Plantar Fasciitis vs Heel Spur: What’s Actually Causing Your Heel Pain?
By Dr. Andrew Kakishita
Heel Pain Is Common, But the Diagnosis Is Often Confusing
If you have heel pain, there is a good chance someone has mentioned a heel spur. Many patients hear this after getting an X-ray and assume the spur is the reason they hurt.
The reality is more nuanced. Heel spurs are frequently present even in people who have no pain at all.
What Is a Heel Spur?
A heel spur is a small bony growth that forms where the plantar fascia attaches to the heel bone. It develops gradually over time in response to repeated stress.
Importantly, the presence of a heel spur does not automatically mean it is the source of pain. Many people walk around with heel spurs and never know they have them.
What Is Plantar Fasciitis?
Plantar fasciitis refers to irritation and overload of the plantar fascia, the thick band of tissue that helps support the arch of your foot.
This condition is usually related to how much load the tissue is handling compared to how well it can recover. Activity levels, footwear, calf strength, ankle mobility, and daily demands like prolonged standing all play a role.
Why Imaging Does Not Tell the Whole Story
X-rays are useful for showing bone structure, but they do not explain how the foot is functioning.
Pain is influenced by movement patterns, tissue capacity, and how stress is distributed through the foot and lower leg. An image alone cannot tell that story.
When care focuses only on what shows up on imaging instead of how the body is functioning, progress often stalls.
Why Heel Spurs Are Often Blamed Incorrectly
Because heel spurs are easy to see on imaging, they are frequently blamed even when they are not the primary driver of pain.
In many cases, the plantar fascia itself is irritated due to overload. Addressing strength, mobility, and load management tends to be far more effective than focusing on the spur itself.
Where Shockwave Therapy Fits In for Plantar Fasciitis
When it comes to treating plantar fasciitis, shockwave therapy is one of the most well-supported conservative options available.
The vast majority of research shows that shockwave therapy can be highly effective for plantar fasciitis, especially in cases that have not responded well to rest, stretching, or basic treatments alone.
Shockwave therapy works by delivering mechanical energy to the irritated tissue. This helps stimulate blood flow, cellular activity, and tissue remodeling, which can improve the plantar fascia’s ability to tolerate load over time.
It is not a standalone cure. The best results typically come when shockwave therapy is combined with appropriate rehab, strength work, and load management rather than used in isolation.
What Actually Helps Heel Pain Improve
Successful treatment looks beyond a single structure.
This often includes improving calf and foot strength, addressing ankle mobility, managing daily activity levels, and gradually rebuilding the tissue’s tolerance to load. Shockwave therapy can be a valuable tool within this process when used appropriately.
Relief comes from restoring function, not just calming symptoms.
Choosing the Right Approach Matters
If your heel pain has not improved with rest, stretching, or shoe changes alone, it does not mean you are broken.
It often means the underlying cause has not been fully addressed. Understanding the difference between plantar fasciitis and heel spurs, and knowing which treatments are supported by research, can help guide more effective care and reduce unnecessary frustration.