Heel Spurs Physiotherapy Brisbane southside.
What is a heel spur?
A heel spur is a bony protrusion — a calcium deposit — that develops on the underside of the calcaneus (heel bone), typically at the attachment point of the plantar fascia or the Achilles tendon. They are detected on X-ray and are frequently blamed for heel pain — but the clinical evidence tells a more nuanced and important story.
It is important to note that heel spurs are not the cause but a consequence — therefore treatment for heel spurs often focuses on relieving symptoms and addressing the underlying cause, such as plantar fasciitis. Studies consistently show that heel spurs are present on X-ray in a significant proportion of people with no heel pain at all — and equally, many people with severe heel pain have no spur visible on imaging. The spur itself is a marker of chronic tensile stress at the plantar fascia or Achilles insertion — a record of how long and hard these structures have been working — rather than the pain generator.
This is one of the most clinically important distinctions in foot pain management. Treating the heel spur — which has been done historically by surgically removing it — rarely resolves the pain, because the spur was not causing it. Treating the underlying biomechanical problem that produced the spur is what produces lasting relief.
Why do heel spurs develop?
Heel spurs form through a process called endochondral ossification — the gradual calcification of the fibrocartilaginous enthesis (the attachment zone) of the plantar fascia or Achilles tendon at the calcaneus. Repeated tensile stress at these attachment points produces micro-tearing and a chronic repair response, and over years, calcium is deposited in the repeatedly stressed tissue. The result on X-ray is the characteristic bony protrusion.
The same factors that produce plantar fasciitis and Achilles tendinopathy — excessive tensile load at these insertions — are what produce heel spurs. Tight calf muscles that increase plantar fascia tension, flat feet or high arches that alter calcaneal loading, obesity that increases the compression and tensile forces on the heel, and high-volume running or occupational standing on hard surfaces are the most consistent contributors.
What are the symptoms?
The symptoms of heel spurs are the symptoms of their underlying causes rather than of the spur itself. Plantar heel pain — sharp or burning pain at the bottom of the heel, classically worst with the first steps in the morning or after prolonged sitting — is the hallmark of plantar fasciitis and is present regardless of whether a spur is visible on imaging. Posterior heel pain at the Achilles insertion — particularly with direct pressure from footwear at the back of the heel — is the hallmark of insertional Achilles tendinopathy, again present with or without a bony spur.
The morning pain pattern is particularly characteristic — the plantar fascia shortens overnight in a non-weight-bearing position, and the first steps stretch it acutely against its insertion, producing the sharp start-up pain. This typically eases after several minutes of walking as the fascia warms up and lengthens, then returns after prolonged activity.
How is it diagnosed?
Plain X-ray identifies the heel spur itself — its size, location and orientation. However as discussed above, the X-ray finding alone does not establish it as the pain source. Clinical assessment is essential — palpation of the plantar fascia at its calcaneal insertion, assessment of calf flexibility, foot arch assessment, and functional loading tests establish the diagnosis of the underlying condition producing symptoms. Ultrasound is the most useful imaging for the plantar fascia itself, directly visualising fascia thickness, echogenicity and any tears. MRI provides comprehensive assessment including bone marrow oedema (which does indicate active bone stress) and soft tissue pathology.
How can physiotherapy help?
Physiotherapy addresses the underlying biomechanical contributors to heel pain — not the spur itself — and is the most evidence-based conservative treatment for both plantar fasciitis and insertional Achilles tendinopathy.
Calf and plantar fascia flexibility — targeted stretching of the gastrocnemius and soleus, and plantar fascia-specific stretching — reduces the tensile load on the calcaneal insertion during walking and standing. The evidence for plantar fascia stretching in plantar fasciitis is among the strongest of any conservative intervention. Morning stretching before the first steps — stretching the foot and calf before getting out of bed — specifically addresses the acute loading of the cold, shortened fascia that produces the characteristic morning pain.
Intrinsic foot muscle strengthening — progressive strengthening of the foot intrinsics that actively support the plantar arch — reduces the passive tensile demand on the plantar fascia during weight-bearing. The short foot exercise and progressive toe exercises build this active support systematically.
Load management — temporarily reducing the activities most provocative of heel pain, progressing load gradually as symptoms settle, and identifying the training or occupational load that triggered the onset — is as important as the direct physiotherapy interventions.
Orthotic management — heel cups that cushion the calcaneal insertion, plantar fascia offloading orthotics, and night splints that maintain a gentle dorsiflexion stretch overnight — provide meaningful symptomatic relief and load reduction during the rehabilitation period. The night splint is particularly valuable for the morning pain pattern, preventing the overnight shortening of the plantar fascia that produces first-step pain.
Footwear assessment — shoes with adequate heel cushioning, arch support and appropriate heel height — reduces calcaneal impact loading and plantar fascia strain during daily activity.
Mulligan joint mobilisation of the ankle and subtalar joint improves dorsiflexion range, reducing the compensatory plantar fascia strain that restricted ankle mobility produces during the push-off phase of gait. This is one of the most effective manual therapy techniques for plantar heel pain and is particularly indicated where ankle dorsiflexion is restricted.
Dry needling of the intrinsic foot muscles and calf musculature reduces trigger point contributions to plantar fascia tension. Clinical Pilates provides an excellent low-impact environment for progressive foot and lower limb strengthening during the rehabilitation period.
For the full detail on plantar fascia rehabilitation see our plantar fasciitis page. For insertional Achilles tendinopathy management, see our Achilles tendinopathy page.
