Disclaimer: This article is for general educational purposes only and does not constitute medical advice. Always consult a qualified health professional for advice specific to your condition. © 2026 Better Physiotherapy Bundoora.
Many people with heel pain are told they have a “heel spur” on X-ray and that this is the cause of their pain. In most cases, this is a misconception. The spur is an incidental finding — the real problem is plantar fasciitis, which responds very well to physiotherapy.
What Is a Heel Spur?
A calcaneal spur is a calcium deposit that forms on the underside of the heel bone at the attachment of the plantar fascia. Studies have found calcaneal spurs in approximately 15% of the general population — with most people having no pain whatsoever. The presence of a spur on X-ray does not correlate well with pain severity.
The spur develops as a response to chronic repetitive tension at the plantar fascia-calcaneus junction. It is an adaptation — not a disease — and removing it surgically does not reliably resolve heel pain.
The Real Problem: Plantar Fasciitis
Plantar fasciitis is degeneration and inflammation of the plantar fascia — the thick band of tissue running along the sole of the foot. Classic symptoms include:
- Sharp heel pain with the first steps in the morning
- Pain that eases with walking but returns after rest
- Tenderness at the medial heel (inside of the heel, at the fascia attachment)
- Worsening after prolonged standing or walking
Physiotherapy Treatment
- High-load strength training — the Rathleff protocol of heavy, slow heel raises produces excellent results for plantar fasciitis. The progressive tendon loading stimulates fascial remodelling
- Calf flexibility — tight gastrocnemius and soleus increase plantar fascia tension; calf stretching is a standard component of treatment
- Foot intrinsic strengthening — short foot exercises and toe curls strengthen the plantar foot muscles that support the arch
- Footwear advice — supportive footwear with cushioned heel reduces fascial load; going barefoot, especially first thing in the morning, is commonly aggravating
- Shockwave therapy — particularly effective for chronic plantar fasciitis (>3 months). See our article on shockwave therapy
- Taping — low-Dye taping reduces plantar fascia strain and provides short-term pain relief during the acute phase
Frequently Asked Questions
What is a heel spur?
A calcaneal heel spur is a bony growth that develops on the underside of the heel bone (calcaneus) at the attachment of the plantar fascia. It forms in response to chronic tension at this attachment. The spur itself has no nerve supply and does not directly cause pain — it is the inflamed, degenerative plantar fascia around it that is painful.
If the spur doesn't cause pain, why does my heel hurt?
Heel pain at the bottom of the foot in the morning, improving with walking but worsening after rest, is plantar fasciitis — degeneration and inflammation of the plantar fascia at its calcaneal attachment. The spur is a consequence of chronic fascial tension, not the cause of pain. Treating the plantar fascia (the real problem) resolves the pain whether or not a spur is present.
What is the fastest way to get rid of heel pain?
The most effective combination for plantar fasciitis: calf raises (Alfredson protocol or high-load single leg heel raises), load modification (reducing aggravating activities while staying active), supportive footwear or heel cup, and physiotherapy. Shockwave therapy produces excellent results for stubborn cases that fail to respond to initial treatment within 6–8 weeks.
Is cortisone injection good for heel pain?
Cortisone provides faster short-term pain relief but does not address the underlying fascial degeneration. Studies show no difference between cortisone and physiotherapy at 6 and 12 months. Repeated cortisone injections carry a risk of plantar fascia rupture — generally limited to one or two injections at most.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora