What Is Plantar Fasciitis (And Why Does My Heel Hurt)?
Plantar fasciitis happens when the thick band of tissue running along the bottom of your foot—from your heel to your toes—gets damaged and inflamed. This tissue, called the plantar fascia, acts like a shock absorber for your arch. When it develops tiny tears from overuse or stress, you get that characteristic stabbing heel pain, especially with your first steps in the morning.<sup>1</sup>
Here's what's actually happening. Your plantar fascia has relatively poor blood supply, which is exactly why this condition gets so stubborn. During the night, your body tries to heal the damaged tissue. As part of that process, the plantar fascia contracts and shortens. When you step out of bed in the morning, you're literally tearing apart all the repair work your body did overnight. That's the medical term we call post-static dyskinesia—but you just know it as excruciating first-step pain.<sup>2</sup>
Think of it like a construction crew that started a job but never finished. Your body began trying to heal the injury, but for various reasons—poor blood supply, scar tissue formation, or simply time—that healing process stalled out. The tissue stays in a state of chronic inflammation without ever progressing to actual repair.
We call this a failed healing response, and it's the reason home treatments eventually stop working.
And here's what most people don't realize: that heel spur you might see on an X-ray? It's almost never the cause of your pain. Heel spurs are present in many people with zero pain. The spur is a result of plantar fasciitis, not the cause. Less than 5% of heel spurs actually need removal.
Why Does Plantar Fasciitis Happen?
The simple answer? The stress on your plantar fascia exceeds your body's ability to heal it. Every step you take creates
force on this tissue—1.2 times your body weight when walking, 3 times your body weight when running.<sup>3</sup> When those microtears accumulate faster than your body can repair them, you develop plantar fasciitis.
But your plantar fascia isn't working in isolation. It's part of a complex chain that starts in your mid-back and runs all the way to your toes. Think of your body like a puppet on strings. When one string gets tighter or twisted, it affects everything below it. Tight calf muscles pull on the heel cord (Achilles tendon), which increases tension on the plantar fascia.
That's why treating just the heel often isn't enough.
After treating thousands of patients with heel pain in my Houston practice, I've identified the most common triggers. A sudden increase in activity—like training for a 5K when you haven't run in years. Worn-out or unsupportive shoes that lost their cushioning. Weight gain, even just 10 pounds, because remember that force multiplication effect. Age plays a role too—plantar fasciitis is most common between ages 40 and 60.
Your foot structure matters as well. Both flat feet and high arches can create abnormal stress across the plantar fascia. Standing on hard surfaces all day compounds the problem. And here's what catches people by surprise: tight calves or a tight Achilles tendon are present in nearly every case of chronic plantar fasciitis I see.
What most people don't realize? Plantar fasciitis won't always "just go away on its own." Sometimes it does, sure. But often you're allowing acute inflammation to become chronic degeneration. The longer you wait, the more stubborn it gets.
The Frozen Water Bottle Myth (And Other Things That Make It Worse)
You've probably seen this advice everywhere online: freeze a water bottle and roll your foot on it. Some people swear
by it.
I'm going to tell you why it's actually making things worse.
While rolling on ice might provide temporary relief through numbing, the force of rubbing your plantar fascia against something hard can actually aggravate the microtears in tissue that's already damaged. You're getting short-term pain relief but long-term worsening of the condition. The numbing effect tricks you into thinking you're helping when you're really creating more inflammation.
Here's the problem with internet advice—it echoes around until everyone believes it must be true. But there are several other common "remedies" that are actively hurting your recovery.
Aggressive morning stretching is a big one. When you first wake up, your plantar fascia is in that shortened, contracted position from overnight healing. Forcing it to stretch immediately tears apart that repair work. Wait at least an hour after waking before doing any stretching.
Heat therapy is another mistake I see constantly. People think heat will "loosen things up," but heat increases blood flow and inflammation. When you have an inflamed plantar fascia, that's the last thing you need. Ice reduces inflammation. Heat makes it worse.
And going barefoot at home? You're re-adding insult to injury. Walking on hard tile or hardwood floors without any support puts maximum stress on already-damaged tissue. Those comfortable old slippers you love? If they don't have arch support, they're part of the problem.
