Why Everyone Gets Confused About Heel Spurs and Plantar Fasciitis
I see this confusion in my Houston office every single week. A patient comes in with heel pain, they've had an X-ray somewhere else, and the report mentions a heel spur. Naturally, they assume the spur is what's causing their pain.
Here's what usually happens next. They start looking online for "heel spur treatment" and find information that doesn't quite match what they're experiencing. Or their doctor mentioned plantar fasciitis during the visit, but the X-ray report talks about the spur. Now they're treating a bone spur when the real problem is something else entirely.
But here's what most people don't realize: about 10% of the population has heel spurs without any pain at all. They could get an X-ray for an unrelated reason and discover they have a spur they never even knew was there. The spur is visible on imaging, so doctors mention it—but visible doesn't mean it's the cause of your pain.
The truth is, the heel spur is almost always a symptom of the real problem, not the problem itself. And that real problem? It's usually plantar fasciitis.
What Is Plantar Fasciitis? (And What Is a Heel Spur?)
The plantar fascia is a thick band of tissue that runs along the bottom of your foot from your heel to your toes. Think of 
it like a bowstring that supports your arch and absorbs shock when you walk. When this tissue becomes damaged and inflamed, that's plantar fasciitis.
You'll know plantar fasciitis by its signature symptom: that stabbing pain in your heel when you take your first steps in the morning. It often improves a bit as you move around, then comes back after you've been sitting for a while or at the end of a long day on your feet. The pain is usually worst at the inside edge of your heel, right where the plantar fascia attaches to the heel bone.
Here's where it gets interesting. When your plantar fascia is chronically inflamed, it's constantly pulling on that attachment point at your heel bone. Your body responds to this chronic stress by laying down extra calcium deposits at the site. Over time, these deposits form what we call a heel spur—a little hook or shelf of bone that you can see on an X-ray.
This is called Wolff's Law: bone adapts to the stresses placed on it. The heel spur isn't causing the plantar fasciitis—the plantar fasciitis is causing the heel spur. The spur is your body's attempt to reinforce an area that's under constant stress.
So here's what matters: about 50% of people with plantar fasciitis have heel spurs, and about 50% don't. But whether you have a spur or not, the treatment is almost always the same—because we're treating the plantar fasciitis, not the spur.
And here's the really important part: only about 5% of heel spurs actually cause pain on their own.
Why Your Heel Pain Keeps Coming Back (The Stalled Healing Response)
If you've been dealing with heel pain for weeks or months, you're probably wondering: why won't this just heal? You've rested it, you've iced it, you've tried everything—and it keeps coming back.
Here's what's actually happening. When tissue is chronically injured, it often gets stuck in what we call a failed healing response. Your body started trying to heal the injury, but for various reasons—poor blood supply, scar tissue formation, or simply time—that healing process stalled out. The tissue remains in a state of chronic inflammation without progressing to true repair. It's like having a construction crew that started a job but never finished it.
The plantar fascia has relatively poor blood supply compared to other tissues in your body. This is why plantar fasciitis can be such a chronic, stubborn condition. Without good blood flow, your body struggles to deliver all the healing factors it needs to complete the repair process.
And here's what makes it worse: every morning when you take those first painful steps, you're essentially picking at the scab. During periods of inactivity—like when you're sleeping—the plantar fascia contracts and starts to heal. When you suddenly stand up and put weight on it, you're pulling apart all that repair work your body did overnight. That's why the morning pain is so intense.
This cycle of partial healing and re-injury is exactly why conservative treatments like rest and ice often provide temporary relief but don't solve the problem. Understanding this is key because it explains why treatments that actively stimulate your body's healing response—like shockwave therapy and PRP—can be so effective when everything else has failed.
How Your Houston Podiatrist Figures Out What's Actually Causing Your Pain
Here's the good news: figuring out whether you have plantar fasciitis, a problematic heel spur, or both isn't complicated. The diagnosis is actually pretty straightforward once we examine your foot.
When you come in, I'll start by asking about your symptoms—when the pain is worst, what makes it better or worse, how long you've been dealing with it. Then I'll examine your foot, feeling for tender spots and checking how your ankle and calf muscles are moving. Often, I can tell what's going on just from this physical exam.
If you've already had an X-ray that shows a heel spur, that's helpful information—but it doesn't change much about how we approach treatment. The X-ray shows us the structure of your foot, but the exam tells us what's actually causing your pain. In the vast majority of cases, it's the plantar fasciitis that's the culprit, whether you have a spur or not.
Occasionally, if your symptoms are unusual or if I'm concerned about something else going on, I might order an MRI or ultrasound. But for most patients, we can figure out exactly what's wrong and start treatment on the same day.
What to Expect When You Come In
When you come in for your appointment, we'll spend about 30-45 minutes together. I'm going to start by asking you about your symptoms—when the heel pain started, what time of day it's worst, what you've already tried. I want to understand your complete picture before I even touch your foot.
