What Is Plantar Fasciitis?
The plantar fascia is the thick band of connective tissue running along the bottom of your foot — from your heel bone 
all the way to the base of your toes. Think of it as the bowstring that holds your foot's arch in shape under load. When it's healthy, you don't think about it at all. When it's damaged and inflamed — that's heel pain and plantar fasciitis — you think about it with every single step.
Here's what's actually happening when you feel that stabbing pain first thing in the morning. During rest — overnight, or even after sitting for an hour — the plantar fascia partially heals in a shortened, contracted position. The moment you stand up, those first steps tear that partial repair apart. Podiatrists call this post-static dyskinesia. You know it as the ice-pick-in-the-heel sensation that gradually eases once you've walked around for ten or fifteen minutes.
What most people don't realize is that morning pain isn't a quirk. It's a signal. Your body is actively trying to repair the tissue every single night. The fact that it hurts means the damage is significant enough that healing attempts are happening repeatedly — but never finishing.
Here's why. The plantar fascia has poor blood supply compared to most soft tissue in your body. Blood flow is how your body delivers repair materials to an injury. Without enough of it, the healing process stalls. Your body's construction crew shows up, starts the job, and then runs out of supplies. Research in the Journal of the American Podiatric Medical Association{:target="_blank"} confirmed that chronic plantar fasciitis shows degenerative collagen changes — not active inflammation — which is precisely why anti-inflammatory treatments alone fall short for so many people.<sup>1</sup>
Why Does Plantar Fasciitis Keep Coming Back?
Here's the thing most people don't hear from their first provider: plantar fasciitis isn't just an inflammation problem. It's a mechanics problem. If your foot isn't functioning right — whether that's flat feet putting extra strain on your arch, high arches that can't absorb shock, or overpronation (your foot rolling inward excessively with each step) — every stride is overloading the fascia. Rest reduces the pain. But the moment you're back on your feet, the same mechanical stress hits the same damaged tissue the same way.
Your plantar fascia isn't working in isolation either. It's part of a chain that runs from your mid-back all the way to your toes. When your calf muscles are tight — nearly universal in plantar fasciitis, and especially common among Houston runners and people who spend long days on hard tile and hardwood — they increase the pull on your heel with every step. I don't just examine the heel when you come in. I look at everything from the hips down, because that's where the real drivers usually are.
And then there's what happens at the tissue level once this has been going for a while. Repeated micro-tearing leads to scar tissue. Scar tissue disrupts normal collagen, creates adhesions, and further reduces blood flow. At some point the fascia shifts from "acutely inflamed" to a chronic degenerative state — what I call a failed healing response. The tissue is caught between injured and healed, rebuilding nothing. This is why running injuries that start in the heel so often end running seasons entirely when they go untreated.
That's also why "just rest it" stops working. You feel better. You go back to your normal routine. The pain comes back — sometimes within days. I see this cycle constantly in my Houston podiatry practice, and it's entirely preventable once you know what's driving it.
How a Houston Podiatrist Treats Plantar Fasciitis — From First Steps to Full Recovery
After treating thousands of patients with plantar fasciitis, I've found that the biggest predictor of outcomes isn't how severe the pain is — it's how complete the treatment plan is. Here's how I think about it. We start with the least invasive approach that makes sense for where you are right now, and we escalate only if we need to. Most people never get past Level 3. But knowing what comes next — and that there's always a next step — means you never have to settle for "learn to live with it."
Level 1: Foundation First — Shoes and Activity
Before anything else, we talk about what your feet are walking on and what they're wearing. No bare feet on hard floors. Not even to get your morning coffee. Houston homes are full of tile and hardwood, and every unprotected step on those surfaces reloads the fascia before it has any chance to recover. This alone makes a measurable difference.
Activity modification — not elimination — is the other piece. I'm not going to tell you to stop moving. But I may ask you to swap running for swimming temporarily, or to shorten your standing shifts until we have your mechanics under control. If there's no improvement in three to four weeks at this level, we move forward.
Level 2: At-Home Care — Stretching, Ice, and Night Splints
The three-step morning stretch is the most important thing I can give you to do at home. Before your feet hit the floor — while you're still in bed — gently flex your foot toward your shin, stretch your toes back, and hold for 30 seconds. That pre-loads the fascia gradually instead of tearing the overnight repair apart with your first step.
After activity, a frozen water bottle rolled under the arch for 10 to 15 minutes reduces the inflammatory load. A night splint — a brace worn while you sleep that holds your foot at 90 degrees — prevents the fascia from contracting overnight, which is what causes morning pain in the first place. Most people notice a real difference in two to three weeks. I'll be direct, though: these tools manage the load. They don't correct the mechanics causing the overload. You'll hit a ceiling at this level, and most chronic cases already have.
Level 3: Custom Orthotics + Cortisone — The Mechanical Fix
This is the section you came here for.
Think of custom orthotics like eyeglasses for your feet. Glasses don't cure your vision — they compensate for your 
biomechanical reality so your eyes can function without strain. Custom orthotics do the same thing for your plantar fascia. They're fabricated from a 3D digital scan of your foot in a corrected position, built to address your specific mechanical issue — whether that's flat arches, overpronation, or uneven loading. They don't do the work for your feet. They help your feet work the way they're supposed to.