What You Can Actually Do at Home
Now that we've covered what NOT to do, let's talk about what actually helps. I'm going to be honest with you: home treatments can control inflammation and provide support, but they can't restart stalled healing. For many people, home care is enough. For others, it's an important first step before we need to do more.
If your heel pain is relatively new—less than 6 weeks—and caused by a clear trigger, home care alone might resolve it in 4-6 weeks. But if you've had pain for months, or if it keeps coming back after temporary improvement, home treatments aren't addressing the root cause.
Rest and Activity Modification
Switch to low-impact activities like swimming or cycling. Reduce unnecessary standing. I know it's not glamorous, but rest is essential. You can't heal tissue you're constantly re-injuring.
Ice (The Right Way)
Use a cloth-covered ice pack—not a frozen water bottle you're rolling on. Apply it to your heel for 15-20 minutes, 2-3 times daily. Keep it stationary. No rolling, no rubbing, no friction against damaged tissue.
Proper Footwear—Always
I can't stress this enough: no barefoot walking on hard surfaces. Ever.
This is especially important for Houston patients—our humid climate means your feet are already dealing with moisture and potential fungal issues. Adding the stress of unsupported walking on tile or hardwood floors is a recipe for chronic heel pain.
Wear supportive house shoes at home. I recommend Vionic Wave Sandals for around the house. And those comfortable old slippers you love? They're making your condition worse.
Calf Stretching (Timing Matters)
Gentle calf stretches reduce tension on the Achilles tendon and plantar fascia. But timing is crucial. Never do aggressive stretching first thing in the morning—wait at least an hour after waking. Then do gentle stretches: 15-30 seconds, 2-3 sets, 3 times daily.
Night Splints
These devices keep your foot flexed at 90 degrees while you sleep, preventing that overnight contraction. Some people see relief within days. Wear them consistently for 2-4 weeks.
NSAIDs (Short-Term Only)
Ibuprofen or naproxen can control inflammation, but they don't heal anything—they just manage symptoms. Use them for maximum 10 days without consulting a doctor. They're a bridge, not a solution.
How a Houston Podiatrist Treats Heel Pain: Beyond Home Remedies
After treating thousands of patients with chronic heel pain, I've developed a clear treatment philosophy: we start with the least invasive options and only escalate when necessary. But here's the crucial part: "conservative care" doesn't mean we're just buying time until surgery.
There are powerful treatment options between ice packs and the operating room—what I call The Third Option.
I find that people are reluctant to come into the office with heel pain because they're sure they need surgery. Most end up surprised that there are other options. Here's the key statistic: 95% of plantar fasciitis cases resolve without any surgery.<sup>6</sup>
Let me walk you through what those solutions actually look like.
Level 1: Custom Orthotics
Think of custom orthotics like eyeglasses for your feet. They're made from a 3D mold or scan of YOUR feet, addressing YOUR specific biomechanics—whether that's flat feet, high arches, or over-pronation.
Those $30 inserts at Walgreens? They're better than nothing, but they're generic. Custom orthotics are tailored to redistribute pressure away from your heel and support your arch exactly where you need it.
Success rate: 60-70% see significant improvement as part of a comprehensive plan
Timeline: 3-4 weeks for noticeable pain reduction
Cost: $700 for the first pair, $350 for additional pairs
Level 2: Cortisone Injections (When Needed)
I used a cortisone injection myself when I developed plantar fasciitis. It essentially hits the pause button on inflammation—gives your body a break from the pain cycle. But it doesn't restart the healing process.
When do I use cortisone? For acute flare-ups that are preventing you from doing other treatments, or when pain is severe (8-10 out of 10). It's a tool to get you functional enough to do the work that actually fixes the problem.
Relief: Within 24-48 hours
Duration: 4-12 weeks
Limit: 2-3 per year (risk of tissue damage if overused)
Cost: $120 per injection
Reality check: if you need more than two cortisone shots in a year, we need to address the underlying problem differently.
Level 3: Shockwave Therapy (The Third Option Begins)
Shockwave therapy is where things get interesting. Despite the scary name, these aren't electric shocks—they're
acoustic pressure waves, like sound waves, that stimulate healing at a cellular level.