Then I'll examine your foot and ankle. I'll press on specific spots to see where you're most tender—usually right at that inside edge of your heel where the plantar fascia attaches. I'm also going to check your ankle range of motion and have you do a few simple movements so I can see how your calf muscles and Achilles tendon are functioning. Tight calves contribute to plantar fasciitis in nearly every patient I see, so this tells me a lot about what's causing your problem.
If you brought X-rays with you or if you've had imaging done elsewhere, we'll review those together. I'll show you exactly what I'm seeing—whether there's a spur, what the bone structure looks like, and most importantly, I'll explain why the spur probably isn't what's causing your pain. If you haven't had any imaging and I think we need it, we can get X-rays done right here in the office.
Once I know what's going on, we'll talk through your treatment options. I'll explain what I recommend starting with—usually that's addressing footwear, starting stretching exercises, and getting you fitted for custom orthotics. We'll also discuss what happens if conservative treatment doesn't get you where you want to be, so you understand the full spectrum of what's available.
Most patients leave that first appointment with a clear understanding of what's wrong and a specific plan for fixing it. You'll know exactly what to do at home, when to come back for follow-up, and what realistic timelines look like for improvement. And if your pain is severe, we can often do a cortisone injection the same day to get you some immediate relief while the other treatments start working.
Treatment Options: From Simple Changes to Advanced Therapies
Here's how we approach your heel pain in our Houston practice. I always start with the least invasive options and only move to more aggressive treatment if we need to. Let me walk you through the complete spectrum of what's available.
Start With the Basics: Lifestyle Changes
Sometimes, the solution is as simple as changing your shoes and adjusting your daily habits. If you're walking around barefoot at home—especially on hard floors—stop immediately. Those first steps on hard surfaces without any support are when a lot of the damage happens. Keep a pair of supportive sandals next to your bed.
Replace your athletic shoes if they're more than six months old or have worn-down heels. And if you're standing on concrete all day—whether that's downtown Houston or at the Med Center—realize that those hard surfaces are absolutely brutal on your plantar fascia. Look for shoes with good arch support and cushioned heels.
At-Home Care That Actually Helps
Ice bottle rolling is hands-down one of the most effective things you can do at home. Fill a water bottle, freeze it, and roll your foot on it for 15-20 minutes, three or four times a day. This reduces inflammation right where you need it.
Calf stretching is essential—and I mean essential. Nearly every plantar fasciitis patient I see has tight calf muscles pulling on the plantar fascia. Hold each stretch for 30 seconds, do it three times, and repeat three times a day. Yes, that's a lot of stretching. But it works.
Now, I'll be honest about over-the-counter arch supports. They're better than nothing, but they're not a solution. Most people find generic inserts don't provide enough support to actually address the biomechanical issues causing the problem. But if you're waiting to come in for custom orthotics, they can help a bit in the meantime.
Custom Orthotics: The Foundation of Treatment
This is where we really start addressing the root cause. Custom orthotics are molded specifically to your feet—not some average foot shape that doesn't exist in real life. Think of them like eyeglasses for your feet. While you're wearing your glasses, you can see. When you take them off, you can't. In the same way, orthotics compensate for your biomechanical issues while you're wearing them.
When you come in, I'll take a mold of your feet. The orthotics are ready in about 2-3 weeks, and they'll last 3-5 years with normal use. You'll invest $700 for custom orthotics, but they're addressing the mechanical forces that caused your plantar fasciitis in the first place.
Most patients notice significant improvement within 2-3 weeks of wearing them consistently.
When Conservative Treatment Isn't Enough
If we've tried stretching, proper shoes, and orthotics for 6-8 weeks without significant improvement, it's time to consider additional options. A corticosteroid injection can calm down severe inflammation quickly—you'll usually feel relief within 48-72 hours.
But here's what I tell every patient: this is pain management, not a cure. The injection buys us time to let other treatments work. I'll limit these to 2-3 per year because repeated cortisone injections can actually weaken tissue over time.
Remy Laser Therapy: Reducing Pain and Inflammation
The Remy Class IV laser is one of the most effective tools we have for reducing pain and inflammation in chronic heel pain. This isn't the same as the low-level lasers you might see at other offices—the Remy delivers significantly more power, which means it penetrates deeper into the tissue where the plantar fascia attaches to your heel.
Here's what happens during treatment: the laser energy increases circulation to the area, reduces inflammation, and helps your cells produce more ATP (the energy currency your body uses for healing). Most patients feel warmth during the treatment, and many notice some immediate pain relief.
You'll typically need 6-12 sessions, done 2-3 times per week. Each session takes about 10 minutes, and there's zero downtime—you walk out and go about your day. I particularly like using the Remy laser in combination with other treatments. It works beautifully alongside custom orthotics, and it can prepare the tissue for shockwave therapy or PRP by reducing inflammation first.
Shockwave Therapy: The Game-Changer
After treating thousands of patients with this technology, I can tell you that shockwave therapy has changed the game 
for chronic heel pain. Think of it like aerating a lawn—by creating small channels in compacted soil, you allow water, air, and nutrients to penetrate more deeply. Similarly, shockwave therapy creates controlled microtrauma that jumpstarts your body's stalled healing response.
