Somebody takes an X-ray of a painful heel, points at a small bony beak on the front of the heel bone, and says “there it is — a heel spur”. It is a satisfying moment. It is also, most of the time, the wrong conclusion, and acting on it sends people down a treatment path aimed at the wrong target.

What a heel spur actually is

A heel spur, or calcaneal spur, is a small outgrowth of bone on the heel bone (the calcaneus). Bone lays itself down where soft tissue pulls on it repeatedly. That is the whole mechanism: a spur is a record of long-term traction at the point where soft tissue anchors into bone — what anatomists call an enthesis.

One detail is worth correcting straight away, because almost everybody has the picture wrong. The plantar spur does not point down into the sole like a nail. It grows forward, along the line of pull, lying roughly parallel to the underside of the foot. People arrive convinced there is a spike stabbing into the heel with every step, and there is not — which is worth knowing before anyone starts talking about cutting it out.

Two different spurs get called “heel spurs”, and they are not the same problem:

Everything below is about the plantar spur unless it says otherwise. If your pain is at the back of the heel, read Achilles tendonitis instead — the treatment is genuinely different, and some of the advice for one is actively unhelpful for the other.

The evidence that the spur is not the pain

Three findings, taken together, make the case:

1. Plenty of people have a spur and no pain. Imaging studies of people with no heel symptoms at all find calcaneal spurs in a substantial minority — commonly quoted figures sit around one in five. A finding that common in pain-free feet cannot be assumed to be the cause of pain in a sore one.
2. The spur is usually not in the plantar fascia. Anatomical work on dissected heels has shown the spur typically forms within the origin of the small muscles beneath the fascia — flexor digitorum brevis in particular — rather than inside the fascia itself. The structure that hurts and the structure the spur grows in are not the same structure.
3. Spur size does not track with pain. A big spur does not mean a worse heel. People get better while their spur stays exactly where it is, which it does.

So what is causing the pain?

In the large majority of people who arrive with a “heel spur”, the actual diagnosis is plantar fasciitis — more accurately a degenerative change at the fascia’s attachment, which is why “-itis” is a slightly misleading name for it. The classic pattern is unmistakable once you know it: the first few steps out of bed are the worst part of the day, it eases as you move, and it comes back after you have been sitting.

But a proportion of heels that get labelled “spur” are something else entirely, and the spur on the X-ray is a distraction:

• Fat pad problems — pain in the middle of the heel, worse barefoot on hard floors, feeling like a deep bruise rather than a first-step stab.
• Calcaneal stress fracture — pain that builds with activity rather than easing, sore when the heel is squeezed from both sides, sometimes aching at night.
• Nerve entrapment — burning or tingling, often without the classic morning pattern, from irritation of a small nerve branch under the heel.
• Inflammatory arthritis — worth thinking about when both heels hurt, when the person is young, or when other joints, the back, the eyes, the skin or the gut are also involved.

Working out which of these you have is the entire job, and it is done by examination and history, not by looking at a spur. Our guide to heel pain by location walks through the same reasoning.

How heel spurs are treated

Because the spur is not the target, the treatment is the treatment for whatever soft-tissue problem produced it — usually the fascia. That means:

• Loading the tissue deliberately rather than resting it into weakness — plantar-fascia-specific stretching and progressive calf work.
• Changing what the heel is asked to do for a while: less standing on hard flat ground, a temporary reduction in the activity that spiked it.
• Support under the arch and cushioning under the heel, from shoes and inserts.
• Second-line options when months pass without progress — injections, shockwave, custom orthoses — each with real trade-offs, covered in the treatment guide.

What is almost never the answer is surgical removal of the spur on its own. Where surgery is genuinely indicated for stubborn plantar heel pain, the operation addresses the fascia and the surrounding tissue; taking the bone out is not what makes the difference, and it carries its own risks. Any conversation that begins and ends with “we’ll shave the spur off” deserves a second opinion.

Common questions

How do I get rid of a spur in my heel?

Realistically, you do not — and in almost all cases you do not need to. The spur is bone. It does not dissolve with stretching, ice, creams or supplements, and no non-surgical treatment removes it. What changes is the pain, and the pain comes from the soft tissue around it. People become completely pain-free with the spur still visible on a repeat X-ray. Aim at the symptom, not the shadow.

How do I know if it’s a heel spur?

You cannot tell by feel, and neither can anyone else — a spur is only visible on imaging. What you can describe is the pattern: where exactly it hurts, whether the first steps in the morning are the worst part, whether it eases with movement, whether pressing one specific spot reproduces it. That pattern is what identifies the problem. The X-ray, if one is taken, is usually confirming what the examination already said, or ruling out something else such as a stress fracture.

What happens if a heel spur is left untreated?

The spur itself does nothing. It does not grow through the skin, it does not “spread”, and having one does not commit you to surgery later. The thing worth treating is the soft-tissue problem it sits with. Left alone, plantar heel pain often does settle over months to a year, but “often” is doing a lot of work in that sentence: some heels stay sore for years, the limp changes how you load the other leg, and pain that has been present a long time is harder to shift than pain caught early. Untreated is not dangerous. It is just slower and less certain than it needs to be.

What is a heel spur versus plantar fasciitis?

Plantar fasciitis is a soft-tissue condition — degenerative change and pain at the point where the plantar fascia anchors into the heel bone. A heel spur is a bony outgrowth in that same neighbourhood. They frequently appear together, which is why they get treated as one thing, but they are not: many people have the spur without pain, and many people have textbook plantar fasciitis with no spur at all on X-ray. Plantar fasciitis is the diagnosis. The spur is a radiological finding.

Should I ask for an X-ray?

Not for the purpose of finding a spur — the answer would not change your treatment. X-rays earn their place when something in the story or examination suggests a different diagnosis: a suspected stress fracture, pain after an injury, a heel that is not behaving like a fascia problem, or symptoms that have not budged despite sensible treatment. Your clinician should be able to say what question the image is being taken to answer.

Further reading

• Martin RL, Davenport TE, Reischl SF, et al. Heel pain — plantar fasciitis: revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 2014 — the clinical practice guideline underpinning most of the treatment advice on this site.
• Kumai T, Benjamin M. Heel spur formation and the subcalcaneal enthesis of the plantar fascia. Journal of Rheumatology, 2002 — the anatomical work on where the spur actually forms.
• Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur: fact or fiction? Foot and Ankle Surgery, 2012.