Think of it like aerating a lawn. You're creating pathways for healing factors to reach damaged tissue. The treatment increases blood flow, breaks up scar tissue, and triggers growth factors that restart that stalled healing response.
I used shockwave therapy on my own plantar fasciitis, and it was a game-changer. After months of dealing with morning heel pain, the shockwave treatments finally got me back to running half marathons.
Protocol: 3 sessions, once per week, 10-15 minutes each
Sensation: Tapping feeling, about 4-5 out of 10 on the discomfort scale
After-effects: Some redness or soreness that resolves within 24 hours
Success rate: 82% find their pain resolved after the full treatment<sup>4</sup>
Timeline: Weeks 2-4 you'll notice improvement, full benefit in 3-6 months
Cost: $750 for the 3-session package
This treatment almost makes surgery obsolete for chronic heel pain.
Level 4: PRP (Platelet-Rich Plasma) - Liquid Gold
PRP therapy uses your body's own healing factors. We draw a small amount of your blood, spin it in a centrifuge to concentrate the platelets and growth factors, then inject that "liquid gold" directly into the damaged plantar fascia using ultrasound guidance for precision.
The entire procedure takes 15-20 minutes. You'll have some soreness for 1-2 days—that's a normal healing response. Minimal downtime.
Success rate: 70-80% with chronic tendon problems see significant improvement<sup>5</sup>
Timeline: Improvement begins in 2-4 weeks, continued improvement over 3-6 months
Cost: $850
Here's the key difference: unlike cortisone which provides rapid but temporary relief, regenerative treatments work by stimulating your body's natural healing processes. You're not masking pain—you're fixing the problem.
Level 5: Combined Shockwave + PRP (Optimal for Chronic Cases)
For stubborn cases, we combine both treatments. Think of it this way: PRP provides the seeds—the growth factors. Shockwave prepares the soil and creates optimal growth conditions. Together, they're more powerful than either alone.
We do the PRP injection first, then start shockwave sessions a few days later, three times over three weeks.
Combined success rate: 85-95% (the highest success rate short of surgery)
Cost: $1,600 total ($850 for PRP + $750 for shockwave)
Timeline:
- Weeks 1-2: Some soreness as healing kicks in
- Weeks 3-4: Initial improvement
- Months 2-3: Significant improvement
- Months 3-6: Full benefit realized
Insurance note: Currently, most insurance plans including Medicare don't cover PRP or regenerative medicine—these are cash-pay procedures. But here's how I think about it: if you've been doing physical therapy with $30-50 copays twice a week for months, getting repeated cortisone injections, and buying different shoes and inserts, you're already spending significant money without resolving the problem. Many patients find regenerative medicine more cost-effective in the long run.
Additional Regenerative Options
Remy Laser Therapy
The Remy Laser is a cutting-edge treatment that uses specific wavelengths of light to penetrate deep into damaged tissue. It works by stimulating cellular regeneration and reducing inflammation at a molecular level.
I use this for patients who want a completely non-invasive option or who are combining treatments for maximum effect. The laser sessions are painless—you just feel a warming sensation. Many patients do this in combination with shockwave or PRP for enhanced results.
Protocol: 6-8 sessions over 3-4 weeks
Sensation: Gentle warmth, completely painless
Timeline: Gradual improvement over 4-8 weeks
Cost: Typically bundled with other treatments
Red Light Therapy
Red light therapy uses specific wavelengths to boost circulation and accelerate tissue repair. It's particularly effective for chronic inflammation that's been resistant to other treatments.
We often incorporate this as an adjunct to other regenerative treatments. It's completely non-invasive and helps create an optimal healing environment in the tissue.
BPC-157 Peptide Therapy
BPC-157 is a peptide that's showing remarkable results for tendon and ligament healing. It works by enhancing your body's natural repair mechanisms and promoting blood vessel formation in damaged tissue.
For chronic plantar fasciitis cases where the healing response has completely stalled, BPC-157 can be a game-changer. We can administer it through injection or as part of a comprehensive regenerative protocol.
What's exciting is that we now have treatments that almost make surgery obsolete. The combination of shockwave, PRP, laser therapy, red light, and peptides gives us more tools than ever to restart healing in stubborn cases.