The treatment itself takes about 10 minutes per session. You'll come in once a week for three weeks. There's no downtime—you walk out and go about your day.
About 82% of patients find significant relief after completing the full treatment course. In my Houston practice, I've found it particularly effective for patients who've been dealing with heel pain for more than six months without improvement from conservative care alone. You'll pay $1,500-3,000 for the full treatment series, and most patients tell me it's worth every penny to finally be out of pain.
PRP Therapy: Liquid Gold for Healing
I call PRP liquid gold because of what it does for stubborn heel pain. Unlike cortisone, which just reduces inflammation, PRP actually helps your body complete that stalled healing process. We draw a small amount of your blood, concentrate the healing platelets, and inject them precisely where your plantar fascia attaches to your heel bone.
You'll have some soreness for 3-5 days after the injection—that's actually a good sign that your body's healing response is kicking in. Improvement is gradual, usually becoming noticeable over 3-6 months. About 70-85% of patients see significant improvement with PRP.
The cost typically runs $500-1,500, and it's often not covered by insurance. But for many patients, it's the treatment that finally works after everything else has failed.
The "Third Option": Combined PRP and Shockwave
Here's where it gets really exciting. In most medical offices, doctors think in terms of medicate or operate. If medication doesn't work, the next step is surgery.
But what if there's a third option that most doctors never mentioned?
When we combine PRP and shockwave therapy, we're addressing the problem from two angles simultaneously. It's like planting seeds in a garden—PRP provides the seeds (the growth factors and healing proteins), while shockwave therapy prepares the soil and creates optimal growth conditions. Together, they create a powerful healing environment. About 85-95% of patients who do combined treatment avoid surgery entirely.
For many of my Houston patients, this has meant the difference between returning to running marathons and facing months of surgical recovery. The regenerative medicine approach takes time—we're talking about 3-6 months for full results—but the outcomes are lasting.
Surgery: Only When Everything Else Has Failed
Look, I know that foot surgery sounds scary. But here's what I want you to know upfront: only about 5% of plantar fasciitis patients actually need surgery.
That's it. 95% get better without ever going to the operating room.
Surgery becomes an option when you've genuinely tried everything else for 12-18 months without improvement. At that point, we're usually doing one of two procedures: a gastrocnemius recession (releasing tight calf muscles) or a partial plantar fascia release. Both have success rates above 90% when patients are properly selected.
The surgery itself is quick—usually less than an hour. You can walk right after in a surgical boot, no crutches needed. Most patients are back in regular shoes within 6-8 weeks. The recovery is much easier than most people imagine, and if you've already been dealing with heel pain for over a year, those 6-8 weeks of recovery are totally worth it to finally be done with the problem.
Very rarely—in that small percentage of cases where the heel spur itself is causing pain—we'll remove the spur during surgery. But again, that's unusual. Most of the time, we're addressing the plantar fasciitis, and the spur just stays where it is without causing any problems.
Not sure which treatment is right for you? Call us at 713-785-7881 or request an appointment to discuss your specific situation. We'll figure out the best approach for your heel pain together.
So Do You Have Plantar Fasciitis, a Heel Spur, or Both?
Here's the bottom line: you almost certainly have both. That heel spur on your X-ray is real, and it's there because your plantar fascia has been pulling on your heel bone for months or years.
But in 95% of cases, the plantar fasciitis is what's causing your pain, not the spur itself.
This is why we treat the plantar fasciitis whether or not you have a visible heel spur on imaging. The plantar fasciitis treatment addresses the inflamed tissue, the biomechanical forces that caused the problem, and that stalled healing response we talked about earlier. When the plantar fasciitis gets better, your heel pain goes away—spur or no spur.
The only time I focus on the spur itself is in that rare 5% of cases where the fat pad under your heel has worn away and the spur is actually rubbing against tissue. If that's what's happening, we'll know from your exam—the pain pattern is different, and there are specific treatments that can help.
But for the vast majority of patients reading this article, your pain is coming from plantar fasciitis, and that's what we're going to fix.
Now you understand what's really going on in your heel. You're not confused anymore about whether you have one condition or two, and you're not wasting time treating the wrong problem.
Your Next Steps for Heel Pain Relief
I know how frustrating it is to deal with heel pain for months while getting conflicting information about what's wrong. You've probably spent hours researching online, trying different treatments, and wondering why nothing seems to work.
That confusion ends here.
In our Houston office, I'll examine your foot, review any imaging you've had, and explain exactly what's causing your pain and what we can do about it. We'll start with conservative treatment—proper footwear, stretching, custom orthotics—and only move to more advanced options if we need to. Most patients see significant improvement within a few weeks to a few months, and only 5% ever need surgery.
Either way, I need to see you to figure out what's really going on with your heel. Don't spend another month confused about whether you're treating the right condition. Call us at 713-785-7881 or request an appointment online to get answers and start treatment that actually works. The sooner we figure out what's causing your heel pain, the faster we can get you back to living without that stabbing pain every morning.
