotherapy, load management, footwear advice, and targeted support such as orthotics or heel cups when needed.

What is the best treatment for heel spur pain?

The best treatment is usually a combination of education, load management, stretching, strengthening, footwear advice, and short-term support. A physiotherapist can tailor this to your work, walking, and sport goals.

Is a heel spur the same as plantar fasciitis?

No. A heel spur is a bony growth, while plantar fasciitis is irritation of the plantar fascia and nearby tissues. They often occur together, but the pain usually comes from the irritated soft tissues rather than the spur itself.

What shoes are best for heel spurs?

Shoes with good cushioning, heel support, and stable arch support are often helpful. The best choice depends on your foot shape, work demands, and activity level, so personalised advice is often worthwhile.

Related Heel Pain Articles

1. Plantar Fasciitis – Learn how plantar heel pain develops and how it is treated.
2. Retrocalcaneal Bursitis – Learn about pain at the back of the heel and how it differs from plantar heel pain.
3. Achilles Tendinopathy – Review another common source of heel and calf pain.
4. Sever’s Disease – A common cause of heel pain in active children and teenagers.
5. Heel Pain – Explore the broader heel pain cluster and related diagnoses.
6. Foot Pain – Review other foot conditions that can affect walking and sport.
7. Heel, Foot and Ankle Pain FAQs – Common answers to foot and heel pain questions.

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References

1. Koc TA Jr, Bise CG, McDonough CM, et al. Heel Pain – Plantar Fasciitis: Revision 2023. J Orthop Sports Phys Ther. 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303
2. Morrissey D, Cotchett M, Said JH, et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med. 2021;55(19):1106-1118. doi:10.1136/bjsports-2019-101970
3. Drake C, Malliaras P, McSorley E, et al. Medical imaging for plantar heel pain: a systematic review and meta-analysis. J Foot Ankle Res. 2022;15(1):10. doi:10.1186/s13047-022-00507-2