That sharp, stabbing pain under your heel the moment your feet hit the floor in the morning. The deep ache that builds after hours on your feet. The soreness that won’t quit no matter how much you rest, stretch, or change your shoes.

If this sounds familiar, you are not alone. Heel pain is the single most common foot complaint I see at Podiatry of SA and in over 20 years of treating patients, two conditions recur: plantar fasciitis and heel spurs. They are frequently confused, often occur together, and yet they are not the same condition, and treating one as the other can delay your recovery significantly.

In this guide, I am going to break down exactly what each condition is, how to tell them apart, and which treatments actually work so you can stop guessing and start healing.

— Dr. Mevelyn Morse, DPM, Board-Certified Podiatrist, Podiatry of SA

What Is Plantar Fasciitis?

Plantar fasciitis is inflammation of the plantar fascia a thick, fibrous band of tissue that runs along the bottom of your foot, connecting your heel bone to the base of your toes. This band functions like a bowstring, absorbing shock and supporting the arch of your foot with every step you take. When it is repeatedly overstretched or overloaded, microscopic tears develop in the tissue and inflammation sets in.

It is the most common cause of heel pain in adults, affecting approximately 2 million Americans every year. According to the American Academy of Orthopaedic Surgeons (AAOS), plantar fasciitis most commonly affects runners, teachers, nurses, retail workers, and anyone who spends long hours standing or walking on hard surfaces.

The classic signs of plantar fasciitis include:

• Sharp, stabbing pain with your very first steps in the morning or after sitting for a long period
• Pain that eases after a few minutes of walking but gradually returns with prolonged activity
• Discomfort concentrated along the bottom of the heel or inner arch not the back of the heel
• Increased soreness after not during exercise or activity
• Tightness in the calf or Achilles tendon that accompanies the heel pain
  Clinical Note from Dr. Morse: “The morning pain pattern is the most telling sign I look for. When a patient tells me their first steps out of bed feel like stepping on a nail, and then it eases up after a few minutes of walking that’s textbook plantar fasciitis. The pain happens because the fascia tightens overnight, then gets suddenly stretched the moment you stand up.”

What Is a Heel Spur?

A heel spur clinically known as a calcaneal spur is a calcium deposit that builds up on the underside of the heel bone (calcaneus) over time. It forms as the body’s attempt to protect itself: repeated pulling of the plantar fascia on the heel bone gradually causes the bone to develop a small, hook-like bony protrusion in response to chronic stress.

Here is a fact that surprises most of my patients: heel spurs are often completely painless. According to the American Academy of Orthopaedic Surgeons, approximately 1 in 10 people has a heel spur, but only 1 in 20 of those people experiences any pain from it. In most cases, the pain that people blame on a heel spur is actually coming from the surrounding plantar fascia inflammation not the spur itself.

Signs that may be associated with a heel spur:

• A dull, chronic ache at the front-underside of the heel bone
• Tenderness when pressing directly on a specific point at the bottom of the heel
• Pain that tends to worsen progressively with activity over time
• No definitive pain-free period in the morning (unlike plantar fasciitis)
• Cannot be diagnosed by symptoms alone requires an X-ray to confirm
  Clinical Note from Dr. Morse: “In my experience, a lot of patients come in convinced they have a heel spur because of something they read online. And while heel spurs do show up on X-rays, I always explain that the spur itself isn’t usually what’s causing the pain. The real culprit is almost always the plantar fascia. Treat that inflammation, and the pain resolves regardless of whether a spur is present.”

Heel Spur vs. Plantar Fasciitis: Key Differences at a Glance

Can You Have Both Plantar Fasciitis and a Heel Spur at the Same Time?

Yes and this is extremely common. In fact, roughly 50% of people with plantar fasciitis also have a heel spur, because both conditions are driven by the same underlying mechanical stress on the heel and plantar fascia.

When both are present, plantar fasciitis is almost always the primary driver of pain. Treating the heel spur in isolation without addressing the fascia inflammation rarely resolves symptoms. This is one of the most important reasons to get a proper podiatric evaluation before starting any treatment program.

At Podiatry of SA, our approach always starts with identifying the root cause not just chasing the symptom.

What Causes Plantar Fasciitis and Heel Spurs?

Both conditions share the same core risk factors. The most common causes I see in my San Antonio patients include:

• Flat feet (fallen arches) or high arches: both alter how your foot distributes weight and increase fascia strain
• Tight calf muscles or a shortened Achilles tendon: this increases the pulling force on the plantar fascia with every step
• A sudden spike in activity: starting a new running or walking program, or significantly increasing your daily step count without proper conditioning
• Long hours standing on hard surfaces: concrete floors, tile, and hard pavement are particularly taxing on the fascia
• Excess body weight increases the compressive load on the plantar fascia significantly
• Worn-out or unsupportive footwear: shoes without adequate arch support or cushioning accelerate fascia stress
• Age: plantar fasciitis and heel spurs are most common between the ages of 40 and 60, as tissue elasticity naturally decreases

Treatment: What Actually Works

The good news for my patients: over 90% of plantar fasciitis and heel spur cases resolve without surgery when treated early and consistently. Here’s what works:

