Heel Spurs – What They Are and Why They Don't Always Cause Pain
Heel spurs are calcium deposits that don't necessarily cause pain. Learn why some spurs hurt and others don't, and discover effective treatment options to manage heel pain.
By Dr. Robert Hoover, DPM, FACFAS
Heel Spurs – What They Are and Why They Don't Always Cause Pain
You've probably heard that heel spurs cause heel pain, but here's the surprising truth: many people have heel spurs and never experience any pain. Understanding what heel spurs actually are, why some cause symptoms while others don't, and how to manage them can help ease your concerns and guide appropriate treatment decisions.
What Are Heel Spurs?
A heel spur is a calcium deposit that forms a small, pointed bone projection on your heel bone (calcaneus). These spurs typically develop on the bottom of your heel where the plantar fascia attaches, though they can also form at the back of the heel where the Achilles tendon attaches.
Heels spurs are benign bony growths—not infections or tumors. They develop gradually over months or years and are visible on X-ray imaging.
The Heel Spur and Plantar Fasciitis Connection
Many people assume heel spurs cause plantar fasciitis, but the relationship is more complex:
Heel Spurs Don't Cause Fasciitis: Surprisingly, research shows that heel spurs themselves don't cause pain. Many people with heel spurs have no symptoms whatsoever. The AAOS plantar fasciitis and bone-spurs page draws the same line: the spur shows up on X-ray, but most people with a heel spur don't have heel pain — the fascia is usually what's hurting. In fact, roughly 50% of people with heel spurs never experience heel pain.
Shared Risk Factors: Heel spurs and plantar fasciitis develop from similar causes—repetitive strain, biomechanical imbalances, and inflammation. They often occur together, but the spur isn't the problem; the fascia inflammation is.
The Inflammation Is the Issue: When plantar fasciitis develops, the inflamed fascia may calcify over time, forming a heel spur. The spur is essentially a marker of previous or ongoing inflammation, not the cause of pain.
How Heel Spurs Develop
Understanding spur formation helps explain why not all spurs cause problems:
Repetitive Strain: Repetitive stress on the plantar fascia triggers micro-tears and inflammation. Your body responds by depositing calcium at the attachment site, forming a spur.
Biomechanical Factors: Excessive foot pronation, flat feet, tight calf muscles, and poor arch support change how forces distribute through your foot. This increased stress accelerates spur formation.
Age: Heel spurs are more common as we age, with highest incidence in people over 40. Decades of mechanical stress on the heel create ideal conditions for calcification.
Inflammatory Conditions: Arthritis and other inflammatory diseases increase heel spur development.
Lifestyle Factors: Prolonged standing, high-impact activities, excess body weight, and poor footwear all contribute to spur formation.
Genetics: Some people's bodies are more prone to calcification at attachment sites, partly due to genetic predisposition.
Why Some Heel Spurs Cause Pain and Others Don't
This is the key question many patients ask—why do some people with spurs have terrible pain while others have none?
Associated Plantar Fasciitis: People with painful heels usually have plantar fasciitis along with the spur. The inflammation, not the spur, causes pain.
Spur Morphology: Spurs vary in size, shape, and exact location. Some may irritate surrounding soft tissues more than others, though this isn't the primary pain source.
Soft Tissue Inflammation: The tissues surrounding the spur (bursa, fascia, and other soft structures) may become inflamed. This inflammation, pressing against the spur, can cause pain.
Individual Pain Sensitivity: People vary in pain sensitivity. Some tolerate the same anatomical finding that causes severe symptoms in others.
Functional Loading: How you load your feet during activities affects symptom development. Two people with identical spurs may have different pain levels based on activity patterns.
Recognizing Heel Spur Symptoms
When heel spurs do cause symptoms, they typically include:
Heel Pain: Sharp or dull pain in the heel, particularly at the base where the plantar fascia attaches. Pain may feel like a knife or pointed object under your heel.
Morning Pain: Many people experience worst pain immediately upon waking, before getting out of bed. Taking those first steps is often excruciating. Pain may improve slightly as you warm up.
Pain After Rest: Pain typically worsens after prolonged rest or sitting. Standing again after rest often triggers sharp discomfort.
Activity-Related Pain: High-impact activities, prolonged standing, or activities requiring forefoot pressure often trigger or worsen pain.
Radiating Pain: Pain may extend along the arch toward the ball of your foot or into your calf.
Visible Swelling: Some people develop visible swelling or redness in the heel area, though this isn't always present.
