Heel Spurs: What They Are and How They Differ From Heel Pain
If a sore heel has sent you looking for answers, heel spur is one of the first names you'll meet. It sounds like a thorn of bone, though the foot around it is busier, and less straightforward, than the name suggests.
A sore heel tends to speak up first thing in the morning, somewhere between the bed and the bathroom. A sharp ache under the heel can shorten your stride for the first few steps, then fade as the foot warms up, only to return after a long drive or a long meeting. After a few weeks of that, it's natural to want a name for it.
A line on an imaging report can supply one. The report shows something real, a small point of bone on the heel, and that makes it feel like the answer. Whether a spur is the answer, though, is a separate question from whether it's there.
The short answer
A heel spur is a small growth of extra bone on the heel bone, usually on the underside, where the thick band of tissue under the foot attaches. Many spurs cause no pain at all and turn up by chance on imaging. When a heel does hurt, the source is usually the soft tissue around the bone, most often that band, the plantar fascia, or the Achilles tendon at the back of the heel.
What people commonly do is check their shoes, stretch the calves and soles gently, build activity up slowly and, for some, add a cushioned heel pad or insole. Heel pain that lasts beyond a few weeks of everyday care, or comes with swelling, redness, warmth or numbness, is worth taking to a healthcare professional, and so is any new heel pain if you have diabetes.
What a heel spur is and how one forms
The heel bone is the largest bone in the foot, and a spur, sometimes called a bone spur, is a small extra growth on it, often described as pointed or hook-like. Most often it sits on the underside, where the plantar fascia attaches: the thick band of tissue that runs from the heel bone to the base of the toes and helps hold up the arch. A spur can also form at the back of the heel, where the Achilles tendon joins the bone.
Calcium deposits collect on the bone gradually, usually over months, and the process is linked to long-term strain on the muscles and ligaments of the foot and to a plantar fascia that's stretched again and again. One way to picture it is the body adding bone where a spot has been under steady stress, much as skin thickens where it rubs. Why one person grows a spur and another doesn't isn't fully understood.
Why a spur doesn't always mean pain
Many spurs cause no pain at all. Plenty are found by chance, on pictures taken for some other reason, and the people who have them never felt a thing. Among people who do have heel pain, imaging finds a spur in some and none in others.
When the heel does hurt, the usual source is the soft tissue around the bone. Most often it's the plantar fascia, which is under tension with every step; irritation and strain of that band is called plantar fasciitis, one of the most common causes of heel pain. Pain at the back of the heel more often involves the Achilles tendon, which is covered in why the back of your heel aches.
A spur and a sore plantar fascia often turn up together, because long-term strain where the fascia meets the heel bone is thought to be one way a spur forms. A spur may therefore be a sign that the area has been under load, not the cause of the soreness. It can occasionally irritate nearby tissue, but it's usually not the main source of the pain.
What a sore heel feels like, and what makes one more likely
A sore heel is often described as a sharp, stabbing ache under the heel with the first steps after sleeping or sitting, settling into a duller ache as you keep moving. It can return after long stretches of standing or walking, and pressing on the bottom of the heel may be tender. Nothing in that pattern shows whether a spur is present, but if it sounds familiar, a healthcare professional can tell what is going on.
What raises the odds of a sore heel mostly comes down to load, because the heel is where each step lands. Running or jogging on hard surfaces, long hours on hard floors, a sudden jump in activity and tight calves are all linked to heel pain and to spurs. So are extra body weight, flat feet or high arches, and shoes that are worn out or short on cushioning and arch support. Age is linked too.
Everyday habits for a sore heel
Advice for a sore heel tends to be much the same whether or not a spur has been found. Calf stretches, supportive shoes and a slow build-up of activity are among the habits most often suggested, and they need little more than a wall and a chair. Move slowly and gently, stop anything that doesn't feel right, and check with a healthcare professional first if you're recovering from an injury or surgery.
Check the shoes you wear most
Press a thumb into the heel cushioning: it should spring back. Cushioned soles, some arch support and a firm heel are what many people look for, and worn-out cushioning is linked to heel strain, so a pair that has gone flat is worth replacing.
Add a cushioned heel pad
A soft heel cup or a cushioned, supportive insole is one thing some people try, especially in shoes with thin footbeds. Wear it for part of the day at first.
Stretch your calves gently
Face a wall, step one foot back and keep that knee straight with the heel down. Lean in until you feel a gentle pull, hold for about 30 seconds, then switch legs.
Stretch the sole of your foot
Sit with one foot across the opposite knee and draw the toes slowly back toward your shin until you feel a stretch along the sole. Hold for about 10 seconds, relax, and repeat a few times on each foot.
Build activity up gradually
After a break, add walking or running a little at a time, and choose softer surfaces such as a track or grass over concrete when you can.
Heel pain often takes weeks to months to settle, so these are habits to fold into the day rather than a one-time effort. More ways to stretch the calves are in calf stretches for people who stand all day.
What a healthcare professional may do
A healthcare professional may start with questions: where the heel hurts, when it's worst, how long it has been going on and what a typical day on your feet looks like. They may press along the heel and arch to find the tender spot, move the foot and ankle, and watch you stand and walk. Imaging is where a spur comes into view: pictures of the bone can show one and may help rule out other causes of heel pain, and other kinds of imaging can look more closely at soft tissue.
From there, a professional may talk through options. They can include a stretching routine, supportive footwear, padding for the heel, taping, custom-made inserts, resting from the activity that sets the pain off and a splint worn at night. For some people other care comes up, and for a few, surgery is discussed.
When heel pain may mean something more
A sore heel after a busy stretch, a long day on hard floors or a week in new shoes is common, and it often follows a familiar pattern: worst with the first steps, easier once the foot has warmed up. A spur found on imaging when nothing hurts is not unusual either.
Pay closer attention when the pattern changes. Pain that is still there after a few weeks of everyday care, or that keeps getting worse, doesn't fit that picture. Neither does a swollen, red or warm heel, numbness or tingling, or pain that arrives suddenly, such as after a fall. These are reasons to get the heel looked at rather than reasons to push through.
Questions people ask
Do heel spurs go away, or need to be removed?
A spur is bone, so once it has formed it generally stays put unless it's removed. That usually isn't needed, because a spur found on imaging often isn't the source of the pain. Surgery is generally considered only for pain that hasn't improved after other options have been tried, and that's a conversation for a foot and ankle specialist.
Is it all right to keep walking or exercising with a sore heel?
Many people keep moving but cut back on whatever sets the pain off, such as long runs or hours on a hard floor, and add it back a little at a time. Pain that sharpens during activity or lingers well afterward is worth mentioning to a healthcare professional.
The bottom line
It's easy to blame a spur, because it's the part of a sore heel that shows up plainly on a picture. But a picture shows bone, and most heel pain comes from the tissue around it, so the more useful question is usually what the heel has been asked to carry. A heel can carry a spur without a single sore step, and it can hurt with no spur at all.
