Plantar Fasciitis vs. Heel Spurs: Clearing Up the Confusion

Heel pain has a way of sending people straight to Google, where two terms tend to appear over and over again: plantar fasciitis and heel spurs. They are often discussed together, which makes it easy to assume they are two names for the same problem.

They are not. Plantar fasciitis involves the plantar fascia, the strong band of tissue running along the bottom of the foot from the heel toward the toes. A heel spur is a bony growth that can develop along the heel bone. The two can occur together, but seeing a heel spur on an X-ray does not necessarily mean the spur is what is causing your pain. [1]

That distinction is important in physical therapy because we treat the painful, limited movement pattern in front of us, not simply what appears on an image.

What Is Plantar Fasciitis?

Plantar fasciitis is one of the most common causes of pain along the bottom of the heel. The plantar fascia supports the arch and helps the foot manage forces as you stand, walk, and run. When that tissue becomes irritated, the result is often a sharp or aching pain near its attachment to the heel bone. [1]

One of the most recognizable symptoms is pain during the first few steps after getting out of bed in the morning or after sitting for an extended period. The pain may ease somewhat once you begin moving, only to return after prolonged standing, walking, or higher-impact activity. [1][2]

Plantar fasciitis is not limited to runners. Changes in activity level, prolonged time on your feet, limited ankle mobility, foot mechanics, and other factors can contribute to the amount of stress placed on the plantar fascia. For some people, the symptoms begin after a sudden increase in walking or exercise. For others, they develop gradually.

What Is a Heel Spur?

A heel spur is a bony growth that forms on the calcaneus, or heel bone. Heel spurs can sometimes be seen on an X-ray in people who also have plantar fasciitis, which is one reason the two conditions became so closely associated. [1]

The important part is that the spur itself is not necessarily responsible for the pain. AAOS specifically notes that heel spurs do not cause plantar fasciitis pain and that plantar fasciitis can be successfully treated without removing the spur. [1]

This is where the confusion often starts. A patient has heel pain, an X-ray shows a spur, and the spur becomes the obvious thing to blame. But an imaging finding and the source of your symptoms are not always the same thing.

So Which One Is Actually Causing the Heel Pain?

In many patients with the classic symptoms of plantar fasciitis, the plantar fascia is the structure being treated rather than the heel spur itself. The symptom pattern, physical examination, activity history, tenderness, foot and ankle mobility, and response to movement all help determine what is contributing to the pain.

• A physical therapist may ask questions such as:
• Is the pain worst with your first steps in the morning?
• Does it return after sitting for a long period?
• Where exactly is the heel tender?
• Did the symptoms begin after a change in running, walking, work, or exercise?
• How well does the ankle move?
• How strong are the calf, foot, and lower leg?
• Does the way you walk or run increase stress through the painful area?

Those findings tell us much more about how the foot is functioning than the presence of a heel spur alone.

If your heel pain is persistent, unusual, or not following the expected pattern, it is also important to consider other possible causes. Our companion NY Bone & Joint Specialists article, Foot Pain That Won't Quit: When to See a Specialist, explains when ongoing foot pain may need a more detailed diagnostic evaluation.

Why Treating the X-Ray Is the Wrong Approach

Imagine an X-ray shows a prominent heel spur, but your symptoms and examination are consistent with plantar fasciitis. Removing or trying to somehow “break up” that spur would not address the way the plantar fascia is tolerating load, the mobility of the ankle, or the strength and movement deficits contributing to the problem.

Physical therapy cannot make a heel spur disappear, nor does it need to in most cases of plantar fasciitis. The goal is to reduce symptoms and improve the way the foot and lower leg manage everyday forces.

This is why the diagnosis matters. Effective rehabilitation looks at how the entire foot and ankle are functioning rather than focusing on one finding from an image.

How Physical Therapy Treats Plantar Fasciitis

Physical therapy for plantar fasciitis is not simply a matter of stretching the bottom of your foot until it stops hurting. Current clinical guidelines support a combination of approaches selected according to the individual patient, including plantar fascia and calf stretching, manual therapy, taping, therapeutic exercise, and education about activity and loading. [2]

A rehabilitation program may address several areas at once.

