Heel spurs and plantar fasciitis are not the same thing, and in most cases the spur is not what is hurting you. A heel spur is a small bony growth on the underside of the heel bone. Plantar fasciitis is irritation of the plantar fascia, the thick band of tissue running from your heel to your toes. They often show up together, but plenty of people have a spur on X-ray and no pain at all, which is the clearest sign the spur is rarely the pain generator. For both, the treatment is the same: reduce the load on the plantar fascia rather than try to get rid of the spur.
In this article
- What is the difference between a heel spur and plantar fasciitis?
- Why is the spur usually not the cause of the pain?
- How do you tell which one you have?
- What actually helps heel pain?
- Do you need custom orthotics for a heel spur?
- How long does heel pain take to settle?
- Frequently asked questions
What is the difference between a heel spur and plantar fasciitis?
One is a bone problem and one is a soft tissue problem. They sit in almost the same place, which is why they get confused so often.
| Heel spur | Plantar fasciitis | |
|---|---|---|
| What it is | A bony growth on the underside of the heel bone | Irritation and degeneration of the plantar fascia |
| Where it hurts | Often nothing at all, or a localised ache under the heel | Under the heel, frequently radiating into the arch |
| Classic symptom | No signature pattern of its own | Sharp pain on the first steps in the morning, easing as you move |
| How it is found | Seen on an X-ray, often by accident | Diagnosed from your symptoms and a physical examination |
| Does it go away | The spur stays, but the pain around it usually settles | Yes, in most cases, with conservative treatment |
Both sit under the umbrella of heel pain, and both respond to the same first line care. Our plantar fasciitis page covers the soft tissue side in more detail.
Why is the spur usually not the cause of the pain?
Because heel spurs appear routinely in people who have never had a sore heel. When one is found on an X-ray taken for an unrelated reason, it is an incidental finding, not an explanation.
What is usually happening is this. Repeated tension through the plantar fascia irritates the tissue where it anchors into the heel bone, and over time the body lays down extra bone at that anchor point. The spur is a consequence of the strain, not the source of the pain.
That changes what you do about it. Chase the spur and you end up thinking about surgery. Address the load through the fascia and you are on the path that works for most people.
How do you tell which one you have?
You cannot tell a spur from fasciitis by feel alone, and you do not usually need to. The symptom pattern is what guides treatment.
- First step pain. Sharp heel pain on your first steps out of bed, easing after five or ten minutes, is the hallmark of plantar fasciitis.
- Pain after sitting. The same sharpness returning when you stand after a long period seated points the same way.
- Pain that builds through the day. This suggests load related irritation rather than a bony problem.
- Pinpoint bony tenderness with swelling. This needs assessment, as it can indicate a heel stress fracture.
An X-ray may confirm a spur, but a clinician treats the symptoms in front of them. If your heel pain has lasted more than a few weeks and is not improving, see a podiatrist or GP.
What actually helps heel pain?
Conservative treatment resolves heel pain for the large majority of people. Cleveland Clinic notes that more than 90 per cent improve without surgery. The core of it is unglamorous and consistent.
- Reduce the peak load. Cut back temporarily on what aggravates it, particularly running and long days on hard floors.
- Support the arch. A contoured orthotic reduces how far the arch flattens under load, lowering the tension pulling on the heel.
- Stretch daily. Calf and plantar fascia stretches before your first steps make the morning pain far more manageable.
- Wear supportive shoes indoors. Barefoot on tiles or floorboards is a common reason heel pain stalls.
- Give it time. Stopping at the first improvement is the usual reason it returns.
Arch support does the heavy lifting, because it is the only one of these working every step you take.
Contoured arch support to reduce plantar fascia tension, a stabilising heel cup, and a metatarsal dome that relieves pressure under the ball of the foot. Designed by Australian podiatrists and included in the Australian Register of Therapeutic Goods (ARTG 441576) as a Class 1 medical device.
Do you need custom orthotics for a heel spur?
