These two conditions are constantly confused — partly because they often occur together, and partly because they cause the same symptom: heel pain. But they're different things, they have different causes, and treating the wrong one wastes time.
Plantar Fasciitis: The Soft Tissue Problem
Plantar fasciitis is inflammation of the plantar fascia — the thick band of tissue that runs from your heel bone to your toes, supporting the arch. When this tissue is repeatedly overstretched or overloaded, microscopic tears develop and the tissue becomes inflamed.
The defining symptom is pain with the first steps in the morning that eases after walking. This happens because the fascia tightens overnight and then tears slightly when you load it for the first time. The pain often returns after sitting for extended periods.
Plantar fasciitis is a soft tissue problem. It responds to rest, stretching, supportive footwear, insoles, and in persistent cases, injections or shockwave therapy.
Heel Spurs: The Bone Problem
A heel spur is a calcium deposit — a bony growth — that forms on the underside of the heel bone (calcaneus). It develops over months or years as a response to repeated stress at the attachment point of the plantar fascia.
Here's the key fact that surprises most people: heel spurs are usually painless. Studies show that about 10% of the population has heel spurs on X-ray, but only a small fraction of those people have pain. The spur itself is not usually the pain generator — the inflamed plantar fascia around it is.
This matters clinically: Patients who get an X-ray, see a heel spur, and assume that's their problem sometimes pursue unnecessary treatment for the spur (including surgery) when the actual problem — plantar fasciitis — could be resolved conservatively. Treat the fascia first.
Can You Have Both?
Yes, and most patients with chronic plantar fasciitis eventually develop a heel spur at the same location. They share the same root cause: repetitive tension at the heel bone attachment. Think of the spur as a long-term side effect of unresolved plantar fasciitis, not a separate disease.
How to Tell Which One You Have
Symptom-wise, you can't definitively distinguish them without imaging — they feel the same. A podiatrist will typically order an X-ray to determine if a spur is present. But again, the presence of a spur doesn't necessarily change treatment. The treatment approach for both is essentially the same:
- Arch support and orthotics
- Plantar fascia and calf stretching
- Supportive footwear
- Corticosteroid injection if conservative treatment fails
- Shockwave therapy for chronic cases
Surgery is occasionally considered for heel spurs — but only after at least 12 months of failed conservative treatment and only when the spur is genuinely confirmed as the pain source.
Treatment Products That Work for Both
See a podiatrist for a proper diagnosis
An X-ray determines if a spur is present. A podiatrist determines which is causing your pain.