Advanced Treatment Options for Plantar Fasciitis

Updated 9/18/2018
On NBC's "The Doctor's" we explain plantar fasciitis and perform three advanced procedures for heel pain relief before a live studio audience.

There are many treatment approaches to heel pain and no one approach works for everybody. That's why University Foot and Ankle Institute approaches each patient individually.

We are leaders in both education and product development in the treatment of plantar fasciitis offer the most comprehensive diagnostic and treatment equipment available.


Internationally recognized as experts in the field of plantar fasciitis and heel pain, the specialists at UFAI speak and instruct worldwide on the latest techniques and the most innovative products on the market. They are often asked to share their expertise in various medical publications and to participate in clinical trials, including a new technology, which uses high frequency ultrasound to treat heel muscle injuries.

Patients Are Our Number One Priority

We pride ourselves in offering the most advanced care in a compassionate environment. Our patient care is second to none and our family friendly staff will be with you throughout your entire treatment plan. We have onsite imaging services, brace and orthotic manufacturing, physical therapy clinic and state-of-the-art operating rooms. This often eliminates the need to go from one office to another and allows for your physician to work closely with all those involved in your care.


Causes of Heel Pain

Proper diagnosis of heel pain is critical. There are several causes of heel pain and include: cyst, tumor, fracture, bone spur, bursa inflammation and plantar fasciitis.


UFAI has decades of combined experience treating all of these conditions. We offer multiple state-of-the art facilities with on-site MRI, CT, Digital X-ray and Ultrasound technology to properly diagnose your heel pain.


Conservative Treatment Options for Plantar Fasciitis

Conservative care, usually our first line of care, when properly matched to the patient has a very high success rate. Over 70% our heel pain patients find relief with physical therapy, orthotics and shoe change. Less than 5% need advanced treatments and less than 2% require surgery.


The primary conservative treatments for heel pain are intended to calm down the fascia and decrease inflammation. We often see positive results when our patients regularly perform the following treatments:


Physical Therapy and Plantar Fasciitis Stretches

Stretching your calf (Achilles) and plantar fasciitis will relax the tight muscles, reducing heel pain, especially when done prior to getting out of bed in the morning. In addition, a physical therapist can determine the correct stretches for you that will strengthen muscles, improve foot mechanics and reduce stress on the foot. At UFAI, our physicians work closely with our on-site physical therapist, offering advanced protocol for successful physical therapy treatment.


Icing for Heel Pain Relief

Treatment for Plantar Fasciitis, Plantar Fsciitis Surgery
Rollingyourfootonaforzen water bottle massages the fascia, relieving pain and reducing inflammation.


Icing is important in the treatment of plantar fasciitis, especially after activity. Icing will reduce swelling and pain, allowing the tissue to heal faster. Combining ice and massage (rolling the bottom of your foot on a frozen water bottle) is very helpful. It not only brings some pain relief and a reduction in inflammation, it also helps stretch the plantar fascia. This too should be done several times each day.



Heat can be very helpful during the physical therapy period. The heat is applied to the region of pain, which increases blood supply to the region and also warms up the fascia prior to therapy. It’s important to note that ice is the main treatment used for recovery and more helpful than heat.


Orthotics for Plantar Fasciitis

Adding support to the arch through an over-the-counter insole or a custom orthotic insole device (which provides more accurate support) will greatly help support the foot and decrease stress on the arch.


Proper Foot Gear

We recommend stiffer soled shoes. The upper can be soft but the sole needs to be stiff and a little lift is okay. Women do well with wedges and men do better with stiff running shoes or a cowboy boot or a work boot.



Massaging the heel region will break up scar tissue and increase blood to the area to help with healing.


Plantar Fasciitis Night Splints

Plantar Fasciitis Surgery, Night Splints, Heel Pain Treatment
Plantar Fasciitis night splints keep the calf and Achilles stretched during sleep allowing for less tension in the morning.


A night splint may be used in cases that do not respond to physical therapy, stretching and insole modifications. The goal of the night splint is to keep the calf and Achilles stretched during sleep and rest and allows for less tension and stretching of the fascia those first steps in the morning or after a period of rest.


Anti-inflammatory Medications

Over-the-counter anti-inflammatory medications can reduce inflammation in the heel and arch of your foot, helping to ease pain.


Cortisone Injections for Heel Pain

One, maybe two cortisone injections may be used to calm the severe swelling and pain. We usually try to avoid these injections, as cortisone is known not only to reduce inflammation (a good thing) but also damage and weaken the tissue (a bad thing), making it more prone to tear.


In some cases, we have seen this to be effective and contributed to totally recovery, but usually its effectiveness is temporary.


The goal of conservative treatments is to make the fascia and Achilles tendon more limber and stretched, which decreases stress on the arch and lessens pressure through the plantar fascia. Often these treatments are sufficient to make the condition tolerable or eliminate it altogether.


