Heel Spur - How to Get Through it

Heel spurs, medically known as calcaneal spurs, are bony outgrowths that form on the heel bone (calcaneus). These spurs often develop over time as a response to repetitive stress and microtrauma at the site of tendinous or fascial insertion. Despite their association with pain, it’s important to understand that many individuals have heel spurs visible on imaging but experience no symptoms at all. Pain arises not necessarily because of the spur itself, but due to surrounding soft tissue involvement and biomechanical dysfunction.

This article explores heel spurs in detail, covering anatomical, physiological, and holistic perspectives. We’ll also discuss how manual therapy can be used as a powerful, non-invasive approach to support recovery and pain relief.

The Two Types of Heel Spur

There are two primary types of heel spurs, distinguished by their anatomical location:

Plantar Heel Spur: This type forms on the underside of the heel bone, typically at the point where the plantar fascia inserts into the calcaneus. It is often associated with plantar fasciitis or fasciosis and is usually visible on a lateral X-ray as a pointed bony projection facing towards the arch of the foot.

Posterior Heel Spur: Found on the back of the calcaneus, this type forms near the insertion of the Achilles tendon. It can cause irritation of the surrounding soft tissues and is commonly seen in individuals with Achilles tendinopathy. These spurs may also be accompanied by a bursa, leading to additional inflammation and discomfort.
While both types may contribute to discomfort, it's often the soft tissue reaction and altered biomechanics that lead to the sensation of pain, rather than the bone spur itself.

Heel Spurs vs. Misdiagnosis

Heel spurs can be misdiagnosed or conflated with other common conditions due to overlapping symptoms:

Plantar Fasciitis: This is one of the most common causes of heel pain and is often present alongside a plantar heel spur. However, it is primarily a degenerative condition involving the plantar fascia rather than the bone itself.

Achilles Tendinopathy: Pain at the back of the heel could be due to a posterior spur, but also to mid-portion or insertional Achilles tendinopathy, which affects the tendon structure.

Fat Pad Atrophy: In older adults, the heel’s natural cushioning can thin, causing pain that mimics heel spur symptoms.

Nerve Entrapment: The medial calcaneal branch of the tibial nerve or Baxter’s nerve may become entrapped, leading to neuralgic heel pain unrelated to a spur.

Distinguishing between these diagnoses is crucial and typically requires a detailed clinical assessment and, where necessary, imaging.

Common Symptoms of Heel Spurs

When symptomatic, heel spurs can present with the following clinical features:

• A sharp, stabbing pain located either under the heel or at the back of the heel.
• Increased pain with the first steps in the morning or after prolonged rest (post-static dyskinesia).
• Pain that improves with movement but worsens after extended activity.
• Localised swelling, tenderness, or a warm sensation at the site of the spur.
• Compensatory changes in gait, such as limping or toe walking, which may lead to secondary issues in the knee, hip, or back.

Why Do We Develop Heel Spurs?

Heel spurs result from chronic mechanical overload and the body’s attempt to stabilise stressed tissue through ossification. Repetitive traction or compression at the enthesis—the connective tissue interface where tendon or fascia meets bone—triggers microtrauma, collagen disruption, and eventual calcification.

From a biomechanical perspective, poor foot mechanics, collapsed arches, overpronation, and weak intrinsic foot muscles contribute significantly. Tightness in the Achilles tendon or plantar fascia also increases tensile load on the heel, exacerbating stress.

Age plays a significant role as well. As we age, our connective tissues naturally lose elasticity, and recovery from microtrauma becomes slower. This makes older individuals more susceptible to developing heel spurs. Statistically, women are also more likely to develop heel spurs than men, possibly due to differences in footwear, hormone-related connective tissue changes, and biomechanical patterns.

Traditional Chinese Medicine (TCM) interprets heel spurs as a manifestation of stagnation within the Liver and Kidney meridians. The Kidney governs bones, while the Liver governs tendons. Deficiency in these systems can lead to weakness, poor repair, and buildup of pathological factors like Dampness or Blood Stasis.

Ayurveda sees heel spurs as a condition of aggravated Vata—especially when dryness and degeneration dominate. Kapha individuals may also be affected due to inherent heaviness, sluggish circulation, and tendencies toward calcification. The interplay between dry, brittle tissues (Vata) and fluid stagnation (Kapha) sets the stage for chronic enthesopathy and bony overgrowth.

Affected Structures: Nerves, Muscles, Tendons, and Ligaments

Heel spurs impact not only the bone but also a network of soft tissues and nerves. Understanding the origin and spinal segmental innervation of these structures helps manual therapists address the broader patterns of dysfunction:

Muscles: The gastrocnemius and soleus (calf muscles), intrinsic foot muscles like flexor digitorum brevis, and quadratus plantae can become tight or inhibited due to compensation and pain avoidance.

Tendons: The Achilles tendon and plantar fascia are the most directly involved, but the flexor hallucis longus and flexor digitorum longus may also be affected through altered loading.

Ligaments: The long and short plantar ligaments, spring ligament (plantar calcaneonavicular), and lateral ankle stabilisers may all show signs of increased tension or strain.

Nerves:
The tibial nerve originates from the sciatic nerve, which arises from spinal segments L4 to S3. It travels down the posterior leg and branches into:

The medial and lateral plantar nerves (S1–S2), responsible for sensory and motor supply to the plantar foot.

The medial calcaneal nerve (S1–S2), which innervates the heel pad and can become compressed with heel spurs.

