What Triggers a Heel Spur? Risk Factors and Prevention

By Dr. Jonathan Schutza, PT, DPT · Doctor of Physical Therapy

Medically reviewed by Dr. Jonathan Schutza, PT, DPT

A heel spur usually builds quietly over years, but the pain tends to start after something changes. Here's what actually sets it off, what raises your risk, and how to lower the load on your heel without shutting down your life.

Most people don’t come in asking about heel spurs. They come in with heel pain, get an X-ray somewhere along the way, and someone points at a small hook of bone on the bottom of the heel. Then the question becomes: what did I do to cause that?

It’s a fair question, and it hides two different ones.

The first is what built the spur. That’s usually a long, slow story measured in years, and honestly, it’s the less useful question. The second is what set off the pain, because the pain almost never starts the day the spur appears. It starts when something in your week changes. That second question is the one worth digging into, because it’s the one you can do something about.

The spur took years. The pain took weeks.

A heel spur is bone that formed where tissue pulls on bone repeatedly over a long stretch of time. Your body added material at a stress point. That’s an adaptation, not a defect.

Here’s the part that surprises people: plenty of feet have spurs and no pain at all. They show up on X-rays taken for completely unrelated reasons. If the bone itself were the pain generator, that wouldn’t happen.

So when someone tells me their heel pain “started out of nowhere,” I don’t believe the spur suddenly turned on. Something else shifted. The demand on the heel went up, or the heel’s ability to handle that demand went down, and the two crossed.

What actually triggers heel pain around a spur

Almost every case I see traces back to a change. Not always a dramatic one. Look at the six to ten weeks before your pain started and see if any of these ring true.

A jump in standing or walking hours. A new job, a move to a different unit at the hospital, a conference, a week in a city where you walked eight miles a day, a house renovation, a newborn who only settles when you pace. Your heel doesn’t know the difference between exercise and life. It only registers total time under load.

A change in footwear. New shoes, worn-out shoes, switching from supportive work shoes to sandals in the spring, or the opposite: moving from cushioned sneakers into stiff dress shoes for a season of weddings. Also worth noting, and this one gets missed constantly, more time barefoot on hard floors at home. People who used to wear shoes all day at an office and now work from home in socks on tile have quietly changed their heel’s daily diet.

A training change. Adding mileage, adding hills, adding speed work, coming back to running after months off and picking up where you left off instead of where you actually are. The last one is the most common.

A period of doing less, followed by doing normal things again. This trips people up. A stretch of inactivity lowers what your foot can tolerate. Then you return to your usual walking or running volume, and your usual is now too much. Nothing about the activity changed. Your capacity did. Rest calms tissue down, but it doesn’t build anything, and an under-loaded foot is a foot with a lower ceiling.

A gradual increase in the load the whole system carries. Body weight belongs in this conversation, but not as a moral issue. Every step puts force through the heel, and more mass means more force per step. That’s mechanics, not failure, and it’s one variable among many. Someone who gains ten pounds and also takes a job that puts them on concrete for nine hours has changed two things at once.

Stiff calves and ankles. When the ankle doesn’t bend well, the foot finds the range somewhere else, and the tissue at the heel tends to absorb more of it. This is one of the quieter risk factors because it develops slowly and painlessly.

If your spur sits at the back of the heel where the Achilles attaches rather than underneath, the triggers skew slightly differently: sudden hill running, sprint work, and shoes with a rigid heel counter that presses right on the bone. The underlying logic is the same.

Why the flare shows up a day late

Symptoms often lag behind the load that caused them. You do a long day at a trade show and feel fine. The next morning your heel is angry, and you blame the morning, or the bed, or the fact that you did nothing wrong that day.

For many people, a useful rule of thumb: look at the previous 24 to 48 hours, not the previous hour. That lag is also why single activities get unfairly convicted. It wasn’t the ten minutes of exercises. It was the exercises plus a full shift plus the walk to the car plus standing at your kid’s game.

Total load is cumulative. Your heel adds it all up and sends the bill later.

Does walking make heel spurs worse?

Walking loads the heel, so it can absolutely increase symptoms in the short term. That’s different from making the spur worse or damaging the tissue.

The short version: staying as active as you reasonably can is generally better than shutting down, and how your heel responds over the following day tells you whether the amount was right. Complete rest can feel great for two weeks and then hand you a foot that tolerates even less than before. We have a full article on this site about how much walking is reasonable with a heel spur, so I won’t repeat that ground here.

How to get rid of a heel spur quickly?

I’d rather be straight with you than encouraging in a way that isn’t true. There is no way to dissolve a bone spur quickly. No stretch, insert, cream, or device removes bone.

What can change relatively quickly is how sensitive the heel is. Taking pressure off the sore spot, adjusting shoes, modifying the parts of your week that spiked the load, and getting some gentle movement in can settle irritation within days to a couple of weeks for many people. That’s real progress, and it’s worth having.

But sensitivity coming down isn’t the same as the tissue becoming capable again. That’s the gap where recurrence lives. Someone feels better after two weeks of taking it easy, returns to their normal life, and the pain comes back within a week, because nothing was built during the quiet period. Changing the actual load tolerance of fascia and tendon takes weeks to months of gradually asking more of it. In my experience, meaningful change typically shows up somewhere in an eight to twelve week window, sometimes longer if things have been going on for a year or more.

Longer-standing pain doesn’t mean it can’t improve. It usually means starting lower and progressing more patiently.

Will a heel spur eventually go away?

The bone generally stays. Bodies don’t often reabsorb spurs.