Non Surgical Treatment Options for Plantar Fasciitis

While approximately 80% of our patients respond to simple conservative care, heel pain may continue to be a problem for some. This is often due to a lack of blood flow to the damaged tissue resulting in chronic plantar fascia pain and scar formation. In order to correct such issues, the body needs to be alerted to the injury region so it again begins to treat the damaged tissue and help resolve the problem. Advanced non-surgical treatment options include:


Botox / Dysport Injections for Plantar Fasciitis

Dysport is injected into the calf muscle or plantar fascia, tone and stiffness is reduced. This prevents the nerve from over stimulating the muscle by blocking the link between the two. This allows tight calf muscles to stretch, relax and grow. 


When Dysport is injected into the plantar fascia, it relaxes and weakens the strength of the tendon, relieving swelling and pain.


Learn more about Dysport Injections.



Platelet Rich Plasma Therapy (PRP) for Plantar Fasciitis

Dr. Baravarian discusses regenerative medicine therapy for the treatment of plantar fasciitis.


If the chronic plantar fasciitis does not respond to conservative care, an in-office option is platelet rich plasma injection (PRP). PRP injection allows growth factors in the blood to be used to cause inflammation of the injured tissue. This increases the healing response of the body.


With PRP, the blood is drawn and spun down with a centrifuge. Under ultrasound guidance and local anesthesia, an injection of PRP is placed in the damaged tissue. This sparks an increased growth-factor release in the area, which increases the blood supply to the damaged heel region to facilitate a healing process.


Learn more about Platelet Rich Plasma Therapy.


Shockwave Therapy for Plantar Fasciitis

If conservative therapies fail after several months, your doctor may suggest shockwave therapy. Shockwave therapy is a non-invasive, office procedure that permits new blood flow into the area of fascia damage.


Shockwave therapy is a long-term solution and there is a slow improvement with maximum pain relief usually at 3 months. However, there’s usually improvement seen at the start of the third week.


Learn more about Shockwave Therapy for heel pain.



The Relef procedure is a new technique used to treat chronic plantar fasciitis not responsive to conservative care. Relef is a restorative technique that uses a radiofrequency heat mechanism to break up and melt the scar tissue in the heel and plantar fascia region. There is also an increase in blood supply to the heel area that helps with tissue healing.


The procedure is done in the office setting without the need for anesthesia and the patient can walk after the treatment. Protection of the foot in a boot may help rest the fascia and a second treatment may be necessary in stubborn cases.


Learn more about the RELEF Procedure.


Amniotic Stem Cell Therapy for Plantar Fasciitis

During stem cell therapy, the patient's own stem cells are removed by simple blood sample collection. Using a special procedure, unhelpful cells are removed leaving behind the strong healing stem cells. Those cells are injected into the injured area and begin to replicate themselves making healing possible


Learn more about Amniotic stem cell therapy.


Plantar Fasciitis Surgery

Surgery is reserved for the most chronic cases of plantar fasciitis that do not respond to conservative or advanced therapies. The surgical technique depends on the severity of the fasciitis and can include:


Topaz Technology for Plantar Fasciitis

Plantar fasciitis Surgery, Topaz Procedure for Heel Pain
Topaz, a minimally invasive procedure uses high frequency energy to spur healing.

Topaz coblation technology combines bipolar high-frequency energy with a saline-based medium to remove tissue with little, if any, damage to surrounding, healthy tissue. The surgery is a minimally invasive procedure that involves burning tiny holes through the skin and plantar fascia in the heel. Removing tissue irritates the fascia enough to turn a chronic problem into an acute problem by increasing circulation to the damaged area.


The patient's body then increases the natural healing properties, which begin to repair the newly injured ligament. This new acute injury to the ligament is healed in a controlled environment, with the foot immobilized in a boot for 2- 4 weeks. Return to walking and full activity is immediate after surgery and showering is allowed on day two after surgery.


Learn more about Topaz Technology.


TENEX Procedure for Plantar Fasciitis

Doctors use a diagnostic ultrasound to identify the exact site(s) of scar tissue. Using the Tenex probe, the scar tissue is removed and damaged area broken up. The procedure usually takes only 15 minutes and there can be minor swelling.


Learn more about the Tenex Procedure.


Endoscopic Plantar Fasciotomy Surgery

If all forms of care fail, fascia release surgery is used to release the tight fascia. The fascia is cut to relieve tension or pressure from the loss of circulation to tissue or muscle. The surgeons at UFAI have perfected the approach for fascia release. Our endoscopic and minimally invasive fascia release procedure promotes rapid healing with the quickest surgical recovery.


The surgeon makes two small incisions on either side of the heel. An endoscope is inserted in one incision to guide the surgeon. A tiny knife is inserted in the other and a portion of the fascia near the heel is removed. Patients typically have 3 weeks of downtime in a boot.


UFAI, The Right Choice for Your Plantar Fasciitis Treatment

Our physicians are nationally recognized as experts in the treatment of plantar fasciitis. Our results are revolutionary and unmatched in the community; less than 5% of all UFAI patients we see for plantar fascia need surgery and less than 2% need a fascia release.  If conservative care does not work, no other center offers our level of restorative on surgical options for the care of heel pain. Our advanced physical therapy services get you back on your feet quickly and teach you what is necessary to keep you moving.









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