Plantar Fasciitis
Plantar fasciitis is irritation of the thick band of tissue (the plantar fascia) that runs along the bottom of the foot from the heel to the toes. It's one of the most common causes of heel pain, especially pain that's sharpest with the first few steps in the morning. A medical evaluation determines the actual cause of your symptoms; shockwave therapy is sometimes considered for cases that haven't responded to initial conservative care.
Common Symptoms
- Stabbing or sharp pain in the bottom of the heel with the first steps in the morning
- Pain that eases after a few minutes of walking, then returns after long periods of standing
- Heel pain after — not usually during — exercise
- Tenderness when pressing directly on the bottom of the heel
- Pain that's worse after getting up from sitting for a while
Why It Happens
The plantar fascia supports the arch of the foot and absorbs load every time the foot strikes the ground. Repetitive strain — from walking, standing, running, or simply body mechanics and footwear — can create small amounts of irritation and microscopic breakdown in the fascia faster than it can repair itself. Over time this shows up as pain, particularly at the point where the fascia attaches to the heel bone.
Why It Can Become Persistent
Plantar fasciitis often becomes chronic because the fascia gets minimal rest — nearly every step reloads it — and because the tissue changes involved (which increasingly look less like classic "inflammation" and more like a stalled, disorganized healing response, sometimes described as fasciopathy) don't always resolve with generic rest alone. Ill-fitting footwear, higher-impact activity, prolonged standing, and calf tightness can all keep reloading the area faster than it can settle down.
Who Commonly Gets It
Plantar fasciitis is common in runners and other athletes, but it also affects people who stand for long periods at work, people who have recently increased their activity level, and adults in midlife generally. Body weight, foot mechanics, and footwear can all play a role.
How It Is Usually Diagnosed
A provider typically diagnoses plantar fasciitis through a history of your symptoms and a physical exam, including checking for tenderness at the heel and assessing foot mechanics, calf flexibility, and gait. Imaging (such as ultrasound or X-ray) isn't always necessary but may be used to rule out other causes of heel pain, such as a stress fracture, if the presentation is unusual.
Traditional Treatment Options
- Rest and activity modification: Reducing high-impact activity temporarily to lower daily strain on the fascia.
- Stretching and calf/foot mobility work: Targeted stretching for the calf and plantar fascia is a common first-line recommendation.
- Supportive footwear or orthotics: Cushioning and arch support can reduce strain during daily activity.
- Physical therapy: A structured strengthening and mobility program tailored to gait and foot mechanics.
- NSAIDs: Over-the-counter anti-inflammatory medication is sometimes used for short-term symptom relief.
- Corticosteroid injection: Can reduce pain in the short term for some patients, though effects may not be long-lasting and repeated injections carry their own considerations.
Why Someone Might Start Looking for Another Option
Many people try rest, stretching, new shoes, and time — and still have heel pain months later. When plantar fasciitis doesn't respond to a reasonable trial of first-line conservative care, it's common to start researching other options before considering something more invasive.
Where Shockwave Therapy May Fit
Shockwave therapy is one of the more researched non-invasive options for plantar fasciitis that hasn't improved with initial conservative treatment. It doesn't involve needles or medication, and a course of treatment is typically completed over a small number of visits.
How Shockwave Treatment Works for This Area
Acoustic pressure waves are delivered through the skin to the affected area of the plantar fascia. Researchers have studied several biological responses associated with this kind of mechanical stimulation, and clinical trials have evaluated pain and function outcomes specifically for plantar fasciopathy — see What Research Says below.
What the Treatment Feels Like
Most patients describe a firm, rhythmic pressure or tapping sensation at the treatment site. Some tenderness during treatment is common, particularly directly over the sore spot on the heel; your provider will discuss what to expect based on your evaluation.
What Happens During Your First Visit
Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.
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First treatment provided when clinically appropriate following your examination.
Who May Not Be Appropriate
- People who have not yet had a medical evaluation to confirm the cause of their heel pain
- Certain circulatory, neurological, or bleeding-related conditions, per your provider's screening
- Pregnancy, in the treatment area, unless specifically cleared by your provider
- Active infection, open wounds, or certain bone conditions at the treatment site
This list is not exhaustive. Your provider will screen for contraindications during your evaluation.
Frequently Asked Questions
Shockwave therapy has been studied in multiple randomized trials and systematic reviews for plantar fasciopathy (the tissue-level process behind plantar fasciitis), with several reviews reporting improvements in pain. Whether it's appropriate for your specific case depends on a clinical evaluation.
