Heel Spurs vs Plantar Fasciitis FAQs

Most heel pain comes from plantar fasciitis, not heel spurs. Heel spurs and plantar fasciitis are related, but they are not the same condition. If you are comparing these two problems, it also helps to consider other causes of heel pain, as symptoms can overlap.

In practice, many people with plantar heel pain do not need imaging straight away. Your physiotherapist can assess your symptoms, foot loading, calf flexibility, tenderness, and walking mechanics to guide diagnosis. Imaging may help if symptoms are unclear, severe, linked to trauma, or not improving as expected.

What is the difference between heel spurs and plantar fasciitis?

The main difference is that a heel spur is a bony growth, while plantar fasciitis is irritation or overload of the plantar fascia. Heel spurs may appear on X-ray without causing pain, whereas plantar fasciitis more often matches the classic first-step heel pain pattern.

Key differences at a glance

• Heel spurs are usually identified on X-ray.
• Plantar fasciitis is often diagnosed from symptoms and assessment.
• Both conditions can occur together.
• Many people have a heel spur without pain.
• First-step pain strongly suggests plantar fascia irritation.

Heel Spurs vs Plantar Fasciitis: Quick Comparison

Feature	Heel Spur	Plantar Fasciitis
Main issue	A bony growth on the heel bone.	Irritation or overload of the plantar fascia.
Typical pain pattern	May cause no pain, even when visible on X-ray.	Often sharp first-step pain after sleep or rest.
How it is found	Usually seen on X-ray.	Often diagnosed from symptoms and physical assessment.
Can they occur together?	Yes, heel spurs can occur with plantar fascia overload.	Yes, plantar fasciitis can occur with or without a spur.

What are heel spurs?

Heel spurs, also called calcaneal spurs, are bony growths that form near the underside of the heel bone. They typically develop over time where the plantar fascia and surrounding tissues attach to the calcaneus.

A heel spur may look significant on an X-ray, but it does not always cause pain. In many cases, the primary issue is irritation of the surrounding soft tissue, particularly the plantar fascia.

What is plantar fasciitis?

Plantar fasciitis involves irritation of the thick band of tissue that runs from the heel to the toes and supports your arch. Many cases behave more like a load-related tissue irritation than a simple inflammatory condition.

This condition is one of the most common causes of plantar heel pain and often develops when activity levels exceed what the tissue can tolerate.

How do symptoms differ between heel spurs and plantar fasciitis?

Plantar fasciitis usually follows a recognisable pain pattern, whereas a heel spur may cause no symptoms. Sharp pain with your first steps in the morning or after rest is far more typical of plantar fasciitis.

Common signs include:

• pain under the heel when getting out of bed
• pain after sitting and then standing
• soreness under the heel or arch after prolonged standing or walking
• pain that eases with movement but returns later

By contrast, a heel spur is often an incidental finding on imaging.

How do you diagnose heel spurs and plantar fasciitis?

Heel spurs are usually confirmed with X-ray. Plantar fasciitis is often diagnosed clinically, although ultrasound or MRI may assist when symptoms are unclear or persistent.

Your physiotherapist may assess tenderness, first-step pain, calf flexibility, foot posture, and walking patterns. Other causes such as Achilles tendinopathy or broader foot pain may also be considered.

For a broader overview, Healthdirect provides helpful information on plantar fasciitis.

Can you have heel spurs and plantar fasciitis at the same time?

Yes. These conditions often occur together, particularly with long-term plantar heel overload. However, the pain usually comes from the surrounding soft tissues rather than the spur itself.

How can physiotherapy help plantar heel pain?

Physiotherapy aims to reduce irritation, improve load tolerance, and guide a gradual return to normal activity. A treatment plan may include education, footwear advice, taping, strength work, plantar fascia loading, and pacing strategies.

• calf stretching and strengthening
• plantar fascia loading exercises
• foot muscle strengthening
• taping and support strategies
• footwear advice

Supports such as heel cups or orthotics may assist as part of a broader management plan.

When should you seek help for heel pain?

You should seek help if your heel pain is worsening, not improving after several weeks, changing your walking pattern, or limiting work, exercise, or sleep.

A clear diagnosis helps guide the right treatment plan. You can also explore our heel pain FAQs for more information.

Heel Spurs vs Plantar Fasciitis FAQs

Are heel spurs always painful?

No. Many people have heel spurs on X-ray without heel pain. A heel spur may sit near the plantar fascia attachment, but pain often comes from the surrounding soft tissue rather than the spur itself. This is why symptoms and physical assessment matter more than the X-ray image alone.

Is first-step pain more likely to be plantar fasciitis?

Yes. Sharp heel pain with your first steps in the morning, or after sitting, is more typical of plantar fasciitis than a heel spur alone. The pain may ease as you move, then return after long periods of standing, walking or running.

Do I need an X-ray for plantar fasciitis?

Not always. Many cases of plantar fasciitis can be assessed clinically by reviewing your pain pattern, heel tenderness, calf flexibility, foot posture and walking mechanics. Imaging may help if symptoms are unusual, severe, linked to trauma, or not improving as expected.

Can orthotics or heel cups help plantar heel pain?

Orthotics, heel cups or footwear changes may help some people reduce strain and improve comfort. They usually work best as part of a broader plan that also considers calf strength, plantar fascia loading, walking volume, work demands and gradual return to activity.

Can a heel spur go away?

The bony spur usually remains, but symptoms can still improve. Treatment generally focuses on reducing soft tissue irritation, improving load tolerance and addressing contributing factors. Many people feel better even though the spur remains visible on imaging.

When should I book a physiotherapy assessment for heel pain?

Book an assessment if heel pain is worsening, lasting more than a few weeks, changing how you walk, or limiting work, exercise or sleep. A physiotherapist can help identify whether the pain pattern fits plantar fasciitis, heel spur irritation, Achilles tendinopathy or another heel pain source.

References

1. Drake C, Whittaker GA, Kaminski MR, et al. Medical imaging for plantar heel pain: a systematic review and meta-analysis. J Foot Ankle Res. 2022;15(1):4. doi:10.1186/s13047-021-00507-2
2. Koc TA Jr, Bise CG, Neville C, et al. Heel Pain – Plantar Fasciitis: Revision 2023. J Orthop Sports Phys Ther. 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303
3. Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur: fact or fiction?. Foot Ankle Surg. 2012;18(1):39-41. doi:10.1016/j.fas.2011.03.003
4. Kirkpatrick J, Yassaie O, Mirjalili SA. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations. J Anat. 2017;230(6):743-751. doi:10.1111/joa.12607