Heel Spurs: What Are They Really?

A calcaneal (heel) spur is a bony outgrowth on the underside or back of the heel bone (calcaneus). They develop over time from repetitive stress where the plantar fascia (bottom of heel) or Achilles tendon (back of heel) attaches to the bone. Heel spurs are extremely common — present in approximately 15% of adults — and are often found incidentally on X-rays in people with no symptoms. This is a crucial point: the spur itself is rarely the source of pain. The pain is caused by inflammation of the attached soft tissue (plantar fascia or Achilles tendon).

Plantar Heel Spur vs. Posterior Heel Spur

Plantar calcaneal spur: Under the heel, associated with plantar fasciitis. Sharp pain on the first steps in the morning or after rest. Posterior calcaneal spur: At the back of the heel, associated with Achilles tendinopathy (insertional). Pain at the back of the heel with walking and running.

Physiotherapy Treatment

Plantar Fascia Stretching and Loading

The Strassburg sock (worn at night to keep the plantar fascia stretched) and morning pre-walking plantar fascia stretches significantly reduce plantar heel spur pain. Progressive plantar fascia loading (single-leg calf raises on a step, full range) promotes tissue remodelling.

Calf Muscle Release and Strengthening

Tight gastrocnemius and soleus increase plantar fascia tension. Regular calf stretching combined with eccentric calf strengthening is the most evidence-based intervention.

Orthotic Insoles

Heel cups or custom orthotic insoles redistribute pressure away from the spur and reduce plantar fascia tension during walking.

Shockwave Therapy

For chronic heel spur pain (over 6 months) that has not responded to conservative management, shockwave therapy provides significant benefit in approximately 70% of cases.