Understanding.
The plantar fascia supports the arch of the foot. Its dysfunction, also called plantar fasciitis, can cause pain at its insertion on the heel.
The assessment.
The diagnosis is usually clinical. Imaging is reserved for atypical or persistent presentations to investigate another cause.
Treatments.
Treatment is based on adapting the stresses, stretching the plantar fascia and calf muscle, and wearing appropriate footwear. Orthotics or shockwave therapy may be discussed. Injections require an assessment of their benefits and risks. Surgery is rarely necessary.
Follow-up.
Improvement is often gradual. Resumption of impact should be adjusted according to tolerance.
When initial measures are insufficient
The regularity of stretching and the adaptation of stress levels are reassessed. Night splints or shockwave therapy may be discussed. A corticosteroid injection requires careful consideration, particularly regarding the risk of aponeurosis rupture.
Surgery reserved for resistant cases
After well-managed, prolonged treatment, a procedure on the plantar fascia or on an excessively contracted calf muscle may be considered depending on the assessment. The goal is not to systematically remove a bone spur. Residual pain, nerve damage, or changes in weight-bearing patterns are possible.
Your questions.
Should a heel spur be removed?+
No. It can be present without pain and is not, in itself, an indication for surgery.
Why are the first steps painful?+
Re-tensioning after rest can trigger pain; this is common but not sufficient on its own for diagnosis.
How long does recovery take?+
Improvement is often assessed over several months. Atypical or worsening pain requires reassessment.