Plantar Fasciitis vs. Heel Spurs

By Dr. Andrew Kakishita, DC | Pleasant Grove, UT Chiropractor

You can have one without the other, and that surprises almost everyone.

Two Different Things That Get Confused Constantly

Plantar fasciitis and heel spurs get lumped together so often that most people assume they are the same condition. They are not. Plantar fasciitis is damage and degeneration in the soft tissue band on the bottom of your foot. A heel spur is an actual bony growth on your heel bone. One is soft tissue, the other is bone.

Plenty of People Have a Spur With No Pain at All

Here is the part that surprises most patients: heel spurs are extremely common in people who have no heel pain whatsoever. Studies have found spurs in a wide range of pain free feet, sometimes discovered completely by accident on an X-ray taken for something unrelated. Having a spur does not mean you are destined for pain.

How Doctors Actually Tell the Two Apart

Diagnosing a heel spur is straightforward, it shows up clearly on an X-ray as a small hook or point of bone extending from your heel. Diagnosing plantar fasciitis is a bit different. It is usually based on your symptoms and a hands-on exam, since the actual damage is happening in soft tissue that does not show up well on a standard X-ray. Some clinics use ultrasound to get a clearer look at the thickness and condition of the fascia itself. This matters because a spur showing up on an X-ray does not automatically confirm that the spur is the reason you are in pain.

So Why Do They Show Up Together So Often

When they do occur together, researchers think it often works the other way than most people assume. Rather than the spur causing the fasciitis, ongoing stress and traction from a struggling plantar fascia may actually encourage a spur to form over time at that attachment point. The spur may be more of a side effect of the fascia problem than the cause of it.

Why Surgery for Heel Spurs Often Disappoints People

Because heel spurs are easy to see on an X-ray, they used to be treated as the obvious target for surgery when heel pain would not go away. The results were often underwhelming. Removing the spur does not address the fascia tissue that was actually degenerated and causing the pain in the first place, so a meaningful number of patients who had spur removal surgery continued to deal with heel pain afterward. This has shifted a lot of clinical thinking toward treating the fascia itself rather than chasing the bony spur on the scan.

What Actually Overlaps Between the Two

Both conditions tend to show up under similar circumstances: carrying extra body weight, spending long hours on your feet, and general wear and tear on the foot over the years. Research has found that people with both a spur and diagnosed plantar fasciitis tend to have a higher body weight on average than people who have a spur with no pain at all, which supports the idea that ongoing mechanical stress is the common thread tying both conditions together, rather than the spur itself driving the pain. Footwear plays a role too. Flat, unsupportive shoes let the fascia absorb more stress with every step, which contributes to fascia irritation and, over the long run, the traction that can encourage a spur to form. Age matters as well, spurs become more common the older you get, simply because the fascia has had more years of pulling on that same attachment point.

What Treatment Actually Looks Like

Treating plantar fasciitis, whether or not a spur is present, usually combines a few things working together. Shockwave therapy stimulates healing directly in the degenerated fascia tissue. Chiropractic adjustments and soft tissue work address any joint restrictions or tightness in the foot, ankle, and calf that are adding extra strain. Supportive footwear and a gradual return to activity round out the plan. None of this specifically targets a spur, and none of it needs to, since the fascia is what is actually driving your symptoms.

The Bottom Line

If an X-ray shows a spur, do not assume that is automatically your pain source, and do not assume you need surgery to fix it. At Kinetic Chiropractic in Pleasant Grove, we focus on the tissue that is actually causing your symptoms.

A Few Common Questions

Do I need surgery to get rid of a heel spur?

Rarely. Since the spur itself is usually not the source of pain, treating the fascia through shockwave therapy and addressing the mechanics tends to resolve symptoms without needing to touch the spur surgically.

Will a heel spur go away on its own?

Once bone forms, it typically stays, but that is usually fine, since an asymptomatic spur does not need to disappear for your pain to resolve.

Can physical therapy or chiropractic care shrink a heel spur?

No treatment reliably shrinks a heel spur, but that is not really the goal. The goal is calming and repairing the fascia tissue causing your actual pain.

Should I get an X-ray if I have heel pain?

It is reasonable to rule out other causes, but keep in mind that whatever the X-ray shows about a spur will not necessarily explain your pain either way. Your symptom pattern and a hands-on exam usually matter more than the image.