Do Heel Spurs Cause Heel Pain? What Research Shows

By Nova Physical Therapy, an outpatient physical therapy clinic in North Hollywood, CA | Published October 2026

You finally get an X-ray for your heel pain, and the report mentions a "heel spur." It's easy to picture a sharp bone poking into your foot with every step, and to assume it needs to come out.

The research tells a different story. This article explains what a heel spur is, whether it actually causes heel pain, how it relates to plantar fasciitis, whether it needs to be removed, and what helps heel pain.

This article is general education. It can't interpret your X-ray; your physician or podiatrist is the right person to explain your imaging.

The short answer

A heel spur is a small bony growth on the bottom of the heel bone, often seen on X-ray. Many people with plantar fasciitis have one, but according to the American Academy of Orthopaedic Surgeons, heel spurs do not cause plantar fasciitis pain, and most people with heel spurs have no heel pain at all (AAOS OrthoInfo). Treatment for heel pain focuses on the soft tissue, not the spur, and more than 90% of people with plantar fasciitis improve within 10 months of starting simple treatment. In California, you can see a physical therapist without a referral.

What is a heel spur?

A heel spur, or calcaneal spur, is a small bony projection that forms where soft tissues attach to the heel bone. On the bottom of the heel, it sits near the attachment of the plantar fascia and the small muscles of the foot.

Spurs develop slowly over time. They become more common with age and are often found by chance on an X-ray taken for another reason. You can't feel a spur under the skin, and having one doesn't mean anything is "sharp" or "stabbing" into your foot.

Do heel spurs cause pain?

Usually, no. The AAOS states plainly that heel spurs do not cause plantar fasciitis pain and that most people who have bone spurs on their heels do not have heel pain (AAOS OrthoInfo).

Spurs and heel pain often show up together because they share some of the same risk factors, like age, body weight, and years of load on the foot. But when heel pain improves with treatment, the spur is still there. That's a good sign the pain was coming from somewhere else, most often the plantar fascia.

Is it a heel spur or plantar fasciitis?

They're not either-or. A heel spur is something seen on an X-ray. Plantar fasciitis describes irritation of the band of tissue along the bottom of the foot, and it's a common cause of heel pain whether or not a spur is present.

Plantar heel pain often follows a recognizable pattern (NHS):

•          Pain on the bottom of the heel and arch

•          Pain that's worst with your first steps in the morning or after resting

•          Pain that eases as you move, then returns after long periods of standing or walking

Read our post on heel pain in the morning and plantar fasciitis for more on that pattern and what helps.

Do heel spurs need to be removed?

Rarely. Because spurs don't cause plantar fasciitis pain, treatment can work without removing one. The AAOS notes that surgery for plantar fasciitis is generally reserved for people who haven't improved after about 12 months of consistent nonsurgical treatment, and that surgeons usually leave large spurs alone (AAOS OrthoInfo).

Questions about surgery, injections, or what your imaging shows are best directed to your physician or podiatrist.

What helps heel pain?

The American Physical Therapy Association's 2023 heel pain guideline supports a combination of treatments aimed at the soft tissues of the foot and calf (Koc et al., JOSPT 2023):

•          Stretching of the plantar fascia and calf

•          Manual therapy for the foot, ankle, and calf

•          Taping for short-term relief

•          Night splints for people with consistent first-step morning pain

•          Shoe inserts or orthoses, as part of a broader plan

•          Strengthening of the foot and ankle muscles

•          Education about load, footwear, and activity

Simple steps that help many people:

•          Wear supportive, cushioned shoes, even at home

•          Stretch your calf and foot before your first steps in the morning

•          Cut back on long periods of standing, walking, or running for a while, then build back gradually

•          Avoid walking barefoot on hard floors

How can physical therapy help?

