A heel spur is an outgrowth of bone where the plantar fascia and the muscles of the sole attach to the heel. It shows on an X-ray and the name sounds alarming, but the important fact is a different one: there are people with a spur and no pain, and people with exactly the same heel pain and no spur. In other words, the spike of bone is rarely what hurts.
What usually hurts is the tissue pulling on it. The spur forms precisely because that traction has been repeating for a long time, so it is more a trace of what has been happening than the problem itself. That is why the approach is not aimed at the bone: it is aimed at the cause of the traction —loading, footwear, ankle mobility, the way the foot works— which is what can be changed.
What is assessed in the clinic
- Exactly where it hurts and at what times of day, which is what points the diagnosis.
- The state of the plantar fascia and the Achilles tendon, and ankle mobility.
- Loading and gait, to see what is pulling on the heel attachment.
- Footwear and any recent change in activity, surface or weight.
- Offloading measures and, where appropriate, insoles to spread the tension.
Have you been told you have a spur and the heel still hurts?
Book an appointmentFrequently asked questions
- Can the spur be removed?
- A surgical option exists, but a prior question is worth asking first: whether the spur is what hurts. In most cases it is not — there are people with a spur and no pain, and people with the same pain and no spur — so removing the bony point without treating what pulls on it usually leaves the pain where it was. That is why the approach starts by identifying which structure is overloaded and what is overloading it, and works there. If after a properly conducted conservative treatment the pain still limits your life, then it is time to consider other options, and that assessment is made by a specialist with the imaging in front of them.
- Do I need an X-ray?
- To know whether you have a spur, yes; to know why your heel hurts, it is almost never the first step. Diagnosing heel pain is done by examining: exactly where it hurts, at what moments, the state of the fascia and the Achilles tendon, how much the ankle moves and how you load the foot. That is what orients the picture, and imaging is requested when it answers a specific question the examination has left open — ruling out a stress fracture, for instance. The risk of starting with the X-ray is real and has a name: finding a spur, stopping there and not looking further, so that a tendon or nerve problem goes unseen.
