Heel Spurs: Do They Really Cause Pain?
A heel spur is a small bony growth on the heel bone. They are common, often painless, and usually a sign of long-standing strain rather than the real cause of heel pain.
What a heel spur is
A heel spur (calcaneal spur) is a deposit of calcium that forms a bony projection on the underside or back of the heel bone, usually where the plantar fascia or Achilles tendon attaches. It builds up slowly over months in response to repeated tension on those tissues.
Do they cause pain?
This surprises many people: heel spurs are often not the source of pain. Plenty of people have spurs on X-ray with no symptoms at all, while others have severe heel pain and no spur. The spur is usually a marker of chronic strain rather than the thing pressing on a nerve.
What actually hurts
When a spur is found alongside heel pain, the real culprit is usually the soft tissue, most often plantar fasciitis or, at the back of the heel, Achilles or bursa problems. Treating that soft-tissue inflammation is what relieves the pain — not the spur itself.
Treatment
Because the spur is rarely the problem, treatment targets the underlying condition: calf and fascia stretching, supportive cushioned shoes, heel cups or orthotics, load management and anti-inflammatory measures. Most people improve without ever removing the spur. Surgery for a spur alone is uncommon.
When to see a professional
See a podiatrist if heel pain lasts more than a few weeks despite self-care, so the actual cause can be identified and treated. Do not assume a spur seen on an X-ray is what needs fixing.
How common are heel spurs?
Heel spurs are far more common than the pain they get blamed for. Imaging studies have found inferior (under-the-heel) calcaneal spurs in roughly 10–30% of the general adult population, and a large share of those people have no heel pain whatsoever. Conversely, many people with classic plantar fasciitis have no spur on X-ray at all. That mismatch is the single most important fact about heel spurs: the spur and the pain often travel separately.
Two kinds of heel spur
| Inferior (plantar) spur | Posterior spur | |
|---|---|---|
| Location | Underside of the heel, at the plantar fascia attachment | Back of the heel, at the Achilles attachment |
| Linked condition | Plantar fasciitis | Achilles tendinopathy, Haglund's deformity |
| Typical pain | Sharp first-step pain under the heel in the morning | Pain and stiffness at the back of the heel, worse with activity |
Working out which tissue is actually irritated — not whether a spur exists — is what decides treatment. Our heel pain causes guide walks through telling these apart.
Self-care that targets the pain, not the spur
Because the spur itself is rarely the problem, evidence-backed self-care aims at the strained soft tissue:
- Calf and plantar-fascia stretching, two to three times daily — the best-supported first-line measure for plantar heel pain (see our stretch routine).
- Cushioned heel cups or supportive insoles to spread load away from the tender spot.
- Supportive shoes with a modest heel and firm midsole; avoid long spells barefoot on hard floors during a flare.
- Load management — ease off the aggravating activity for a few weeks rather than pushing through.
Most people improve within weeks to a few months without any procedure aimed at the spur. Surgical spur removal on its own is uncommon and reserved for stubborn cases after thorough conservative treatment.
When is an X-ray worth it?
Spotting a spur on imaging rarely changes the initial plan, because treatment targets the soft tissue regardless. Imaging becomes useful mainly when pain fails to settle after several weeks of self-care, when there was a specific injury, or when a clinician needs to rule out a stress fracture or other bone problem. If you are shown a spur on a scan, ask what soft-tissue diagnosis it sits alongside — that is the thing being treated.
Frequently asked questions
- Do heel spurs need to be removed?
- Rarely. Because the spur is usually not the source of pain, treating the underlying soft-tissue problem resolves symptoms for most people without surgery.
- Can you feel a heel spur?
- Not usually as a distinct lump from the outside. Pain attributed to a spur almost always comes from the surrounding plantar fascia or tendon, not the bone itself.
- What is the difference between a heel spur and plantar fasciitis?
- Plantar fasciitis is inflammation of the tissue along the sole; a heel spur is a bony growth that can form where that tissue attaches. The fasciitis is what hurts; the spur is a by-product.
Sources & further reading
- Heel spurs and plantar fasciitis, www.mayoclinic.org
- Heel pain, www.nhs.uk
- Calcaneal spur, www.apma.org