Restore Ankle and Foot Mobility

Limited movement through the ankle can change how the foot handles each step. Your therapist may assess ankle dorsiflexion, calf flexibility, foot mobility, and the way the toes and arch move during walking.

Treatment can include manual therapy and targeted mobility exercises when restrictions are present. The purpose is not to make every joint as flexible as possible. It is to restore enough movement for the foot and ankle to perform their normal roles efficiently. [2]

Stretch the Plantar Fascia and Calf

Stretching has a strong role in plantar fasciitis rehabilitation. Both plantar fascia-specific stretching and calf stretching are recommended in current physical therapy guidelines for plantar heel pain. [2]

A plantar fascia-specific stretch typically places the toes into extension to tension the tissue along the bottom of the foot. Calf stretching addresses the gastrocnemius and soleus muscles, which influence ankle mobility and the forces transmitted through the heel.

Research has also shown that plantar fascia-specific stretching can improve outcomes in patients with chronic plantar heel pain. [3]

Build Strength Instead of Only Chasing Flexibility

Stretching may help with symptoms, but it is not the entire rehabilitation program. The foot and lower leg also need enough strength to tolerate the demands placed on them.

Depending on your examination, strengthening may involve the calf, intrinsic foot muscles, and other muscles of the lower extremity. Progressive resistance exercise has been studied as part of plantar fasciitis treatment and may improve pain and function. [4]

The exercise level should match what your foot can currently tolerate. Jumping straight into aggressive strengthening when normal walking is still highly painful is not the same as gradually rebuilding capacity.

Manage How Much Load the Foot Is Taking

Plantar fasciitis is often aggravated when the amount of stress placed on the foot exceeds what the tissue can tolerate. That does not always mean you need complete rest.

A runner may temporarily reduce mileage or high-intensity sessions. Someone who stands throughout the workday may need a different strategy for managing activity and recovery. Your therapist can help determine which activities should be reduced temporarily and which can continue without repeatedly aggravating symptoms.

The goal is to keep you moving while giving the plantar fascia a chance to recover and gradually tolerate more.

What About Orthotics, Taping, and Night Splints?

These can all have a place in treatment, but they are not interchangeable and they are not substitutes for a complete rehabilitation program.

Taping may provide short-term relief for some patients with plantar heel pain. Foot orthoses may also be used as part of treatment, although current physical therapy guidelines recommend against using orthoses as the only treatment for either short- or long-term pain relief. [2]

Night splints may be appropriate for patients who consistently experience significant first-step pain in the morning. They hold the ankle and foot in a position that maintains a gentle stretch while you sleep. [2]

Which of these options makes sense depends on your symptoms and examination. There is no single insert, brace, or stretch that works equally well for every case of heel pain.

Exercises for Plantar Fasciitis Should Match the Problem

Searching for plantar fasciitis exercises will give you dozens of stretches and strengthening drills. Some may be appropriate. Others may be too easy, too aggressive, or unrelated to the specific limitations contributing to your symptoms.

ASPT's guide to exercises for plantar fasciitis includes examples of commonly used calf, plantar fascia, and foot exercises. The important part is not simply collecting more exercises. It is understanding why you are doing each one and how it fits into your progression.

A physical therapist can adjust the amount of resistance, range of motion, frequency, and overall exercise load as your symptoms improve. That progression is especially important if your goal is returning to running or another activity that places repetitive force through the foot.

What If an X-Ray Shows a Heel Spur?

Do not assume that finding automatically explains your symptoms.

Heel spurs can coexist with plantar fasciitis, but their presence does not prove that the bony growth is causing the pain. [1] Your clinician should interpret the X-ray alongside your symptom pattern and physical examination.

If your presentation is typical for plantar fasciitis, rehabilitation can still focus on improving the function of the plantar fascia and surrounding structures. The spur does not need to disappear for your symptoms to improve. [1]

When Heel Pain May Need More Than Physical Therapy

Physical therapy is appropriate for many cases of plantar fasciitis, but not every painful heel should be assumed to have the same diagnosis.