The pain is a different story, and this is the part that matters. Many people become fully comfortable walking, standing, and running with a spur still visible on imaging. Nothing on the X-ray changed. What changed was how much the heel could handle. That’s why I don’t treat a spur on a report as a verdict about your future.

What causes heel spurs to flare?

Once a heel has become sensitive, flares tend to follow a predictable set of causes:

• A day that was longer on your feet than the last few
• New shoes, or old shoes that finally gave up
• A hard surface you’re not used to (concrete, tile, sand, a track)
• Coming back from a rest break at your old volume
• Travel days, which stack sitting, hard airport floors, and unfamiliar shoes
• Adding a workout without subtracting anything else
• A single spike, like helping a friend move

A flare is not a sign the work was wrong or that progress was erased. It’s feedback. Look at what changed in the day or two before, dial that piece back a notch, keep the rest going, and watch the trend over weeks rather than the number today.

What is mistaken for a heel spur?

Quite a bit, which is why I don’t like heel pain being diagnosed by X-ray alone. Plantar fasciopathy is the most common overlap. Fat pad irritation, Achilles problems at the insertion, an irritated nerve on the inner side of the heel, bursitis at the back of the heel, and stress-related bone pain in the calcaneus can all produce pain in the same neighborhood. Each responds to something different. A hands-on exam sorts out which one it is, and we’ve covered the specific distinctions in more detail elsewhere on the site.

What is worse, heel spurs or plantar fasciitis?

This question comes up a lot, and it’s a bit like asking whether the smoke or the fire is worse. They usually travel together and share the same cause: more stress at that heel attachment than the tissue could comfortably handle.

The spur is the bone’s record of that stress. The fascia is where the pain usually lives. Practically speaking, having a spur doesn’t make your outcome worse, and it doesn’t change the plan much. Both improve through the same route: settle the irritation, then rebuild what the foot can tolerate.

What are the best shoes for heel spurs?

There is no single best shoe, and any list that claims otherwise is guessing about your foot. What I look for:

• Enough cushioning under the heel to blunt impact, especially if you’re on hard floors all day
• A bit of heel-to-toe drop, which slightly reduces the pull through the calf and fascia for many people
• A stiff enough sole that your foot isn’t working overtime through every step
• A heel collar that doesn’t press on a sore spot, if your pain is at the back
• Something you’ll actually wear, including at home

And one thing people underestimate: change shoes gradually. A supportive shoe introduced all at once is still a change, and changes are what trigger flares. Rotate it in.

Do Hoka shoes help with heel spurs? For some people, yes. Thick cushioning and a rockered sole reduce the work the foot does per step, and that can feel like immediate relief. Other people find that same softness makes their foot work harder to stabilize and prefer something firmer. Brand loyalty isn’t a treatment plan. A shoe reduces load; it doesn’t build capacity. Use it as a tool while you do the other work.

What do podiatrists do for heel spurs?

Podiatrists are a good resource, and there’s real overlap in how we approach this. Typical options include footwear guidance, custom or off-the-shelf orthotics, taping, night splints, anti-inflammatory medication, corticosteroid injection for stubborn cases, shockwave therapy, and in rare situations surgery. Imaging when the picture isn’t clear.

Those things can help. Where I see people get stuck isn’t with any one of those choices; it’s when nothing in the plan addresses what happens after the pain quiets down. An injection can calm a heel beautifully and still leave a foot that can’t tolerate a ten-hour shift, because the injection didn’t change what the tissue can handle. Orthotics can reduce stress on the fascia, which is useful, and they work best alongside a plan for gradually asking the foot to do more.

Often the missing piece isn’t another treatment. It’s knowing how to progress.

Prevention: lower the spikes, raise the ceiling

Prevention isn’t about protecting your heel from work. It’s about making your heel good at work.

Change one thing at a time. New shoes, new mileage, new surface, new job. Pick one. Give it a couple of weeks before adding the next.

Ramp gradually and hold. Whether it’s walking distance or running volume, increase modestly, then stay there long enough for the tissue to catch up before moving again. Early improvements come mostly from your nervous system getting more efficient. The structural change comes later, which is exactly why stopping the moment pain resolves sets people up for a repeat.

Build the calf and foot. Heel raises, loaded through full range, done consistently over months, are one of the highest-value things you can do for the whole back of the lower leg and the bottom of the foot. Slow, controlled, boring. Consistency beats intensity here.

Keep some ankle motion available. If your ankle can’t bend, the demand goes somewhere, and that somewhere is often the heel.

Respect the hidden hours. Barefoot on tile, standing at a counter, pacing on the phone. They count.

Use a workable comfort guideline. For most people I work with, keeping discomfort at or below roughly a 4 out of 10 during activity, and back near baseline within about 24 hours, is a reasonable place to operate. Some soreness while you’re building is normal. Pain that climbs through the session and stays elevated the next day means the dose was too much, not that you did damage.

Watch function, not just the pain number. Standing longer before it bothers you. Recovering faster after a long day. Walking farther with the same amount of ache. Those are wins, even if the pain score hasn’t moved yet.

When to get it looked at

Most heel pain responds well to sensible load management and a real strengthening plan. Get an in-person evaluation if the pain came on suddenly and sharply, if you can’t bear weight, if it’s worse at night or at rest rather than with activity, if there’s swelling, redness, warmth, numbness, or tingling, or if it’s simply not budging after a few weeks of doing reasonable things. Those patterns can point to something other than an irritated heel attachment, and it’s worth sorting out rather than guessing.

If you’ve already had the X-ray and someone showed you the spur, here’s the reframe I’d offer: that bone is a record of what your heel has been asked to do. It isn’t a prediction. What comes next depends far more on how you build the foot back up than on the shape of the bone in the picture.