Diagnosis: Identifying Heel Spurs
Diagnosis typically involves:
Clinical History and Physical Examination: We discuss your pain characteristics, what triggers and relieves symptoms, and how long you've had heel pain. Physical examination includes palpation of the heel to identify tender points.
X-Ray Imaging: X-rays clearly show heel spurs, revealing their size, location, and shape. However, X-rays are often unnecessary for diagnosis—many painful heels don't have spurs, and many painless heels do.
Ultrasound: Ultrasound imaging shows both bony spurs and soft tissue inflammation, providing more complete information about what's actually causing your pain.
Differential Diagnosis: We ensure heel pain isn't caused by other conditions like Achilles tendinitis, plantar fasciitis without spurs, stress fractures, or nerve entrapment.
Treatment: Addressing Heel Spur Pain
Since the spur itself typically isn't the problem, treatment focuses on managing inflammation and addressing biomechanical factors:
Conservative Management (First-Line Treatment)
Activity Modification and Rest: Reducing high-impact activities and prolonged standing allows inflammation to subside. This is particularly important in early treatment.
Ice Application: Applying ice for 15-20 minutes, 3-4 times daily reduces inflammation and provides pain relief. This is especially helpful after activities that trigger pain.
Anti-Inflammatory Medications: NSAIDs like ibuprofen effectively reduce inflammation and pain. These address the inflammation driving your symptoms, not the spur itself.
Heel Cushioning and Padding: Soft heel cups and padded insoles reduce pressure on the painful heel and provide immediate pain relief. Specialized heel pads that take pressure off the spur area are particularly helpful.
Stretch and Strengthening: Calf stretches, plantar fascia stretches, and foot-strengthening exercises address the biomechanical issues causing inflammation. Regular stretching is essential for long-term relief.
Proper Footwear: Shoes with:
- Good heel cushioning
- Adequate arch support
- Low to moderate heel height (1-1.5 inches)
- Flexibility in the forefoot
Improper footwear is often the primary culprit; proper shoes alone sometimes provide complete relief.
Custom Orthotics: Orthotics address the underlying biomechanical issues—excess pronation, poor arch support, or abnormal weight distribution—that created the conditions for heel spur formation.
Advanced Conservative Treatments
Night Splints: Special splints keep your foot in a dorsiflexed position (toes pointed upward) while sleeping. This prevents the plantar fascia from tightening overnight, reducing morning pain significantly.
Physical Therapy: Supervised therapy provides professional guidance on stretching, strengthening, and biomechanical correction. A skilled therapist can identify and address specific movement patterns perpetuating inflammation.
Corticosteroid Injections: When conservative measures don't provide adequate relief, targeted steroid injections into the inflamed tissues around the spur can provide sustained pain relief. Multiple injections over time may be needed.
Platelet-Rich Plasma (PRP) Injections: Emerging evidence suggests PRP injections may stimulate healing of the plantar fascia and surrounding tissues.
Surgical Intervention
Surgery is rarely necessary for heel spur pain. When conservative treatment fails after 6-12 months and pain significantly impacts quality of life, surgical options exist:
Plantar Fascia Release: Removing the spur alone typically doesn't help—the underlying fascial inflammation persists. Instead, the plantar fascia is partially or completely released. The spur may or may not be removed.
Success Rates: Surgery provides pain relief in 60-90% of cases, though some residual symptoms persist in some patients. Recovery takes 4-6 weeks.
Prevention Strategies
Prevent heel spur development and recurrence:
- Maintain healthy body weight
- Wear supportive, properly-fitted shoes
- Stretch calf muscles and plantar fascia daily
- Strengthen intrinsic foot muscles
- Avoid high heels and unsupported shoes
- Use custom orthotics if prone to spur development
- Incorporate low-impact exercise
- Address foot biomechanical issues
- Take frequent breaks from prolonged standing
The Bottom Line
Heel spurs are a marker of previous or ongoing heel stress—they're not inherently painful. The inflammation, not the spur itself, causes your pain. This understanding changes how we approach treatment: instead of removing the spur, we address the inflammation and biomechanical factors creating it. This approach has excellent success rates, with most people finding complete pain relief through conservative management.
At Central Florida Foot & Ankle Institute, Dr. Robert Hoover and our team across Lake Mary (Waymont and MedPlex) and Downtown Orlando / SODO locations understand heel spur treatment. People also drive in from Sanford, Altamonte, and Longwood — we do not have offices in those towns. We focus on managing your inflammation and correcting the underlying biomechanical issues causing your pain.
Don't assume your heel spur is your problem. Call (407) 307-0006 or book your appointment at https://floridafai.intakeq.com/booking to get accurate diagnosis and effective treatment.