Here's the clinical process: I'll do a full biomechanical exam and watch your gait, then take a 3D digital scan of your foot. The orthotics are custom-fabricated to your specs, usually ready in two to three weeks. Most patients feel a meaningful difference within the first two to four weeks of wearing them. Full resolution typically takes six to twelve weeks.
Cost: $700 for the first pair, $350 for additional pairs. Many insurance plans cover custom orthotics with a podiatrist prescription — worth checking your benefits before assuming it's all out of pocket. They're also FSA and HSA eligible. And they last three to five years with proper care, which makes the long-term cost far lower than repeated drugstore insoles that don't fix anything.
On cortisone: a $120 cortisone injection is useful as what I call a fire extinguisher. It knocks down acute inflammation fast, which can give you enough pain relief to actually do the rehab work. But it doesn't heal the fascia, and repeated injections over time weaken the tissue. I use cortisone as a bridge — never as a long-term strategy. The combined success rate at Level 3 is 70 to 80%. For most people, that's where the story ends.
Level 4: The Third Option — Shockwave and PRP
Here's what most people don't realize: there's an entire category of treatment between conservative care and surgery. Most patients never hear about it. That's the gap I spend a lot of time closing.
Shockwave therapy for chronic heel pain works by delivering focused acoustic energy to the damaged tissue — think of it like aerating a compacted lawn. The micro-channels it creates stimulate your body's natural healing response, increase blood flow to the area, and break down the calcifications and scar tissue that stall the repair process. Three sessions over three weeks, about 10 to 15 minutes each. Success rate: 82% for chronic plantar fasciitis.<sup>3</sup> Cost: $750 for the three-session package.
Platelet-rich plasma (PRP) injections take a different angle. I draw a small amount of your blood, spin it in a centrifuge 
to concentrate the platelets and growth factors, and inject that concentrate directly into the damaged fascia — guided by ultrasound to hit the exact right spot. PRP delivers the raw materials your body needs to actually rebuild the tissue. I describe it as liquid gold for healing: it's your own biology, just concentrated and redirected. Cost: $850.
The real power is in combining them. PRP first — to plant the healing factors in the tissue. Shockwave within a few days — to activate and amplify everything that was just delivered. It's seeds and soil: PRP provides the seeds, shockwave prepares the ground. For chronic cases that haven't responded to anything else, the combined protocol reaches 85 to 95% resolution.<sup>4</sup> These are cash-pay procedures — insurance doesn't cover them — but FSA and HSA funds apply, and for most patients, this is still far less expensive than surgery and its recovery.
You can explore all of these regenerative medicine options between conservative care and surgery on our dedicated page.
Level 5: Surgery — The 5%
Look, I know surgery sounds scary. I hear it from patients constantly. But here's the truth: 95% of my plantar fasciitis patients get better without it. Surgery is the last resort, and I mean that literally — I don't recommend it unless we've genuinely exhausted the options above.
For the 5% who truly need it, plantar fascia release and minimally invasive foot surgery has come a long way. The most common approach is a partial plantar fascia release — an outpatient procedure, usually under an hour — where I cut a portion of the fascia to relieve chronic tension. For appropriate cases, the Tenex procedure offers an ultrasound-guided minimally invasive option that removes damaged tissue with a small needle-sized instrument. Most patients are back in regular shoes within six weeks. It's a real procedure with real recovery, but it's not the ordeal most people imagine.
What to Expect When You Come Into My Houston Office
I want to take the mystery out of what the first appointment looks like. When you come in, I'll start by listening. I want to know how long this has been going on, what you've already tried, what makes it worse, and — most importantly — what you want to get back to. Running? Long workdays? Morning walks? That matters, because that's the goal we're working toward, not just "less pain."
I won't judge you for how long you waited, or for the home remedies you tried. I just need the full picture.
From there, I'll do a thorough physical exam. I'll press on the heel and arch to find exactly where the damage is. I'll watch you walk — not just stand — because your gait tells me things a static exam can't. I'll check your footwear, your calf flexibility, your ankle range of motion. If it makes sense clinically, I'll take X-rays in the office. X-rays don't show the plantar fascia directly, but they can rule out a stress fracture and show me your heel bone structure clearly.
Most patients leave that first visit with treatment already started — taping to take load off the fascia, anti-inflammatory guidance, and in many cases, the casting process for custom orthotics designed for your foot mechanics begun the same day. Depending on what I find, I may also recommend red light therapy to reduce inflammation as part of the initial protocol. You won't leave with a printout telling you to stretch and come back in six weeks. You'll leave with a real plan.
If your plantar fasciitis is relatively new, expect meaningful improvement in two to three weeks. If you've been dealing with this for months, plan for six to twelve weeks for full resolution — depending on how much we need to escalate. A 2018 systematic review in the British Journal of Sports Medicine{:target="_blank"} found that orthotic-based treatment addressing biomechanical root causes — not just symptoms — resolves plantar fasciitis in the vast majority of cases.<sup>2</sup>
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