Do Heel Spurs Cause Plantar Fasciitis?

Heel spurs usually do not cause plantar fasciitis. A spur is a bony growth that forms where the plantar fascia attaches to the heel bone, in response to the same long-term traction that degenerates the fascia. Many people have spurs with no pain, and many with plantar fasciitis have none.

Seeing a spur on your X-ray and being told that is your problem is a reasonable thing to believe, and it is also the reason so many people end up chasing the wrong target.

The Mechanism

Bone rebuilds itself in response to the forces placed on it, a principle known as Wolff's law. Where the plantar fascia pulls on the heel bone with more tension than usual for months or years, the bone responds by laying down extra material at the attachment, forming an enthesophyte, the medical term for a spur. A spur is therefore evidence of long-standing traction, in the way a callus is evidence of long-standing friction.

The pain comes from somewhere else. It comes from the degenerated collagen in the fascia and the sensitized tissue at its attachment, which is the same neighborhood where the spur forms, so the two show up together on an X-ray. They share a cause, sustained overload from a tight calf, weak hip muscles, and poor foot mechanics, but one does not produce the other. That explains why spurs are common in people with no heel pain at all, and why some people with severe plantar fasciitis have no spur.

It also explains why removing a spur so often disappoints. Surgery can take away the bone, but the forces overloading the attachment are unchanged, and so is the degenerated tissue. Until the overload itself is corrected, the fascia keeps degenerating whether or not the spur is present.

When It's Something More Serious

Heel pain after an injury or a sudden increase in activity, especially pain that worsens when you squeeze the sides of the heel, needs evaluation for a stress fracture. Constant pain that wakes you at night, swelling, redness, fever, or unexplained weight loss alongside heel pain also warrants a prompt exam. Pain in both heels with stiffness in your back or other joints is worth raising with your physician.

How This Gets Addressed

Since the spur is a marker and the overload is the problem, care focuses on the forces and the tissue.

Chiropractic care restores ankle and foot joint mechanics so the attachment is not absorbing more traction than it should, and dry needling stimulates repair in the degenerated fascia directly.

Massage therapy releases the calf and small foot muscles that keep pulling on the heel, physical therapy builds graded loading and hip strength, and naturopathic medicine looks at the internal conditions that limit collagen repair.

Each of these addresses a cause, not the bone. You can learn more about our full approach to plantar fasciitis here.

Most patients find their pain resolves even though the spur remains visible on imaging, because what changes is the tissue's tolerance to load, not the bone.

Written By:

Dr. Jason Winkelmann

Naturopathic doctor, Chiropractor, Chronic Pain Specialist, and Educator

Frequently Asked Questions

Can a heel spur go away on its own?

No. Bone does not reabsorb once it has formed. Heel pain can resolve completely while the spur stays exactly where it is, because the pain was coming from the fascia and not from the bone.

Should I have my heel spur removed?

Surgery is generally considered only after months of well-structured conservative care, and because the spur is not reliably the source of pain, results vary. Ask your surgeon what specifically the procedure addresses and how it deals with the forces that overloaded the attachment. That decision belongs with your surgeon and physician.

Why do I have a heel spur but no pain?

Spurs are a response to traction, and traction alone does not always degenerate or sensitize the fascia. Many people with spurs on imaging have no heel symptoms, which is the clearest sign that the spur and the pain are separate things.