Heel Spur vs Plantar Fasciitis: What's the Difference?

Heel pain has a way of taking over your day. It's there when you climb out of bed, it nags at you through a long shift, and it makes you think twice about that evening walk. Two names come up again and again when people try to work out what's going on: plantar fasciitis and heel spurs.

They sound similar, they're often found together, and they're frequently mixed up. But one is a soft-tissue problem and the other is a change in the bone, and knowing which is which makes it much easier to choose the right fix.

What is plantar fasciitis?

Plantar fasciitis is an overload problem in the plantar fascia, the thick, strong band that runs from your heel bone to the base of your toes and helps hold up your arch. When it's asked to do more than it can cope with, the tissue becomes thickened and sore where it joins the heel.

How it feels

• A sharp or stabbing pain under the heel, usually worst with your first steps in the morning
• Pain when you stand up after sitting for a while, which eases once you get moving
• An ache that builds again after long periods standing or walking
• Tenderness on the underside of the heel, often towards the inner side

What brings it on

• Long hours on your feet, especially on hard floors
• Running or a sudden jump in walking or training
• Shoes with little cushioning or arch support
• Tight calf muscles
• Very flat feet or very high arches
• Carrying extra weight

If your pain follows that morning pattern, our guide to what causes heel pain in the morning explains why the first steps hurt most.

What is a heel spur?

A heel spur is a small ledge of extra bone on the underside of the heel bone, close to where the plantar fascia and the small muscles of the foot attach. The name suggests a sharp spike, but it's usually smooth, and it can only be seen on an X-ray.

Spurs are far more common than most people realise. A review in the Journal of Anatomy found them in around 11 to 21% of young and middle-aged adults and about 55% of people over 62, most of whom have no heel pain.

How it feels

• Often, nothing at all. Plenty of people have a spur for years without knowing.
• When there is pain, it's usually hard to tell apart from plantar fasciitis, because the strained tissue around the spur is the more likely source.
• Pain that gets worse the more you walk, burning or tingling, or pain at the back of the heel points to something else, and is worth getting checked.

Why spurs form

• Years of pulling and pressure where tissues attach to the heel bone
• Getting older: spurs become much more common with age
• Carrying extra weight
• Arthritis
• A history of heel pain, including plantar fasciitis

Heel spur vs plantar fasciitis: the key differences

Are heel spurs and plantar fasciitis connected?

They often appear side by side, but one doesn't simply cause the other. The same review found spurs in 59 to 78% of people with current or previous heel pain, and the plantar fascia tends to be thicker when a spur is present. Both seem to reflect long-term strain on the heel. Researchers still debate whether a spur adds to the pain or is simply a sign that the heel has been working hard for a long time. Either way, the fix is the same: reduce the strain.

Do I need an X-ray for heel pain?

Usually not. NHS clinical guidance says there's no need for an X-ray to look for a heel spur, because finding one doesn't change the treatment. A GP may suggest imaging if the pain doesn't settle or something doesn't add up.

How to treat and prevent heel pain

Whether the label is plantar fasciitis, heel spur, or both, these five steps target the strained tissue that's usually behind the pain. NHS Tayside's guidance notes that around 80% of cases settle with simple self-treatment.

1 Take the pressure off

• Ease back on whatever sets the pain off, such as running or long spells standing on hard floors.
• Swap to swimming or cycling for a while to stay active without pounding your heel.
• Use a wrapped ice pack or a frozen bottle under your foot for 10 to 15 minutes after a long day.

2 Stretch and strengthen

• Calf stretch: hands on a wall, back leg straight, heel down, lean in and hold.
• Arch stretch: sit, cross your foot over your knee and gently pull your toes back towards your shin.
• Slow heel raises: rise onto your toes on a step and lower slowly, to build strength in the calf and foot.

For a full daily routine, see how to relieve plantar fasciitis pain at home.

3 Choose shoes that support you

• Pick shoes with a cushioned heel and some arch support.
• Avoid flip-flops, worn-out trainers and completely flat slip-ons.
• Don't walk barefoot on hard floors at home, especially first thing in the morning.

4 Add heel spur inserts or plantar insoles

Good heel spur inserts and plantar fascia insoles do the same job. They cushion the heel, cradle it in a heel cup and support the arch, which eases the pull on the plantar fascia and softens the pressure under the heel bone. NHS clinical guidance recommends heel cushions and off-the-shelf insoles as early treatment, and the 2023 clinical guideline for heel pain recommends insoles that support the arch and cushion the heel, used alongside stretching.

When you're comparing shoe inserts for heel spurs, check for:

Gel heel cups can help in shoes with little room, but full-length plantar insoles give more support because they also hold up the arch. If the pain is at the back of your heel rather than underneath, our Achilles Tendonitis Insoles are designed for that area.

ZakSole insoles combine a deep heel cup, heel cushioning and contoured arch support in a full-length, trim-to-fit design, for £19.99 a pair with free UK delivery and a 30-day trial. Not sure which type suits you? Read how to choose the right insoles for your foot type.

5 If it doesn't settle, get extra help

If several weeks of good self-care haven't helped, a GP can confirm what's going on and may refer you to a physiotherapist or podiatrist. For pain that lasts months, specialists sometimes consider options such as a steroid injection or shockwave therapy. Surgery is rarely needed, and removing a spur on its own is seldom necessary.

When to see a GP

See a GP if your heel pain is severe or stops you doing normal activities, is getting worse or keeps coming back, or hasn't improved after 2 weeks of home treatment. Go sooner if you have tingling or numbness in your foot, or if you have diabetes. The NHS also advises urgent help for severe pain after an injury, or if your foot has changed shape.

Final thoughts

Plantar fasciitis and heel spurs are easy to confuse, but the difference matters less than you might think. Plantar fasciitis is a painful strain of the tissue under your foot. A heel spur is a common change in the bone that often causes no trouble at all. When your heel hurts, it's almost always the tissue that needs attention, and the same simple steps help either way: take the pressure off, stretch and strengthen, wear supportive shoes, and add cushioned insoles with good heel and arch support. If the pain doesn't ease, get it checked.

FAQs

This article is for general information and isn't medical advice. Speak to your GP, a physiotherapist or a podiatrist about ongoing heel pain.