A medical evaluation may be appropriate if you have:

• Severe pain after an injury
• An inability to bear weight
• Significant swelling or bruising
• Numbness or tingling
• Pain that is highly localized over a bone
• Symptoms that continue to worsen despite modifying activity
• Pain that does not fit the usual plantar fasciitis pattern
• Persistent symptoms that are not responding to an appropriate rehabilitation program

Conditions such as stress fractures, nerve problems, tendon injuries, arthritis, and other foot disorders can also cause heel or foot pain. When the diagnosis is uncertain, All Sports Physical Therapy works closely with the foot and ankle specialists at New York Bone & Joint Specialists so patients can receive additional evaluation when needed.

Heel Pain Is About More Than the Spur

The words “heel spur” can sound alarming because they describe something visible and permanent on an X-ray. Plantar fasciitis is less visible, but in many cases it is the soft tissue and the way that tissue is being loaded that matter more to your symptoms. [1]

Successful rehabilitation focuses on what you can change: mobility, strength, activity tolerance, movement mechanics, and the way you gradually return to the activities that matter to you. The goal is not to erase an X-ray finding. It is to help your foot tolerate walking, exercise, work, and everyday life with less pain and better function.

At All Sports Physical Therapy, our physical therapists develop individualized treatment plans for plantar fasciitis and other causes of orthopedic foot pain. If heel pain is interfering with your activity, schedule an appointment at our Upper East Side or Midtown Manhattan location.

Frequently Asked Questions

Is plantar fasciitis the same thing as a heel spur?

No. Plantar fasciitis affects the plantar fascia, while a heel spur is a bony growth on the heel bone. They can occur together, but a heel spur is not considered the cause of plantar fasciitis pain. [1]

Can a heel spur cause pain?

A heel spur seen on an X-ray does not automatically mean it is the source of your symptoms. Heel spurs commonly occur alongside plantar fasciitis, but AAOS notes that the spur itself is not the cause of plantar fasciitis pain. Your symptoms and physical examination are important in determining what is actually hurting. [1]

Can physical therapy get rid of a heel spur?

Physical therapy does not remove a bony heel spur. More importantly, the spur usually does not need to be removed to successfully treat plantar fasciitis. Physical therapy focuses on reducing pain and improving mobility, strength, movement, and the foot's ability to tolerate activity. [1][2]

What exercises are best for plantar fasciitis?

Plantar fascia-specific stretching and calf stretching are strongly supported components of physical therapy for plantar heel pain. Strengthening may also be incorporated to improve the capacity of the foot and lower leg. The exact exercises and progression should be based on your symptoms and examination. [2][3][4]

Should I stop walking or exercising if I have plantar fasciitis?

Not necessarily. Complete rest is not automatically required, but activities that repeatedly aggravate the heel may need to be modified temporarily. A physical therapist can help adjust your activity level and gradually rebuild the foot's tolerance as symptoms improve.

Do orthotics cure plantar fasciitis?

Orthotics can be useful as part of a broader treatment plan, but they should not be the only treatment. Current physical therapy guidelines support combining appropriate orthoses with other interventions such as stretching, manual therapy, taping, exercise, and patient education when indicated. [2]

When should I see a specialist for heel pain?

Seek further evaluation when heel pain is severe, follows an injury, prevents you from bearing weight, is associated with neurological symptoms, or continues to worsen instead of improving. Persistent or atypical heel pain may come from a condition other than plantar fasciitis and may require additional diagnostic evaluation.

Peer-Reviewed Clinical References

[1] American Academy of Orthopaedic Surgeons. Plantar Fasciitis and Bone Spurs. OrthoInfo.

[2] Koc TA Jr, Bise CG, Neville C, Carreira D, Martin R, McDonough CM. Heel Pain — Plantar Fasciitis: Revision 2023. Journal of Orthopaedic & Sports Physical Therapy. 2023.

[3] DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients With Chronic Heel Pain. Journal of Bone and Joint Surgery. 2003.

[4] Rathleff MS, Mølgaard CM, Fredberg U, et al. High-Load Strength Training Improves Outcome in Patients With Plantar Fasciitis. Scandinavian Journal of Medicine & Science in Sports. 2015.

[5] Morrissey D, Cotchett M, Said J'Bari A, et al. Management of Plantar Heel Pain: A Best Practice Guide. British Journal of Sports Medicine. 2021.