Plantar Fasciitis or Heel Spur? How to Tell

Heel pain that stabs with your first steps out of bed is one of the most common foot complaints adults bring to a doctor. Two names come up again and again: plantar fasciitis and heel spurs.

They are related, and they are often confused. This article explains what each one is, how they differ, how they are diagnosed, and what tends to help. It can help you understand your symptoms and decide what to do next, but it cannot diagnose your heel.

What is plantar fasciitis?

Plantar fasciitis is irritation of the plantar fascia, a thick band of tissue that runs along the bottom of your foot from the heel bone to the toes. The fascia supports your arch and absorbs force each time your foot strikes the ground.

Repeated strain can cause small tears and thickening where the fascia attaches to the heel. The result is pain on the bottom of the heel, usually on the inside edge. It is one of the most common causes of heel pain in adults, and it tends to affect people between their 40s and 60s, runners, people who stand for long hours, and people with higher body weight.

Heel pain is just one of many musculoskeletal problems that respond to the same basics of load, rest and strength. Our physical health guide brings those threads together.

What is a heel spur?

A heel spur is a small, hook-shaped growth of extra bone on the underside of the heel bone. It shows up on an X-ray, which is an imaging test that uses a small dose of radiation to picture bones.

Spurs form over months or years as the body responds to ongoing pull and pressure at the spot where the plantar fascia and other tissues attach. They are common, and many people who have one never feel it. Spurs are often found by chance on an X-ray taken for another reason.

When a person with a heel spur does have heel pain, the pain usually comes from the inflamed soft tissue around the spur, most often plantar fasciitis, rather than the bone itself.

How can you tell plantar fasciitis and heel spurs apart?

You usually cannot tell them apart by feel, because most painful heel spurs are really plantar fasciitis with a spur alongside it. The practical question is whether your pain fits the plantar fasciitis pattern or points to something else.

What does plantar fasciitis pain feel like?

The classic sign is sharp heel pain with the first few steps after waking up, which eases after a few minutes of walking. The same pain often returns after sitting for a while, then standing up.

Other common features include:

• Pain on the bottom of the heel, often toward the inside of the foot.
• Pain that gets worse after, rather than during, exercise.
• Tenderness when you press on the bottom of the heel.
• Pain after standing for long periods, especially on hard floors.
• Tight calf muscles or a tight Achilles tendon.

Plantar fasciitis does not usually cause swelling of the whole foot, numbness, or a heel that is red and hot. Those signs suggest another problem. If both feet are puffy, our article on why your feet might be swollen covers causes that need a different approach.

What else can cause heel pain?

Several other conditions cause heel pain, and some need different care. A doctor will think about these if your pain does not match the usual pattern.

If you suspect a stress fracture or a sudden injury, our guide to telling a sprain from a fracture explains why imaging matters.

How do doctors diagnose heel pain?

Plantar fasciitis is usually diagnosed from your symptoms and a physical exam, without any tests. Your doctor will ask when the pain is worst, press on different parts of your heel, and check your arch, ankle flexibility and calf tightness.

An X-ray may be ordered if the pain is not improving with treatment or if a fracture is possible. It may show a heel spur, but because spurs are common in people without pain, finding one does not by itself explain your symptoms. Ultrasound or MRI is occasionally used when the diagnosis is unclear or treatment is not working.

What helps plantar fasciitis and heel spur pain at home?

Most people improve with simple, consistent self-care, although recovery can take several months. According to MedlinePlus, home treatment is the first step for most people, and the same steps are used whether or not a spur is present.

• Stretch your calf and the bottom of your foot. Gentle stretches several times a day, especially before your first steps in the morning, are a core part of treatment.
• Ease the load for a while. Cut back on running, jumping and long periods of standing. Low-impact activity such as cycling or swimming keeps you moving.
• Use ice. Ice the heel for about 15 to 20 minutes, a few times a day, wrapped in a cloth.
• Wear supportive shoes. Choose shoes with good arch support and a cushioned heel, and avoid walking barefoot on hard floors.
• Try heel cups or arch inserts. Over-the-counter inserts help many people; custom orthotics are an option if they do not.
• Consider a night splint. It holds the foot in a gentle stretch overnight and may ease morning pain.
• Use pain relievers as directed. Over-the-counter medicines such as ibuprofen or naproxen may help short term. Check with your doctor if you have stomach, kidney or heart problems.

Once pain settles, return to activity gradually. Building calf and foot strength can help prevent flare-ups, and our piece on telling soreness from an injury can help you judge how much is too much.

Walking is still worth keeping in your routine once pain allows; see why walking is underrated.

What if home treatment does not work?

If several months of consistent self-care have not helped, a doctor may suggest other options. These include physical therapy, custom orthotics, a walking boot, corticosteroid injections, or shock wave therapy, which uses sound waves aimed at the heel.

Steroid injections may give short-term relief, but repeated injections carry risks, including thinning of the heel fat pad and, rarely, rupture of the plantar fascia, so doctors use them sparingly. Surgery to release the fascia or remove a spur is uncommon and usually considered only when pain persists despite many months of other treatment.

When should you see a doctor?

See your doctor or a podiatrist if heel pain has not improved after a few weeks of home care, keeps you from your normal activities, or keeps coming back. Get seen sooner if you have diabetes or poor circulation, because foot problems can become serious quickly.

Also make an appointment if you have:

• Numbness, tingling or burning in the heel or sole.
• Pain at the back of the heel rather than underneath.
• Heel pain that started with a specific injury or a sharp jump in training.
• Pain at night or at rest that does not ease.

Go to urgent care or the emergency room if you cannot put any weight on your foot, if the heel is red, hot and swollen with a fever, if your foot looks deformed after an injury, or if you heard a pop at the back of the heel with sudden pain and weakness pushing off, which can mean a torn Achilles tendon.

Can you prevent plantar fasciitis from coming back?

You cannot rule out a flare-up entirely, but a few habits lower the strain on your heel over time. Most of them are about how quickly you change your activity and what you wear while you do it.

• Build up gradually. Sudden jumps in running distance, hiking or standing time are a common trigger, so raise your load in small steps.
• Replace worn-out shoes. Cushioning and support break down with use, even when the upper still looks fine.
• Keep stretching. Calf and foot stretches are worth continuing a few times a week after the pain is gone.
• Strengthen your feet and calves. Calf raises and simple toe exercises may help the foot handle load.
• Mix in low-impact exercise. Cycling, swimming and rowing let you stay active on days your heel needs a break.

If you stand for work, a cushioned mat and supportive shoes can make a real difference over a long shift. Body weight also affects the load on your heels, and the Physical Activity Guidelines for Americans recommend 150 to 300 minutes of moderate activity a week plus two days of muscle strengthening, which you can usually meet with low-impact options while your heel recovers.