Our physiotherapists Yulia Khasyanova, Eliane Machado and Bethany Kippen all have experience in foot and ankle conditions and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the foot loading assessment and gait analysis underpinning heel spur management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
A heel spur is a bony protrusion — a calcium deposit — that develops on the underside of the calcaneus (heel bone), typically at the attachment point of the plantar fascia or the Achilles tendon. They are detected on X-ray and are frequently blamed for heel pain — but the clinical evidence tells a more nuanced and important story.
It is important to note that heel spurs are not the cause but a consequence — therefore treatment for heel spurs often focuses on relieving symptoms and addressing the underlying cause, such as plantar fasciitis. Studies consistently show that heel spurs are present on X-ray in a significant proportion of people with no heel pain at all — and equally, many people with severe heel pain have no spur visible on imaging. The spur itself is a marker of chronic tensile stress at the plantar fascia or Achilles insertion — a record of how long and hard these structures have been working — rather than the pain generator.
This is one of the most clinically important distinctions in foot pain management. Treating the heel spur — which has been done historically by surgically removing it — rarely resolves the pain, because the spur was not causing it. Treating the underlying biomechanical problem that produced the spur is what produces lasting relief.
Why do heel spurs develop?
Heel spurs form through a process called endochondral ossification — the gradual calcification of the fibrocartilaginous enthesis (the attachment zone) of the plantar fascia or Achilles tendon at the calcaneus. Repeated tensile stress at these attachment points produces micro-tearing and a chronic repair response, and over years, calcium is deposited in the repeatedly stressed tissue. The result on X-ray is the characteristic bony protrusion.
The same factors that produce plantar fasciitis and Achilles tendinopathy — excessive tensile load at these insertions — are what produce heel spurs. Tight calf muscles that increase plantar fascia tension, flat feet or high arches that alter calcaneal loading, obesity that increases the compression and tensile forces on the heel, and high-volume running or occupational standing on hard surfaces are the most consistent contributors.
What are the symptoms?
The symptoms of heel spurs are the symptoms of their underlying causes rather than of the spur itself. Plantar heel pain — sharp or burning pain at the bottom of the heel, classically worst with the first steps in the morning or after prolonged sitting — is the hallmark of plantar fasciitis and is present regardless of whether a spur is visible on imaging. Posterior heel pain at the Achilles insertion — particularly with direct pressure from footwear at the back of the heel — is the hallmark of insertional Achilles tendinopathy, again present with or without a bony spur.
The morning pain pattern is particularly characteristic — the plantar fascia shortens overnight in a non-weight-bearing position, and the first steps stretch it acutely against its insertion, producing the sharp start-up pain. This typically eases after several minutes of walking as the fascia warms up and lengthens, then returns after prolonged activity.
How is it diagnosed?
Plain X-ray identifies the heel spur itself — its size, location and orientation. However as discussed above, the X-ray finding alone does not establish it as the pain source. Clinical assessment is essential — palpation of the plantar fascia at its calcaneal insertion, assessment of calf flexibility, foot arch assessment, and functional loading tests establish the diagnosis of the underlying condition producing symptoms. Ultrasound is the most useful imaging for the plantar fascia itself, directly visualising fascia thickness, echogenicity and any tears. MRI provides comprehensive assessment including bone marrow oedema (which does indicate active bone stress) and soft tissue pathology.
How can physiotherapy help?
Physiotherapy addresses the underlying biomechanical contributors to heel pain — not the spur itself — and is the most evidence-based conservative treatment for both plantar fasciitis and insertional Achilles tendinopathy.
Calf and plantar fascia flexibility — targeted stretching of the gastrocnemius and soleus, and plantar fascia-specific stretching — reduces the tensile load on the calcaneal insertion during walking and standing. The evidence for plantar fascia stretching in plantar fasciitis is among the strongest of any conservative intervention. Morning stretching before the first steps — stretching the foot and calf before getting out of bed — specifically addresses the acute loading of the cold, shortened fascia that produces the characteristic morning pain.
Intrinsic foot muscle strengthening — progressive strengthening of the foot intrinsics that actively support the plantar arch — reduces the passive tensile demand on the plantar fascia during weight-bearing. The short foot exercise and progressive toe exercises build this active support systematically.
Load management — temporarily reducing the activities most provocative of heel pain, progressing load gradually as symptoms settle, and identifying the training or occupational load that triggered the onset — is as important as the direct physiotherapy interventions.
Orthotic management — heel cups that cushion the calcaneal insertion, plantar fascia offloading orthotics, and night splints that maintain a gentle dorsiflexion stretch overnight — provide meaningful symptomatic relief and load reduction during the rehabilitation period. The night splint is particularly valuable for the morning pain pattern, preventing the overnight shortening of the plantar fascia that produces first-step pain.
Footwear assessment — shoes with adequate heel cushioning, arch support and appropriate heel height — reduces calcaneal impact loading and plantar fascia strain during daily activity.
Mulligan joint mobilisation of the ankle and subtalar joint improves dorsiflexion range, reducing the compensatory plantar fascia strain that restricted ankle mobility produces during the push-off phase of gait. This is one of the most effective manual therapy techniques for plantar heel pain and is particularly indicated where ankle dorsiflexion is restricted.
Dry needling of the intrinsic foot muscles and calf musculature reduces trigger point contributions to plantar fascia tension. Clinical Pilates provides an excellent low-impact environment for progressive foot and lower limb strengthening during the rehabilitation period.
For the full detail on plantar fascia rehabilitation see our plantar fasciitis page. For insertional Achilles tendinopathy management, see our Achilles tendinopathy page.
Our physiotherapists Yulia Khasyanova, Eliane Machado and Bethany Kippen all have experience in foot and ankle conditions and are members of the Australian Physiotherapy Association. Eliane's doctoral research in lower limb biomechanics is directly relevant to the foot loading assessment and gait analysis underpinning heel spur management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