First-Line Conservative Treatments

1. Stretching: The Most Underrated Tool

Consistent daily stretching is one of the most clinically proven interventions for plantar fasciitis. The most important stretches to do before getting out of bed each morning:

• Plantar fascia stretch: Sit at the edge of your bed, cross one foot over your knee, and gently pull your toes back toward your shin. Hold 30 seconds, repeat 3 times on each side
• Calf/Achilles stretch: Stand facing a wall, place both hands on the wall, step one foot back, and press the heel flat to the floor. Hold 30 seconds, repeat 3 times
• Towel stretch: Loop a towel around the ball of your foot and gently pull it toward you with a straight knee great for tight mornings

For hands-on massage techniques to complement your stretching, see our guide: Plantar Fasciitis Massage: Techniques for Fast Relief

2. Custom Orthotics

Medical-grade custom orthotics redistribute pressure away from the plantar fascia and correct the biomechanical abnormalities that cause it to become overloaded. In my clinical experience, custom orthotics outperform over-the-counter insoles significantly for patients with structural foot issues like flat feet or high arches.

3. Night Splints

Night splints hold the plantar fascia in a gently stretched position while you sleep preventing it from tightening overnight and dramatically reducing that notorious first-step morning pain. Many of my patients report immediate improvement within the first week of use.

4. Supportive Footwear

Shoes with proper arch support, cushioned soles, and a slight heel rise reduce load on the plantar fascia. Avoid walking barefoot on hard surfaces even around the house during active inflammation.

5. Rest, Ice & Anti-Inflammatories

During flare-ups: reduce high-impact activity, apply ice for 15–20 minutes, 3 times daily, and use NSAIDs (such as ibuprofen) for short-term relief of pain and swelling. This manages symptoms but does not address the underlying cause, which is where professional treatment makes the difference.

Advanced Treatments at Podiatry of SA

When conservative care does not provide sufficient relief after 6–8 weeks, our clinic offers:

Corticosteroid Injections
A precisely targeted anti-inflammatory injection into the plantar fascia provides rapid, significant pain relief for stubborn cases. Most patients feel improvement within 3–5 days of the injection.

Extracorporeal Shockwave Therapy (ESWT)
One of the most effective non-surgical options for chronic plantar fasciitis. ESWT delivers acoustic energy pulses to the heel, stimulating the body’s natural healing response in damaged tissue. Clinical studies referenced by the American Orthopaedic Foot & Ankle Society (AOFAS) support its use in cases unresponsive to standard conservative care.

MLS Laser Therapy
A non-invasive treatment using specific wavelengths of light to reduce inflammation, relieve pain, and accelerate tissue regeneration with no needles and no downtime. Highly effective for patients who want to avoid injections.

Physical Therapy Referral
For complex biomechanical presentations, we coordinate with physical therapists to conduct gait analysis, strengthen muscles, and develop a structured rehabilitation program.

Surgery (Plantar Fascia Release)
Reserved for fewer than 5% of patients those with confirmed plantar fasciitis lasting over 12 months that has not responded to all conservative and advanced treatments. Even then, minimally invasive techniques have made recovery significantly faster than traditional open surgery.

Simple Self-Check: Is It Plantar Fasciitis or Something Else?

Use this checklist to help identify your symptoms before your appointment:

• My heel pain is worst with my very first steps in the morning
• The pain eases after a few minutes of walking but returns later in the day
• I feel pain along the bottom of my heel or arch not the back of my heel
• I spend long hours on my feet or recently increased my activity level
• I have flat feet, high arches, or tight calf muscles
• The pain has persisted for more than 2–3 weeks despite rest

If you checked 3 or more: schedule a podiatric evaluation. Early diagnosis means faster recovery and far fewer interventions needed.

When Should You See a Podiatrist for Heel Pain?

Do not push through heel pain hoping it will resolve on its own. In my experience, patients who wait the longest before seeking care almost always take longer to recover. Please contact Podiatry of SA if:

• Your heel pain has lasted more than 2–3 weeks without improvement
• The pain is severe enough to affect your walking, work, or daily activities
• You notice swelling, bruising, or redness around the heel
• Pain is worse after rest and does not ease with light activity
• You have had multiple flare-ups of heel pain that keep returning
• Home stretching and rest have not provided relief after 2 weeks
• You are a diabetic patient heel and foot pain requires prompt evaluation given the risk of complications

The American Podiatric Medical Association (APMA) recommends seeking professional care for heel pain that persists beyond a few weeks, as delayed treatment significantly increases recovery time.

The Bottom Line: Don’t Let Heel Pain Become a Chronic Problem

Plantar fasciitis and heel spurs are both highly treatable conditions but only when addressed properly and promptly. In my 20+ years treating foot and ankle conditions, the patients who recover fastest and most completely are always those who seek professional care early, before the condition becomes chronic and entrenched.

If your heel pain has lasted more than two weeks, is affecting your daily activities, or keeps coming back no matter what you try, it is time to stop guessing and get a definitive diagnosis. The right treatment plan changes everything.

Ready to Finally Fix Your Heel Pain?

Whether your pain is from plantar fasciitis, a heel spur, or a combination of both the board-certified podiatrists at Podiatry of SA are here to help. We will evaluate your condition thoroughly, identify the exact cause, and build a personalized treatment plan to get you back on your feet as quickly as possible.