Difference Between Heel Spur and Plantar Fasciitis: How to Tell the Difference and Get the Right Treatment

Heel pain is one of the most common complaints podiatrists hear from patients, and two conditions are often at the center of it: heel spurs and plantar fasciitis. These terms are sometimes used interchangeably, but they are not the same. Understanding the difference between a heel spur and plantar fasciitis is key to getting the right diagnosis and treatment plan.

In this article, we’ll break down what each condition is, how they differ, how they’re diagnosed, and what treatment options can bring lasting relief.

What Is Plantar Fasciitis?

Plantar fasciitis is one of the leading causes of heel pain. It occurs when the plantar fascia, a thick band of tissue connecting your heel bone to your toes, becomes inflamed or strained.

Common symptoms include:

• Sharp heel pain, especially with your first steps in the morning or after sitting.
• Pain that improves slightly with movement but worsens after long standing, running, or exercise.
• Tenderness along the heel or arch.

Risk factors for plantar fasciitis include:

• Flat feet or very high arches.
• Tight calf muscles or Achilles tendon.
• Overuse from activities like running or prolonged standing.
• Wearing shoes with poor support or worn-out soles.
• Excess body weight, which increases strain on the plantar fascia.

Most cases are diagnosed through a physical exam and patient history. Imaging such as ultrasound or MRI may be used if symptoms don’t improve or another issue is suspected.

What Is a Heel Spur?

A heel spur is a bony growth (calcium deposit) that develops on the heel bone, often where the plantar fascia attaches. These spurs can look dramatic on X-rays, but the surprising truth is that many people have them without any pain at all.

Key facts about heel spurs:

• They are often discovered incidentally on X-rays.
• They don’t always cause symptoms.
• When painful, they usually cause localized, stabbing pain at the heel bone.
• Pain comes not from the spur itself, but from irritation of surrounding soft tissues.

A heel spur may contribute to discomfort if it aggravates the plantar fascia, but it is not always the primary cause of heel pain.

Difference Between Heel Spur Plantar Fasciitis

While the two conditions can exist together, they are distinct. Here’s how to tell them apart:

Cause

• Plantar fasciitis: Soft tissue inflammation or strain of the plantar fascia. ‍
• Heel spur: A bony growth on the heel bone.

Pain Timing

• Plantar fasciitis: Pain is worst in the morning or after rest, then may ease slightly before returning with prolonged activity.
• ‍Heel spur: Pain tends to be sharper and more localized, appearing when tissue around the spur is irritated. ‍

Pain Location

• Plantar fasciitis: Pain spreads across the bottom of the heel and sometimes into the arch.
• ‍Heel spur: Pain is focused directly under the heel bone. ‍

Diagnosis

• Plantar fasciitis: Usually diagnosed clinically; imaging may confirm tissue changes. ‍
• Heel spur: Visible on X-ray, though many heel spurs do not cause symptoms.

Treatment

• Plantar fasciitis: Emphasizes stretching, supportive shoes, orthotics, and reducing inflammation. ‍
• Heel spur: Similar treatments apply; surgery to remove the spur is rare and only considered if pain persists. ‍
• The bottom line: plantar fasciitis is a soft tissue condition, while a heel spur is a bony change. Plantar fasciitis is often the true source of heel pain, even when a spur is present.

Treatment Options for Heel Spurs and Plantar Fasciitis

Because these conditions often overlap, treatment is usually similar. Most patients improve with conservative care and do not need surgery.

Conservative Care

• Rest and Activity Modification: Avoid activities that aggravate the heel.
• Ice and nonsteroidal anti-inflammatory drugs (NSAIDs): Reduce pain and inflammation.
• Supportive Footwear: Shoes with cushioning and arch support relieve stress on the heel.
• Orthotic Inserts: Custom or over-the-counter orthotics redistribute pressure.
• Stretching Exercises: Stretch the calf muscles and plantar fascia daily to ease strain.
• Night Splints: Keep the fascia gently stretched overnight to reduce morning pain.

Advanced Care

If symptoms don’t improve after several months of conservative treatment, your podiatrist may recommend:

• Corticosteroid Injections: For targeted pain and inflammation relief. ‍
• Shockwave Therapy (ESWT): Stimulates healing in chronic cases. ‍
• Physical Therapy: To strengthen the foot, improve flexibility, and correct gait issues. ‍
• Surgery: Rarely needed. In severe cases, surgery may release the plantar fascia or remove a spur that continues to cause pain.

When to See a Podiatrist

If heel pain lasts more than a few weeks despite rest and home remedies, it’s important to see a podiatrist. A professional evaluation ensures you get the right diagnosis and treatment. Since heel spurs and plantar fasciitis can coexist, it takes expertise to determine which one is actually causing your pain.

Preventing Heel Pain

Even after recovery, prevention is key to avoiding recurrence. Helpful strategies include:

• Wearing supportive shoes with cushioning.
• Replacing worn-out shoes before they lose their structure.
• Stretching your calves and plantar fascia daily.
• Maintaining a healthy weight to reduce foot strain.
• Avoiding long periods of barefoot walking on hard surfaces.

Final Thoughts

The difference between a heel spur and plantar fasciitis lies in their origin: plantar fasciitis is a soft tissue problem, while a heel spur is a bony growth. While they may occur together, plantar fasciitis is usually the main cause of heel pain.

If you’re experiencing persistent heel pain, don’t wait for it to worsen. At FAS The Woodlands, our podiatrists specialize in accurate diagnosis and advanced treatment to get you back on your feet comfortably.

Take the first step toward pain-free living: Book an appointment today.