1. Introduction / Plain Theory

A heel spur refers to a bony outgrowth on the underside of the heel bone (calcaneus), typically visible on X-ray.
While often blamed as the source of pain, in most cases the true problem is plantar fasciitis — a condition involving micro-tears, inflammation, or degeneration in the plantar fascia, the thick connective tissue that supports the arch of the foot.

The heel spur itself is usually a secondary adaptation — a result of chronic traction from the fascia — rather than the primary cause of pain.
Plantar fasciitis accounts for over 80% of heel pain cases and is particularly common in runners, individuals who stand for long hours, and those with reduced foot or ankle mobility.

Pain arises due to repetitive microtrauma and tension overload, often from altered biomechanics, poor footwear, or systemic factors affecting connective tissue health.

2. Typical Symptoms and Functional Impact

• Sharp or stabbing pain in the heel or arch, especially during the first steps in the morning or after rest.

• Pain that gradually lessens with gentle movement but returns after long periods of standing or walking.

• Local tenderness under the heel.

• In chronic cases, dull aching throughout the day or when climbing stairs.

Functional impact:
Heel pain can significantly limit walking, standing, and exercise.
If prolonged, it may lead to gait compensations — placing extra strain on the knees, hips, and lower back.

Red flags:
Sudden, severe heel pain after trauma or swelling should be assessed for fracture or nerve entrapment.

3. Contributing Factors / Underlying Causes

Plantar fascia irritation and heel spur formation result from repetitive tension and overload at the fascia’s attachment to the calcaneus.

Common contributing factors include:

• Overpronation or flat feet (reduced arch support).

• Tight calf muscles or Achilles tendon increasing tension on the plantar fascia.

• Reduced ankle mobility (especially dorsiflexion).

• Prolonged standing or walking on hard surfaces.

• Poor footwear or sudden change in activity level.

• Excess body weight increasing plantar pressure.

• Systemic influences: diabetes, inflammatory arthropathies, or reduced connective tissue elasticity.

From an osteopathic viewpoint, heel pain often reflects global biomechanical dysfunction — such as pelvic asymmetry, leg-length discrepancy, or poor load transfer through the lower limb and spine.

4. Osteopathic Approach

Osteopathic treatment for heel spur and plantar fasciitis focuses on reducing local tension, improving circulation, and restoring biomechanical balance from foot to pelvis.

An osteopathic assessment may include:

• Palpation and evaluation of foot arches, ankle, knee, and hip motion.

• Gentle mobilisation of the subtalar, talocrural, and midfoot joints.

• Myofascial and soft-tissue release for the plantar fascia, calf, and Achilles tendon.

• Functional and indirect techniques to reduce sensitivity and improve elasticity.

• Mobilisation of the pelvis and lumbar spine to optimise weight distribution.

• Guidance on footwear, pacing, and gradual reloading strategies.

The goal is to improve load transfer and tissue recovery, not merely relieve local inflammation — addressing the underlying cause of tension that led to the heel pain.

5. Scientific Evidence & References

Evidence supports manual therapy, stretching, and load management as effective conservative treatments for plantar fasciitis.
Studies show that improving calf flexibility, foot mechanics, and tissue mobility can significantly reduce pain and recurrence.

Heel spurs themselves are often incidental findings — pain relief is achieved by correcting mechanical dysfunction and supporting fascial healing.
Osteopathic and physiotherapy-based care aligns closely with best-practice conservative management.

References

1. Buchbinder R. Plantar fasciitis. N Engl J Med. 2004;350(21):2159–2166. Link

2. Riel H, Cotchett M, Rathleff MS. Foot orthoses and calf stretching are effective treatments for plantar heel pain: systematic review and meta-analysis. Br J Sports Med. 2018;52(5):322–328. Link

3. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–237. Link

4. Landorf KB, Menz HB. Plantar heel pain and fasciitis. BMJ. 2008;337:a2205. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for foot and ankle pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

7. Martin RL, et al. Heel pain—plantar fasciitis: clinical practice guideline revision 2023. J Orthop Sports Phys Ther. 2023;53(7):CPG1–CPG44. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for plantar heel pain: network meta-analysis. Front Pain Res. 2024;15:1507445. Link