Heel pain after plantar release surgery

Patient

Q: I had plantar fasciitis release surgery on both feet April 12, 2011. I am still experiencing terrible pain in both of my heals. The Doctor has told me it just needs more time to heal, but this seems like an excessive amount of recovery time. I was prescribed Cymbalta a week ago to help with the pain, but no relief yet. Any ideas you can give me on why this condition is taking so long to heal after surgery

Doctor

A:    Maybe is not the typical presentation of a plantar fasciitis, but based in your description most likely is a plantar fasciitis, which is produced by inflammation of the insertion on the heel of the plantar fascia (a fibrous layer that supports the plantar arch muscles and ligaments), causing remarkable heel and sometimes arch pain that alters your normal daily activities. It is the most common cause of heel/foot pain in US. It can be associate or not with a “heel spur”, maybe in your case, the heel spur is still causing problems. A Calcaneal spur is a bony spur projecting from the back or underside of the heel bone (the calcaneus) that often makes walking painful. A calcaneal spur is also called a heel spur. Spurs at the back of the heel are associated with inflammation of the Achilles tendon (Achilles tendinitis) and cause tenderness and pain at the back of the heel that is made worse by pushing off the ball of the foot. Spurs under the sole (plantar area) are associated with inflammation of the plantar fascia (the "bowstring-like" tissue stretching from the heel underneath the sole) and cause localized tenderness and pain made worse by stepping down on the heel. Initially the pain tends to decrease with walking but gets worse throughout the day as activity increases. The pain worsens by walking barefoot on hard surfaces or walking up stairs. The causes of Plantar Fasciitis are: aging, heel fat pad thinning, too low-arched or too high arched foot, weakness of the calf muscles, leg-length discrepancy, walking or running with inappropriate shoe type on poor cushioned surfaces, a change in the walking or running routine. The suggested strategy to treat conservatively plantar fasciitis after the surgical release would be: physical therapy aimed to stretch the muscles of the calf and foot, using ice packs after the exercise routine to decrease inflammation and pain, relative rest (avoiding activities that reproduce the pain), use of anti-inflammatory meds (example: “Advil”) and replacing of worn-out shoes by adequately cushioned shoes.

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