Heel pain: plantar fasciitis.

Patient

Q: After a 6 mi hike, the following day and 5 weeks later,i'm experiencing intense burning at the base of my heel as well as directly below my heel bone. is this a tendon tear or will it heal on it's own. it's very dibilitating as i cannot play tennis or hike. i've heard of a fasciitis but this does not get better after stretching. any advice? thankyou

Doctor

A:   Plantar Fasciitis 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 pain that alters your normal daily activities. It is the most common cause of heel pain in US. It can be associate or not with a “heel spur”. 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 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 heel pain), use of anti inflammatory drugs (example: “Advil”) and replacement of worn-out shoes by adequately cushioned shoes.For cases that do not respond to the conservative treatment, the corticosteroid injection on the site may be considered and if still there is no significant improvement, Surgery might be considered.

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