A heel spur is a bony growth that can sometimes be seen on X-ray; many people with heel spurs have no pain at all, and many people with plantar fasciitis have no spur. The pain most people associate with a "heel spur" is usually coming from the surrounding soft tissue, not the bone itself.
This varies widely by person and by how long symptoms have been present. Your provider can give you a realistic expectation once they've evaluated your specific case.
What Research Says
Selected sources relevant to plantar fasciitis. See the full Research Center for our complete source registry and methodology.
European Journal of Physical and Rehabilitation Medicine · 2024 · Lippi et al.
Pooled data from randomized trials found extracorporeal shockwave therapy produced meaningful reductions in heel pain for chronic plantar fasciopathy, with a good tolerability profile across the included studies.
Limitations: Included trials varied in energy level, number of sessions, and follow-up duration, and meta-regression identified this heterogeneity as a source of variable effect sizes between studies.
The Journal of Foot and Ankle Surgery · 2020 · Fansa, Talsania, Kennedy, O'Malley
This retrospective chart review of 108 patients (119 heels) treated with unfocused medium-intensity shockwave therapy (OrthoGold 100 device) for plantar fasciitis found pain scores improved significantly (from 6.7 to 2.6 on average) alongside significant gains on validated function subscales, with 81.5% of patients satisfied with the procedure at final follow-up.
Limitations: This is a retrospective chart review without a control group, not a randomized trial — it can show association and patient-reported outcomes but can't rule out improvement from time, other concurrent care, or expectation effects. It was also conducted using the same OrthoGold 100 (SoftWave TRT) device family used at this practice, which is a meaningful strength for relevance but doesn't substitute for independent replication.
Rheumatology International · 2022 · Caner, Güneş, Gökmen, Ataman, Kutlay
This double-blind, sham-controlled trial specifically studied plantar fasciitis in 22 patients with axial spondyloarthritis (an inflammatory arthritis where plantar fascia involvement is a form of enthesitis, not ordinary mechanical plantar fasciitis). Three shockwave sessions one week apart significantly reduced pain and improved pressure-pain thresholds and foot function versus sham, with no adverse events, though plantar fascia thickness on imaging didn't change in either group.
Limitations: Small sample (n=22, 11 per group), and this population — plantar fascia enthesitis specifically in axial spondyloarthritis — is a distinct patient group from typical mechanical plantar fasciitis, so results shouldn't be assumed to generalize to the general plantar fasciitis population without that context.
International Journal of Rheumatology · 2020 · Alpturker, et al.
This single-blind trial of 40 spondyloarthritis patients with plantar fasciitis (enthesitis) compared shockwave therapy to laser therapy; both groups improved significantly on pain, plantar fascia thickness on imaging, and spondyloarthritis-specific disease-activity and function scores, with no significant difference found between the two treatments.
Limitations: No untreated or sham control arm was included (an ethical constraint given both are considered active treatments), only one month of follow-up, and — as with the Caner et al. trial above — this population is plantar fascia enthesitis in spondyloarthritis specifically, not the general mechanical plantar fasciitis population.
Conference presentation (cited in SoftWave/MTS Clinical & PMCF Study Compendium, Sept. 2025) · 2007 · Marx, Thiele
This conference presentation, cited in a SoftWave/MTS manufacturer-compiled clinical and post-market compendium, reports a comparison of focused vs. defocused extracorporeal shockwave therapy for heel spur-associated pain.
Limitations: This is a conference abstract/presentation, not a peer-reviewed journal article — it does not appear in PubMed, Crossref, or Semantic Scholar under this title, and full methodology, sample size, and results are not available in independently indexed form. The source record lists only "an MTS device (unspecified)," not confirmed as the OrthoGold 100 model used at this practice. Treat as preliminary, manufacturer-cited information rather than independently verified evidence.
British Journal of Sports Medicine · 2024 · Rhim, Shin, Kang, Dyrek, Crockett, Galido, Wade, Hollander, Borg-Stein, Sampson, Tenforde
This systematic review of 56 studies (1,874 athletes and physically active individuals) found level-I evidence that shockwave therapy may be effective alone for plantar fasciitis, lateral epicondylitis, and proximal hamstring tendinopathy, and as an adjunct to exercise treatment for medial tibial stress syndrome and osteitis pubis, with generally good tolerability and minimal adverse effects.
Limitations: The review authors note that additional high-quality research is still needed to clarify shockwave therapy's optimal clinical role, dosing, and protocol across these conditions, and evidence quality varied by condition.
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