This diagnosis is often made when a patient presents with a complaint of pain under their heel bone, or calcaneus. It can affect one foot at a time, or both feet simultaneously. The patient usually gives a history of pain after a period of rest. The first few steps after getting up in the morning are the worst, usually followed by a period of improvement, but then after sitting for a while or driving and then walking again can produce the same complaint. Xrays are usually taken to rule out different causes of heel pain, but are often read as normal.
Initial treatment is conservative, with instructions on stretching the Achilles tendon several times a day, icing the painful area, and ibuprofen or other non steroidal anti inflammatory agents of choice. Physical therapy including ultrasound and TENS may be helpful. Running shoes or at least a soft-soled shoe should be worn most of the time, and not wearing flip-flops are important. Walking barefoot on hard surfaces should be avoided. Cortisone injections and orthotics are often prescribed if initial treatment is not successful, and surgery to incise part of the plantar fascia or shock wave therapy are performed in the more recalcitrant cases.