Level 6: Surgery (Only 5% of Cases)
Look, I know foot surgery sounds scary. And honestly, I'm more conservative than most surgeons—I want to exhaust every other option first. But when surgery is truly needed, plantar fascia release surgery works.
The procedure involves releasing a portion of the plantar fascia to reduce tension. We can do it open or endoscopically, depending on your specific situation.
When is surgery necessary?
- Pain persisting 6-12 months despite ALL treatments
- Quality of life severely impacted
- Unable to work or perform daily activities
Success rate: 70-90% achieve significant pain relief
Recovery timeline:
- Week 1: Walking in a protective boot
- Weeks 2-3: Continue boot, gentle range-of-motion exercises
- Weeks 4-6: Transition to supportive shoes, physical therapy begins
- Weeks 7-12: Increase activity, continue PT
- Months 3-6: Return to most normal activities
- Full recovery: 6-12 months
This is a quick and minimally invasive surgery. You can bear full weight on your foot in the boot right away—no crutches needed. The stitches come out in about two weeks.
But remember: 95% of plantar fasciitis cases resolve without surgery. That means if you're doing everything right and you're still in severe pain after 6-12 months, then we talk about surgery. It's truly the last resort.
Ready to get back on your feet without that constant heel pain? Let's figure out which treatment level is right for you. Call our Houston office at 713-785-7881 or request an appointment online.
Schedule Your Evaluation
What to Expect When You Come to My Houston Office
When you come in, I'll start by listening to your story. How long have you had the pain? What makes it better or worse? What have you already tried?
This conversation tells me as much as the physical exam because heel pain doesn't happen in isolation—it's almost always part of a bigger pattern.
Then I'll examine your feet and watch you walk. I'm looking at your entire lower extremity—not just your heel—because remember that chain reaction we discussed? Sometimes the source of the problem is upstream. I'll test your range of motion and muscle strength. I'll feel for areas of tenderness and swelling. I'm checking your foot structure, your ankle flexibility, and especially your calf and Achilles tightness.
If needed, we'll take X-rays right in the office. Not because I think a heel spur is your problem, but to rule out stress fractures or other bone issues that can mimic plantar fasciitis. The entire evaluation usually takes about 30 minutes.
Here's what I won't do: pressure you into an expensive treatment on your first visit. We'll talk through your options, discuss realistic timelines and success rates, and make a plan that makes sense for your life and your budget.
If you've only had heel pain for a few weeks, we'll probably start with custom orthotics and lifestyle modifications. If you've been struggling for months and already tried conservative care, we might talk about shockwave or PRP right away.
Either way, I need to see you—because the sooner we address this properly, the less likely it becomes chronic.
Most patients need a follow-up visit in 4-6 weeks to assess progress. Some conditions improve quickly; others need months. I'll be honest with you about what to expect for YOUR situation. And if something isn't working, we'll adjust the plan. This isn't a one-size-fits-all approach.
Prevention: Keeping Heel Pain From Coming Back
Once you've resolved plantar fasciitis, your job isn't over. The biomechanical factors that caused it in the first place are still there. But with the right habits, most patients can keep heel pain from returning.
Maintain Your Orthotics
If custom orthotics were part of your treatment, keep wearing them. Yes, in all your shoes.
Remember the eyeglasses analogy—they work while you wear them. Stop wearing them, and the problem can return.
Replace Your Shoes Regularly
Running shoes need replacement every 300-500 miles. Daily shoes need replacement every 6-12 months. If your shoes bend in the middle or wring out like a rag, they're done.
Don't wait until they look worn out—the support fails long before the appearance does.
Stretch Your Calves Daily
Two minutes a day prevents months of pain. Keep those calves flexible to reduce tension on your Achilles and plantar fascia. Make it part of your routine, like brushing your teeth.
Don't Ignore Early Warning Signs
If you feel that familiar heel soreness starting, don't wait. Ice it, rest it, and call the office if it persists more than a week.
Catching it early makes all the difference.
Manage Your Weight
Every pound of body weight creates 3-5 pounds of pressure on your plantar fascia. Even small weight changes make a difference. I'm not saying you need to be a marathon runner—just that maintaining a healthy weight protects your feet.