Rethinking Heel Spurs: What They Really Mean for Your Foot Pain
Heel pain is one of the most common complaints we see in the clinic—and it’s no surprise. Whether you're a runner, a tradie, or just spend a lot of time on your feet, that sharp pain under the heel can really disrupt your day. One of the most talked-about culprits? The heel spur. But here’s the thing: heel spurs might not be what we’ve always believed.
📌 What Is a Heel Spur?
A heel spur is a small bony outgrowth on the underside of the heel bone (calcaneus). For years, it’s been blamed for causing pain, especially in people diagnosed with plantar fasciitis. The old theory suggested that constant pulling of the plantar fascia on the heel bone caused inflammation, which then led to a spur forming—sort of like a scar in bone form.
This explanation sounds logical. But it’s not the whole story.
🔍 What Does the Research Say?
Recent studies have challenged the long-held belief that heel spurs form because of tension from the plantar fascia. In fact, imaging and anatomical research show that heel spurs are often not located within the plantar fascia at all. Instead, they’re more commonly found in nearby muscles like the flexor digitorum brevis (FDB) and abductor digiti minimi.
In other words, the spur might not be caused by the plantar fascia—and it might not be causing your pain either.
🤯 Are Heel Spurs Always a Problem?
Not necessarily. Research shows that 11–27% of people have heel spurs on X-rays, even if they don’t have heel pain. One study done over 45 years ago concluded that heel spurs were likely a normal part of aging—not necessarily a cause for concern.
That’s why it’s so important not to jump to conclusions based solely on an X-ray. Just because a spur is there doesn’t mean it’s the source of your discomfort.
🧬 So What Causes Heel Spurs?
There are two main theories:
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Traction theory: Soft tissues (like muscles or fascia) pull on the heel bone over time, triggering bone growth.
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Compression theory: Repeated pressure from the ground (e.g. walking, running, jumping) causes small stresses in the bone, leading to spur formation as a protective response.
Interestingly, bone structure studies show that the orientation of heel spurs aligns more with vertical loading (compression), not with tissue pulling. This adds weight to the theory that heel spurs might be more about shock absorption than injury.
👥 Who's More Likely to Develop a Heel Spur?
You might be more likely to develop a spur if you:
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Are over 50
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Are female
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Are overweight
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Have osteoarthritis
Even so, plenty of people in these groups never experience heel pain.
🧠 What Does This Mean for You?
If you're dealing with heel pain, it’s important to get a thorough assessment—not just rely on what an X-ray shows. At Achieve Podiatry, we look at the whole picture: your history, biomechanics, footwear, activity levels, and clinical testing.
And if your scan shows a heel spur? Don’t panic. It’s just one piece of the puzzle—and it might not be causing your pain at all.
👣 Final Thoughts
Heel spurs aren’t as straightforward as we once thought. They're common, often harmless, and not always related to plantar fasciitis. If you’re experiencing heel pain, let’s get to the root cause together—rather than just focusing on what your X-ray shows.
Book an appointment today and let’s get you walking comfortably again.
References
- Abreu, M.R., Chung, C.B., Mendes, L. et al. (2003). Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis. Skeletal Radiology, 32: 13-21.
- Barrett, S.L., Day, S.V., Pignetti, T.T. et al. (1995). Endoscopic heel anatomy: analysis of 200 fresh frozen specimens. Journal of Foot & Ankle Surgery, 34: 51-56.
- Li, J., Muehleman, C. (2007). Anatomic Relationship of Heel Spur to Surrounding Soft Tissues: Greater variability than previously reported. Clinical Anatomy, 20: 950-955.
- Kumai, T., Benjamin, M. (2002). Heel spur formation and the subcalcaneal enthesis of the plantar fascia. The Journal of Rheumatology, 29: 1957-1964.