Calcaneal Spurs and Heel Pain: Assessment and Care

Does a heel spur cause plantar fasciitis pain?

Many people with heel spurs do not have heel pain. The American Academy of Orthopaedic Surgeons explanation states that heel spurs are not the cause of plantar fasciitis pain and that this pain can be treated without removing the spur.

Plantar fasciitis involves the tissue supporting the arch underneath the foot. Pain around the heel or arch, especially on the first steps after rest, may fit this pattern. The NHS plantar fasciitis guide describes these symptoms. Other causes of heel pain still need to be considered.

What a heel-pain assessment considers

Tell the clinician where the pain is, whether it followed an injury and what happens during walking, standing or running. An examination can assess tenderness, foot and ankle movement and signs of other problems, such as a tendon injury or stress fracture.

A clinician may request an X-ray to investigate bony problems. The AAOS guide discusses this use of imaging. A spur visible on the scan should be interpreted alongside symptoms and examination.

When heel pain needs urgent medical assessment

Seek urgent help for severe pain after injury, a foot or ankle that has changed shape, a snapping or popping sound during the injury, inability to walk, or swelling and bruising around the calf and ankle. Do not assume an existing heel spur explains a new injury.

The NHS heel-pain advice explains these warning signs. Arrange medical review if symptoms are worsening, returning or limiting usual activities, or if self-care has not helped after two weeks. Foot tingling, reduced feeling or heel pain with diabetes also warrant advice.

Activity, shoes and stretching options

For plantar fasciitis, reduce long periods of standing or walking that aggravate symptoms and consider suitable activity that puts less pressure on the feet. Comfortable, cushioned shoes and advice about insoles or heel pads may help with symptom management. Ask a pharmacist or clinician about suitable pain relief.

A physiotherapist may recommend calf or plantar fascia stretches after assessment. The Cambridge University Hospitals leaflet illustrates a supported calf stretch: face a wall or stable chair, place one foot behind the other and gently lean forwards with the back knee straight and heel grounded. Avoid forcing a painful stretch.

Ask which exercises are appropriate, how much to do and whether strengthening should be included. Painful exercises need review rather than automatically moving to a harder version. Our plantar fasciitis guide describes further movement options and care considerations.

Planning physiotherapy and follow-up

Agree on goals that matter to you, such as getting through a work shift or returning to a regular walk. Track first-step discomfort, standing tolerance and how symptoms respond to activity. Review the plan according to those changes, rather than a fixed four-week rehabilitation schedule.

Our foot and ankle physiotherapy page explains assessment and consultation preparation. Persistent symptoms may need further clinical review before treatment changes are chosen.

Common questions about calcaneal spurs

Must the spur be removed for heel pain to improve?

Not for plantar fasciitis simply because a spur appears on an X-ray. Treatment focuses on the assessed cause of symptoms. A specialist can discuss further options if symptoms remain troublesome.

Will an exercise programme remove the spur?

Exercise advice addresses movement, symptoms and function; it should not be presented as a way to remove a bony spur. Ask what each part of your treatment plan is intended to achieve.