Usually not as a first step, and there is real evidence behind that.
A 15 centre randomised trial by Pfeffer and colleagues, published in Foot & Ankle International in 1999, followed 236 patients with heel pain. Those using prefabricated inserts alongside stretching did better than those given custom made polypropylene orthoses. It tested generic prefabricated inserts, not any specific product, so it says nothing about how SOLE5 performs. What it supports is the starting order: begin with a well designed off the shelf device and reserve custom work for cases that do not respond.
Our guide to off the shelf orthotics versus custom orthotics covers this in depth. If your heel pain sits alongside an arch that rolls inward, our page on over-pronation explains why that pattern loads the fascia harder.
Full Length and Half Length Orthotic Insoles together. Heel pain responds best to support in every pair you wear, not just your runners.
How long does heel pain take to settle?
Most people notice the morning pain easing within 4 to 8 weeks. Full resolution commonly takes 3 to 6 months, and a stubborn case can run closer to a year. The range is wide because the tissue heals slowly and most people load it daily regardless.
- Weeks 1 to 2: Insoles into your most worn shoes, including something supportive for indoors.
- Weeks 2 to 6: First step pain becomes shorter and less sharp. The earliest reliable sign it is working.
- Weeks 6 to 12: Pain becomes occasional rather than daily. Gradually rebuild the activity you cut back.
- Beyond 3 months: If nothing has shifted, return to a podiatrist. Imaging, shockwave therapy or a corticosteroid injection may be considered.
For insole selection, see our guide to the best insoles for plantar fasciitis, or browse the full SOLE5 range.
Frequently asked questions
Can you have a heel spur without plantar fasciitis?
Yes, and it is common. Heel spurs are frequently found on X-rays taken for unrelated reasons in people who have never had heel pain. A spur on its own is not a diagnosis and does not necessarily need treating. It becomes relevant only when it sits alongside symptoms, and even then the plantar fascia is usually the structure causing the pain.
Do heel spurs go away on their own?
The bony growth itself does not dissolve or disappear without surgery. The pain associated with it usually does settle with conservative treatment, because that pain comes from the irritated soft tissue around the spur rather than from the bone. This is why most people get better without the spur ever being removed.
Do insoles help heel spurs?
Yes, indirectly and effectively. An orthotic insole cannot change the bone, but it reduces how far the arch flattens under load, which lowers the tension the plantar fascia pulls with at its attachment to the heel. Less tension at that attachment means less irritation, and that is what reduces the pain. A stabilising heel cup also helps by controlling the heel position through each step.
Is it plantar fasciitis or a heel stress fracture?
Plantar fasciitis typically causes sharp pain on the first steps in the morning that eases as you move. A heel stress fracture more often causes pinpoint bony tenderness that worsens with impact, and it may come with swelling. Pain that wakes you at night, or that is getting steadily worse despite rest, should be assessed in person rather than self managed.
Should I stop walking if I have heel pain?
Not completely. Total rest tends to stiffen the tissue and the pain often returns as soon as you resume. The better approach is to reduce the peak load temporarily, cutting back on running and long periods standing on hard surfaces, while keeping gentle regular walking in supportive shoes. Build activity back up gradually as symptoms settle.
Treat the cause, not the spur
SOLE5 Full Length Orthotic Insoles combine contoured arch support, a stabilising heel cup and a metatarsal dome to reduce the tension travelling through your plantar fascia. Designed by Australian podiatrists.
Shop Full Length Orthotic Insoles →Included in the Australian Register of Therapeutic Goods (ARTG 441576) as a Class 1 medical device.
References:
- AAOS OrthoInfo - Plantar Fasciitis and Bone Spurs
- Cleveland Clinic - Heel Spurs
- Mayo Clinic - Plantar Fasciitis
- healthdirect Australia - Plantar Fasciitis
- Pfeffer G, et al. (1999). Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot & Ankle International, 20(4), 214-221
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