A physical therapist looks at what's actually driving your heel pain, not just what's on the X-ray. An evaluation may include:

•          When the pain started and what makes it better or worse

•          Calf flexibility, ankle motion, and foot strength

•          How you walk, and your footwear

•          How much time you spend on your feet at work and during exercise

•          Screening for signs that need a physician's or podiatrist's evaluation

From there, a plan built around the treatments above is adjusted to your foot and goals, with a home program you can keep doing on your own. Physical therapy doesn't guarantee a specific result or timeline.

At Nova Physical Therapy in North Hollywood, every plan for heel pain starts with an evaluation so treatment fits what we find.

When should I see a doctor?

See a physician or podiatrist promptly if you have:

•          Heel pain after a fall, jump, or injury, or a sudden pop in the bottom of your foot

•          Trouble putting weight on your foot

•          Numbness, tingling, or burning in your foot

•          A heel that's red, hot, or swollen, especially with fever

•          Diabetes and any new foot pain

•          Pain in both heels with morning stiffness or pain in other joints

•          Pain that's constant, including at rest or at night

•          Heel pain that hasn't improved after a couple of weeks of self-care, or keeps getting worse

We screen for these signs during every evaluation and refer you to a physician or podiatrist when findings call for medical assessment.

Do I need a referral for physical therapy in California?

Not to get started. California allows direct access to physical therapy. A physical therapist can evaluate and treat you without a referral for up to 45 calendar days or 12 visits, whichever comes first. After that, a physician or podiatrist needs to sign the plan of care for treatment to continue. Your insurance plan may have its own referral rules, so check your coverage.

Frequently asked questions

Can a heel spur go away?
Spurs usually don't go away, but that's okay. Heel pain often improves even when the spur stays, because the spur usually isn't the source of the pain.

Do I need an X-ray for heel pain?
Not usually for typical plantar heel pain. Your physician or podiatrist decides whether imaging is needed, often after an injury or when symptoms aren't improving.

Will shoe inserts help a heel spur?
Inserts can help some people with heel pain as part of a broader plan that includes stretching and strengthening. They don't change the spur, but they may ease load on the heel.

Is it bad to walk with a heel spur?
Walking is usually fine. If walking flares heel pain, shorten your walks for a while and build back gradually.

Why does my heel hurt if spurs don't cause pain?
Heel pain most often comes from the plantar fascia or nearby soft tissues. Other causes, like nerve irritation or a stress fracture, are less common and need an evaluation.

Does heel spur surgery work?
Surgery is rarely needed and is generally considered only after about a year of consistent nonsurgical care. That decision is made with your physician or podiatrist.

Do I need a referral to see a physical therapist?
No, not to start. California allows direct access within the limits described above.

About Nova Physical Therapy

Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, led by a Doctor of Physical Therapy. We help people recover from sports injuries, back and neck pain, work injuries, auto accident injuries, knee pain, and shoulder problems, and we also work with balance problems and rehab after surgery. Patients come to us from North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, and across the San Fernando Valley. Learn more about Nova or see our services.

Schedule an evaluation

If you have been told you have a heel spur and your heel still hurts, an evaluation can help sort out what is driving your pain and which next steps fit you.

Nova Physical Therapy
4795 Vineland Ave #E, North Hollywood, CA 91602
Call (818) 639-3402 | Book an appointment online

Disclaimer

This article is for general education only. It is not medical advice, a diagnosis, or a treatment recommendation for any individual. Imaging results should be interpreted by your physician or podiatrist, and only an in-person evaluation can determine what is right for you. No treatment guarantees symptom resolution, and results vary. Physical therapists evaluate movement and function within their scope of practice and refer to physicians when findings warrant. Physical therapy in California is regulated by the Physical Therapy Board of California.

References

1.        American Academy of Orthopaedic Surgeons, OrthoInfo. Plantar Fasciitis and Bone Spurs. Link

2.        Koc TA Jr, et al. Heel Pain – Plantar Fasciitis: Revision 2023. Clinical Practice Guidelines. J Orthop Sports Phys Ther. 2023. Link

3.        NHS. Plantar Fasciitis. Link