Bone spurs in the heel are small, bony calcium deposits that grow on the underside of the heel bone (calcaneus). They develop gradually over months or years as the body responds to repeated stress and strain on the foot. Here’s the surprising part: most people who have them never know it. A population study of over 1,000 ankle X-rays found that 38% of people had a calcaneal spur, yet the majority experienced no pain at all.
How Heel Spurs Form
The thick band of tissue running along the bottom of your foot, called the plantar fascia, connects your heel bone to your toes and supports your arch. Every step you take pulls on the spot where this tissue attaches to the heel. When that pulling force is excessive or prolonged, the body tries to reinforce the area by depositing calcium at the attachment point. Over time, those calcium deposits harden into a small bony projection, typically shaped like a hook or shelf extending forward from the bottom of the heel.
This process doesn’t happen overnight. Heel spurs are the result of cumulative stress built up over many months. They’re a sign that the heel has been under more mechanical load than it can comfortably handle.
What Causes Them
Several factors increase your risk of developing heel spurs, and most relate to how much force your heel absorbs on a daily basis:
- Excess body weight. Extra pounds increase the load on your plantar fascia and heel bone with every step. Over time, this added pressure causes micro-tears in the tissue, inflammation, and eventually spur formation. Obesity is one of the most significant risk factors.
- Improper footwear. Shoes that lack arch support, have thin soles, or don’t cushion the heel properly force the foot’s muscles and ligaments to work harder. Worn-out athletic shoes fall into this category too.
- High-impact activity. Running, jumping, and other repetitive activities on hard surfaces create constant strain on the heel.
- Foot structure abnormalities. Flat feet or fallen arches distribute weight unevenly, concentrating stress on the heel. These structural issues are more common in people carrying extra weight, creating a compounding effect.
- Age. The prevalence of heel spurs increases with age as the plantar fascia loses flexibility and the fat pad under the heel thins out.
The Relationship With Plantar Fasciitis
Heel spurs and plantar fasciitis are closely linked but not the same condition. Plantar fasciitis is inflammation of the plantar fascia itself. A heel spur is a bony growth that can develop as a consequence of that longstanding tension at the fascia’s attachment point. According to the American Academy of Orthopaedic Surgeons, most people who have bone spurs on their heels do not have heel pain, and heel spurs are not the cause of plantar fasciitis.
This distinction matters for treatment. The American College of Foot and Ankle Surgeons states that “in most cases, infracalcaneal heel pain is a soft tissue-based disorder and calcaneal spurring is most likely not a causative factor.” In other words, the spur you see on an X-ray is usually not the thing generating your pain. The inflamed, overstressed soft tissue around it is. That’s why plantar fasciitis pain can be treated successfully without ever removing the spur.
What the Pain Feels Like
When heel spurs do cause symptoms, the pain closely mimics plantar fasciitis. You’ll typically feel an intense stabbing sensation in the bottom of your heel, worst with your first steps in the morning or after sitting for a while. The pain often eases once you walk for a few minutes as the tissue warms up and stretches, then returns after another period of rest. Standing for long stretches or walking on hard floors can trigger it throughout the day.
Some people describe it as stepping on a sharp pebble or a nail. The pain tends to be localized to one specific spot on the bottom of the heel rather than spread across the whole foot.
How Heel Spurs Are Diagnosed
Most heel pain is diagnosed through a physical exam and your description of symptoms alone. Routine X-rays aren’t necessary for diagnosing plantar fasciitis, but when they are taken, they can clearly show a bony spur extending from the heel bone. The key clinical insight, though, is that finding a spur on imaging generally won’t change your treatment plan. Many people with visible spurs have no pain, and many people with significant heel pain have no visible spur. Advanced imaging like MRI or ultrasound is typically reserved for cases that don’t respond to initial treatment or when a different diagnosis is suspected.
Treatment Without Surgery
The vast majority of heel spur pain resolves with conservative measures. Since the pain usually comes from the surrounding soft tissue rather than the spur itself, treatment focuses on reducing inflammation and relieving strain on the plantar fascia.
Stretching is one of the most effective first steps. Calf stretches and plantar fascia stretches improve flexibility and take tension off the heel. These work best when done consistently, especially before getting out of bed in the morning. Supportive footwear and orthotic inserts provide cushioning and help redistribute pressure more evenly across the foot. Over-the-counter arch supports work for many people, though custom orthotics may be recommended for those with structural foot issues.
Ice applied to the heel for 15 to 20 minutes several times a day can reduce swelling during flare-ups. Anti-inflammatory medications help manage acute pain. Physical therapy may be recommended to build strength, improve flexibility, and correct movement patterns that contribute to the problem. For more persistent cases, corticosteroid injections can reduce inflammation directly at the site, though these are typically used sparingly rather than as a standalone treatment. Shockwave therapy, which uses targeted pressure waves to stimulate healing in damaged tissue, is another option with clinical support for stubborn cases.
Rest and activity modification round out the approach. Reducing high-impact exercise and giving your heel time to recover often makes a noticeable difference within a few weeks.
When Surgery Becomes an Option
Surgery is reserved for chronic, refractory cases where months of conservative treatment haven’t provided relief. The most common surgical approach involves releasing part of the plantar fascia to reduce tension on the heel. The spur itself may or may not be removed, since it’s generally not the primary source of pain.
Recovery depends on the extent of the procedure. If you have a desk job, you may return to work within a few days. Physical or labor-intensive jobs may require several weeks or longer. Full recovery to pre-surgery activity levels typically takes longer still, and your doctor will guide a gradual return to weight-bearing exercise.
Preventing Heel Spurs
Because heel spurs develop from cumulative strain, prevention centers on reducing the daily load on your feet. Wearing shoes with good arch support and adequate heel cushioning is the simplest change you can make. Replace athletic shoes before they lose their cushioning, which typically happens every 300 to 500 miles of use. If you carry extra weight, even modest weight loss meaningfully reduces the force on your plantar fascia with each step. Stretching your calves and the bottoms of your feet regularly keeps the tissue flexible and less prone to micro-tears, especially if you stand for long periods or exercise frequently.