How do I know if I have a heel spur or plantar fasciitis?
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I have this really bad, stabbing pain in the bottom of my heel, and it feels like I'm stepping on a sharp rock, especially after I sit down for a while or first thing when I get out of bed. It usually gets a little better after I walk around for ten minutes, but it comes right back later in the day. I looked up my symptoms, and now I'm confused because the description of the pain for both plantar fasciitis and having a heel spur seems to be exactly the same. I don't know if I should be treating a bone issue or a problem with the band of tissue under my foot. I'm worried about treating the wrong thing and wasting the time it could be healing. Are there any sure ways to confirm one way or the other without a doctor visit?
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Dr. William Naughton, DPM AdminChief Medical OfficerOfficial Account of Dr. William Naughton, DPM. As Chief Medical Officer, Dr. Naughton reviews discussions for medical safety and provides expert biomechanical insights based on 20+ years of surgical experience.Yes - persistent pain at the back of the heel where the Achilles tendon attaches is most often caused by tendon irritation or nearby structural inflammation, and imaging is frequently needed to identify the exact source.
Pain at the posterior heel, particularly at the point where the Achilles tendon inserts into the calcaneus, can arise from several overlapping conditions. The most common include Achilles tendinitis, retrocalcaneal bursitis, Haglund’s deformity, and insertional heel spurs. These conditions often produce nearly identical symptoms—localized tenderness, stiffness after rest, swelling, and pain that worsens with activity- making clinical diagnosis alone unreliable in many cases.
From a biomechanical standpoint, repetitive tension through the Achilles tendon increases compressive and traction forces at its insertion. Over time, this stress can irritate the tendon fibers, inflame the retrocalcaneal bursa, or stimulate bony changes at the heel. Footwear with a rigid heel counter, excessive heel height, or inadequate support often exacerbates symptoms by increasing pressure directly over the affected area.
Imaging plays a critical role in distinguishing between these causes. X-rays are particularly useful for identifying bony pathology such as heel spurs, calcaneal enlargement, or Haglund’s deformity. MRI, on the other hand, is the preferred modality for evaluating soft-tissue involvement, including tendon degeneration, partial tearing, or bursitis. Identifying whether the pain source is primarily bony, tendinous, or inflammatory directly guides appropriate treatment decisions and helps avoid prolonged trial-and-error care.
While diagnostic clarification is underway, early conservative management can significantly reduce strain on the Achilles complex and prevent symptom progression.
- Posterior heel pain commonly involves Achilles tendinitis, bursitis, or bony irritation
- Symptoms often overlap, making imaging essential for an accurate diagnosis
- X-rays assess bone-related causes such as spurs or Haglund’s deformity
- MRI evaluates tendon and bursal inflammation or degeneration
- Supportive footwear, heel lifts, icing, gentle calf stretching, and custom orthotics can reduce Achilles strain
- Persistent symptoms warrant formal imaging and a thorough clinical evacuation
