Stubborn heel pain: heel spur or plantar fasciitis?

For many sufferers, the day begins with a nasty surprise: You get out of bed, put your foot on the ground, and suddenly a sharp knife-like pain shoots through the sole of your foot. This Heel pain in the morning when they first appear, are a classic symptom that immediately makes many think of a heel spur. However, in most cases, the cause lies elsewhere entirely.

In this post, we'll clearly explain why X-rays can often be misleading, the importance of a holistic view of your body, and how modern Heel spur treatment really looks like.

As of November 2026: We have revised this article based on current studies and guidelines.

The Myth of the Bony Spur

Patients are often concerned when a so-called heel spur—a small, bony outgrowth on the heel—is discovered on an X-ray. Many believe that only permanent orthopedic insoles or even surgery can help now.

However, the medical reality is different: the bony spur itself usually does not cause any pain at all. The actual trigger for the pain is usually the overloaded tendon plate under the sole of the foot, the so-called plantar fascia, more specifically its attachment at the heel bone. Specialists refer to this as a Plantar fasciitis.

The suffix «-itis» stands for inflammation. However, researchers found wear marks of the fascia in tissue samples from 50 patients who underwent surgery (Lemont et al. 2003Therefore, the term plantar fasciopathy is increasingly being used today.

That the sprain is not the actual problem is shown by a Danish long-term study involving 174 people. At the follow-up after 5 to 15 years, around two-thirds of those who were now free of complaints still had a sprain, practically the same number as those with persistent pain (Hansen et al. 2018).

The Dutch expert guideline of 2026 therefore advises against only having a scan done to confirm a hernia.

Typical symptoms of heel pain

Plantar fasciitis can usually be detected during the consultation and examination. Typical symptoms include:

• Sharp pain at the bottom of the inside of the heel
• Pain when starting to walk in the morning or after prolonged sitting
• Improvement after a few steps, renewed increase after standing or walking for a long time
• Pain when pressing on the front inner edge of the heel bone

An ultrasound or X-ray is only necessary if the symptoms are atypical or do not improve despite treatment.

Causes: What really causes heel pain

Ankle pain rarely develops overnight. Most often, the plantar fascia becomes more stressed over weeks than it can tolerate. The best indicators of this are:

• Body weight: In an analysis of 51 studies, a BMI above 27 was the most clearly confirmed risk factor (odds ratio 3.7; van Leeuwen et al., BJSM 2016).

• Long standing: Compared to individuals of the same age, gender, and BMI, those affected spent an average of 3.4 hours per day more time in bed (Musculoskeletal Care 2022). Not all studies confirm this association.

• Running sports and hard surfaces: The 2023 US guideline for physiotherapy lists running and standing or walking work on poorly damped surfaces as risk factors. The symptoms often begin after a change in the load.

• Shortened calf muscles: The calf muscle is the most studied muscle. In a study involving 223 people, the calf muscle (Gastrocnemius) was shortened in 80% of those affected, while in healthy feet it was only shortened in about 20% (Foot & Ankle International 2018). In laboratory experiments, the tension of the plantar fascia increased with the stretching of the Achilles tendon.

• Leg muscles: The strength of the calf muscles is often reduced in those affected. This is more a consequence than a cause: In the largest MRI study to date (2026), the short leg muscles were not smaller than in healthy people.

That doesn't prove that the calf is the cause. However, it is the most plausible muscular partner.

Everything is connected: A holistic view of pain

In the Physiotherapy Wipkingen let's never consider complaints in isolation. Just as a persistent tension in the Shoulders or in Neck Often caused by weak trunk muscles or a one-sided sitting position at the desk, the foot is also only a part of a complex system.

Frequently arise Heel pain through imbalances further up the kinetic chain. This can be altered pelvic posture, restricted hip mobility, or muscular imbalances in the core. Our approach is therefore always to address the The body as a whole to analyze and not limit ourselves solely to the local area of pain in the lower extremities.

Modern Therapy: Managing Load, Healing Tissue

A successful Heel spur treatment requires some patience and the right strategy. Simple restraint is rarely effective. Rather, it is about intelligent load management and targeted strengthening of the affected structures.

This is exactly what the Dutch expert guideline of 2026 also recommends: understandable explanation, adapted load and daily stretching or strengthening exercises over at least 12 weeks (Guidelines for fasciopathy of the plantar fascia).

Calculate in months, not in weeks. In a Norwegian study involving 200 participants, the pain intensity decreased within six months in all groups from about 6 to 3 to 4 out of 10 points. Radial shock wave therapy or a supervised strength training program did not provide any additional benefit compared to counseling and exercise intervention (Heide et al., BJSM 2024).

