ConditionBones, joints & muscles
Heel Spur (Calcaneal Spur)
A heel spur is a small, pointed bony outgrowth on the heel bone (calcaneus), seen on X-ray. The common type sits under the heel where the plantar fascia attaches, and another type forms at the back of the heel where the Achilles tendon inserts. Spurs develop slowly from long-term strain. Many people with spurs have no pain at all, and when the heel hurts, the pain usually comes from inflamed or degenerated tissue (plantar fasciitis or Achilles tendinopathy) rather than the spur itself. Most improve without surgery.
Also called: Calcaneal spur, bone spur on the heel, heel bone spur, plantar calcaneal spur, enthesophyte
At a glance
- What it is
- A bony projection on the heel bone at a tendon or ligament attachment.
- Types
- Plantar (under the heel) and posterior (back of the heel, at the Achilles).
- Pain source
- Usually plantar fasciitis or Achilles tendinopathy, not the spur. Many spurs are painless.
- Risk factors
- Age over 40, weight gain, running, prolonged standing, flat or high arches, tight calves.
- Treatment
- Stretching, supportive shoes, heel cups or orthotics, ice, pain relief, physical therapy. Surgery rarely needed.
When to get help
See a doctor within a day or two
- Sudden heel pain after a fall or jump, or inability to bear weight (possible fracture)
- A sudden pop at the back of the heel with difficulty pushing off (possible Achilles rupture)
- A red, hot, swollen heel with fever, or a heel wound in someone with diabetes
Book a routine appointment
- Heel pain lasting more than 2 to 3 weeks despite rest and good shoes
- Heel pain with numbness, tingling or burning (possible nerve entrapment)
- Heel pain with back pain and morning stiffness in a young adult (possible inflammatory arthritis)
Usually safe to manage at home
- Morning heel pain that eases after a few steps, without injury, managed with stretches and supportive shoes
How heel spurs form
Where the plantar fascia (the thick band along the sole) and the Achilles tendon attach to the heel bone, repeated pulling and microtears trigger the body to lay down calcium. Over months to years, this forms a spur. Spurs are found on X-rays in a significant minority of adults, many of whom have never had heel pain.
Heel spur vs plantar fasciitis
| Feature | Heel spur | Plantar fasciitis |
|---|---|---|
| What it is | Bony growth seen on X-ray | Degeneration and inflammation of the plantar fascia |
| Causes pain? | Usually not by itself | Yes, the main cause of heel pain |
| Typical symptom | Often none | Sharp pain with first morning steps, eases then returns |
| Relationship | Often coexists with plantar fasciitis | May exist without a spur |
| Treatment | Treat the soft tissue problem | Stretching, shoes, orthotics, therapy |
Removing a spur rarely fixes heel pain, which is why treatment focuses on the soft tissues.
Posterior heel spurs
Spurs at the back of the heel occur where the Achilles tendon attaches. They often accompany insertional Achilles tendinitis, causing pain and a bump at the back of the heel, worse with shoes that rub, running uphill and the first steps after rest. A prominent bony bump (Haglund's deformity) may also irritate a bursa.
Risk factors
- age over 40
- excess body weight
- running and jumping sports
- jobs with long hours of standing on hard floors
- flat feet or high arches
- tight calf muscles and Achilles tendon
- unsupportive or worn-out shoes
- inflammatory arthritis such as ankylosing spondylitis, which causes spurs at tendon attachments
Symptoms
When symptoms occur, they come from associated conditions:
- sharp or stabbing pain under the heel with the first steps in the morning or after sitting
- a dull ache through the day
- tenderness at the front of the heel underneath
- pain at the back of the heel with a visible bump (posterior spurs)
- pain worse after, rather than during, exercise
Diagnosis
A doctor or podiatrist diagnoses the cause of heel pain from your history and by pressing on specific points. An X-ray shows the spur, but its presence does not prove it is causing pain. Ultrasound or MRI can show plantar fascia thickening, tendon problems or a stress fracture. Thinning of the heel's fat cushion (heel fat pad syndrome) is another cause of pain. Blood tests may be used if inflammatory arthritis is suspected.
Treatment
Most people improve within 6 to 12 months with non-surgical treatment.
Self-care
- calf and plantar fascia stretches several times daily, especially before getting out of bed
- supportive shoes with cushioned heels and good arch support. Avoid walking barefoot on hard floors
- heel cups or pads and over-the-counter arch supports
- ice for 15 minutes after activity, or roll the foot over a frozen water bottle
- reduce high-impact activity temporarily. Switch to cycling or swimming
- weight loss if overweight
- pain relief: NSAIDs such as ibuprofen, following the label dose, for short periods
Medical treatments
- physical therapy: stretching, strengthening and taping
- custom orthotics
- night splints that hold the foot flexed, for morning pain
- corticosteroid injection for persistent plantar fasciitis. Used sparingly because repeated injections can rupture the fascia or thin the heel fat pad. Avoided near the Achilles tendon
- extracorporeal shockwave therapy for chronic cases
Surgery
Considered only after 6 to 12 months of failed non-surgical treatment. Options include partial release of the plantar fascia or a gastrocnemius (calf muscle) recession. Spur removal may be done during surgery for posterior heel problems, but removing a plantar spur alone is rarely indicated.
Prevention
- wear supportive, well-fitting shoes and replace running shoes regularly
- stretch your calves
- increase activity gradually
- maintain a healthy weight
Frequently asked questions
Do heel spurs cause pain?
Often not. Many people have heel spurs on X-ray without any pain. Heel pain usually comes from plantar fasciitis or Achilles tendinopathy, which often coexist with spurs. Treatment therefore focuses on the soft tissues.
What is the difference between a heel spur and plantar fasciitis?
A heel spur is a bony growth on the heel bone. Plantar fasciitis is degeneration and inflammation of the band of tissue on the sole of the foot. Plantar fasciitis causes most heel pain, and it may occur with or without a spur.
How do you get rid of a heel spur?
The spur itself usually stays, but pain can be relieved without surgery through stretching, supportive shoes, heel cups, orthotics, ice and physical therapy. Surgery is reserved for persistent pain after 6 to 12 months of treatment.
What shoes are best for heel spurs?
Shoes with a cushioned, slightly raised heel, firm heel counter and good arch support are best. Avoid flat, unsupportive shoes and going barefoot on hard floors. Heel cups or orthotics can add cushioning.
How long does heel spur pain last?
Heel pain from plantar fasciitis usually improves within 6 to 12 months with consistent stretching and supportive footwear, and most people avoid surgery. Earlier treatment often leads to faster recovery.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Plantar fasciitis and bone spurs
- American College of Foot and Ankle Surgeons: Heel pain clinical consensus statement
- American Podiatric Medical Association: Heel pain
- NHS: Heel pain
- MedlinePlus: Heel pain