Baxter’s nerve (first branch of the lateral plantar nerve, also S1–S2), often involved in chronic heel pain due to entrapment near the medial calcaneus.

Systemic Impact: What Else Can a Heel Spur Cause in the Body?

Heel pain does not stay local. When pain persists, the body responds in ways that often create secondary issues:

Musculoskeletal compensation: We may change our gait, shift our posture, or limit use of the painful foot, causing overuse or tension in the hips, lower back, knees, or even the opposite foot.

Respiratory effects: Pain and immobility can shift our breathing pattern—often resulting in shallow, upper chest breathing rather than diaphragmatic breathing.

Neurochemical and emotional effects: Reduced movement lowers dopamine, serotonin ,and endorphin production. These neurotransmitters are essential for pain modulation, mood stability, and overall well-being.

Behavioural shifts: Pain reduces motivation to exercise, socialise, or engage in enjoyable activities. Over time, this can contribute to low mood or depressive symptoms.
Stagnation: Both from an energetic and physical perspective, heel pain limits fluid and energy movement, contributing to stiffness, inflammation, and lowered vitality.
All of these factors underscore why addressing heel spurs comprehensively is so essential. Recovery should not only aim at resolving the heel pain itself but also at preserving function, emotional well-being, and movement confidence. Healing from a heel spur may take weeks or months depending on severity, but it is entirely possible with the right support and strategy.

What Often Precedes Heel Spurs?

The development of heel spurs usually follows months or years of underlying dysfunction:

Tight calves and plantar fascia reduce tissue elasticity and increase strain on the heel.
Over-pointing of the toes in dancers or yogis creates chronic tensile loading.
Inefficient gait patterns, such as excessive heel striking or poor push-off mechanics, increase impact forces.

Overpronation, where the foot rolls inward excessively during walking or running, alters weight distribution and places prolonged strain on the plantar fascia and heel bone.

Prolonged standing on hard surfaces, especially in unsupportive footwear, compresses the heel and plantar fascia.

Dysfunction in upstream joints—such as the knees, hips, or sacroiliac joints—may shift loading patterns and contribute to compensatory heel stress.

Organ health, particularly kidney and liver function, may affect connective tissue quality, hydration, and systemic inflammation, subtly setting the stage for heel pathology.

Getting Through a Heel Spur: Tools for Recovery

An integrative approach combining biomechanics, lifestyle, and supportive therapy provides the best outcomes.

Footwear and Insoles: Structured shoes with shock absorption and medial arch support reduce strain. Custom or off-the-shelf orthotics can correct mechanical faults, particularly overpronation and gait-related issues. Barefoot walking may be beneficial in some, but only if intrinsic foot musculature is strong and symptoms are mild.

Dietary Support: An anti-inflammatory diet rich in collagen, magnesium, vitamin D, and antioxidants can aid tissue repair. Omega-3 fatty acids support joint and fascia health, while reducing refined sugars and processed fats limits systemic inflammation.

Exercise & Mobility Work: Regular stretching of the calves and plantar fascia can reduce tension. However, if the heel spur has already caused tearing or degeneration in the tendon or fascia, stretching may worsen the condition. In such cases, it is more beneficial to gently stress the tissues through strengthening exercises aimed at tendon remodelling. A manual therapist, osteopath, or physiotherapist can help design the appropriate exercise plan based on the stage and severity of the condition.

Manual Therapy: Crucial for restoring balance, reducing pain, and enhancing proprioception. Mobilisation of the talocrural and subtalar joints, release of myofascial restrictions, and alignment work through the kinetic chain are key components of effective therapy.

Heel Spur and Manual Therapy

Manual therapy offers a multifaceted, science-supported approach to treating heel spurs that goes far beyond local massage. It addresses both local biomechanics and central nervous system modulation.

Neurophysiological Mechanisms: Manual therapy induces a hypoalgesic response, meaning it reduces pain sensitivity by activating descending inhibitory pathways. This involves areas of the brain such as the periaqueductal grey (PAG), a midbrain region critical in pain processing, autonomic regulation, and behavioural responses to threat.

Manual input also modulates the spinal dorsal horn, reducing the amplification of pain signals through temporal summation. This helps explain why repeated manual contact has a cumulative analgesic effect.

Neurochemical Responses: Manual therapy influences serum levels of key biomarkers:
Increases beta-endorphins, serotonin, and endocannabinoids.

Modulates cytokines, reducing inflammatory markers in blood and tissue.

Engages the opioid system, enhancing pain control and tissue healing.

Boosts dopamine, improving motivation and central reward pathways—important in chronic pain states.

Peripheral Benefits:
Enhances local circulation, lymphatic flow, and oxygenation.

Facilitates mechanical change in restricted fascia and joints.

Normalises afferent input to the central nervous system, leading to better motor control and movement quality.

Manual therapy is not just a passive treatment—it’s a communication tool with the nervous system, capable of reorganising perception, relieving pain, and restoring function from the foot to the brain.

Final Thoughts

Heel spurs are a complex, multifactorial condition best addressed through an integrative lens. Understanding their anatomical, mechanical, energetic, and systemic roots empowers both practitioners and patients to approach recovery with confidence.
Manual therapy offers a uniquely powerful method to support healing—not just locally, but across the whole body. By leveraging the body's neurochemical systems, refining biomechanics, and restoring mobility, manual therapy plays a central role in modern musculoskeletal care.