In doing so, an important principle applies: If we specifically target musculature strengthen, we also usually stabilize surrounding joints. This means that a strong foot not only relieves pressure on the heel, but also protects the ankle and knee from excessive strain.

To stimulate healing and relieve tension throughout the body, we rely on proven methods:

• Manual Fascial Therapy To resolve adhesions in the tissue – whether in the sole of the foot, the calf or the radiating fascial chains of the back.

• Neuro-centric Training (Neuroathletics): Movement originates in the brain. Through targeted, neurocentric impulses, we help the nervous system reclassify affected body regions as "safe." This often leads to significant pain reduction and more precise muscular control throughout the body.

• Local voltage regulation: For deep-seated muscle tightening, evidence-based methods can be used in consultation with you, such as Dry needling Or trigger point therapy can be used. These techniques serve as purely factual, optional supplements to target the tension state in the tissue and normalize it. The 2023 US guideline for physiotherapy lists dry needling of the knee and sole as a treatment option (recommendation grade B).

• Tape: A supportive Tape bandage can relieve initial pain in the first few weeks. In a study involving 92 people, the pain was reduced by around 12 points out of 100 after one week with tape (Radford et al. 2006).

• Inserts and heel cushions: They can relieve heel pain, but they do not replace active therapy. In an evaluation of 19 studies, custom-made insoles were no better than prefabricated ones (Whittaker et al., BJSM 2018).

Shock wave and injection They are only considered if there is little progress after about three months of consistent basic therapy. The studies on the shock wave contradict each other. Corticosteroids, according to one study, relieve pain, but according to another, they do not. Cochrane review of 2017 only a little and only for about a month. Discuss both with your doctor.

Self-help: Effective plantar fasciitis exercises for everyday life

You can actively support the healing process yourself. Here is a short checklist with simple Plantar fasciitis exercises, that can be easily integrated into everyday life:

• Stretching the sole of the foot: Sit down and place the painful foot over the other knee. Pull the toes with your hand towards the shinbone until you feel a pull in the sole of the foot. Hold for 10 seconds, 10 repetitions, three times daily, the first time before the first step in the morning.

  In a study involving 101 participants, this exercise reduced the onset of pain more significantly after eight weeks than stretching the Achilles tendon (DiGiovanni et al., JBJS 2006).

• Calf stretch: Stand against a wall, with the painful leg extended backwards. The heel remains on the ground. Lean forward until a pull in the calf is felt (3x 30 seconds hold). Useful as a complement to stretching the sole of the foot.

• Heel lifting with towel roll: Stand on one leg with the front foot on the ground; a rolled towel is placed under the toes. Press yourself up in 3 seconds, hold for 2 seconds, and lower the heel in 3 seconds. Start every second day with 3 sets of 12 repetitions and gradually increase the load over 12 weeks.

  According to the Dutch guideline, this strength training is an equivalent alternative to daily stretching.

• An arched foot strengthens: Place a small towel on the floor and try to pull it towards you while sitting, using only your toes. This also benefits your ankles.

• Fascia massage Roll the sole of the foot in a sitting position with gentle pressure over a small massage ball (e.g., hedgehog ball or tennis ball) to promote local blood circulation.

Dosage adjustment: Stay active, but within reasonable limits. The Dutch guideline sets a pain level of no more than 3 on a scale of 10. Well-damped shoes help in everyday life.

Note: Always start these exercises gently and increase the intensity only as pain allows.

When should you have a medical or physical therapy consultation?

Have the heel examined promptly if the pain occurs at night or at rest, starts very suddenly, is accompanied by redness and swelling, or does not improve despite consistent self-care for several weeks.

You should also have the complaints medically examined in these cases:

• Pain in both heels, especially with morning stiffness lasting more than 30 minutes, back pain or psoriasis: This could be a sign of a rheumatic disease.
• Burning, tingling, numbness, or electric pain: This indicates an irritated or damaged nerve. Trapped nerve.
• Pain that steadily increases after a training increase and eventually persists even at rest: This can be a sign of a stress fracture of the heel bone.
• An injury to the foot, especially in diabetes: An infection must be ruled out here.

If the pain is not at the heel but in the front of the foot, often with tingling in the toes, there is sometimes something else behind it, for example a nerve problem. Morton-Neurom.

Your Path to Pain-Free Movement

Heel pain can be persistent, but it’s very manageable with the right strategy. If you can no longer get out of bed in the morning without discomfort, we’re here to help.

The practice team Physiotherapy Waidfuss invites patients from the Zurich region to contact us with questions or for an individual assessment. Whether you need support from Physiotherapy Höngg or the Physiotherapy Wipkingen searching – Arrange an appointment online – together we will find the way back to a pain-free and active everyday life!