What Is Shockwave Therapy — And Why Does the Name Sound So Scary?
Shockwave therapy — the full name is Extracorporeal Shockwave Therapy, or ESWT — is a non-invasive treatment that 
uses acoustic pressure waves delivered through a handheld device placed against the skin. "Extracorporeal" just means outside the body. Nothing breaks the skin. No electricity. No anesthesia required. The device sits on your heel, and the sessions take 10 to 15 minutes.
Here's what's actually happening beneath the surface. The acoustic waves do four things simultaneously: they increase blood flow to the damaged tissue, break up scar tissue and calcifications that have formed around the injury, trigger the release of growth factors that your body uses to repair itself, and create controlled microtrauma that essentially tells your stalled healing process to restart. Think of it like aerating a lawn. Compacted soil blocks water, air, and nutrients from reaching the roots. Punch channels through that compaction, and suddenly everything healing-related can get where it needs to go. Your chronically injured plantar fascia has been starved of exactly those resources.
You might feel mild discomfort during treatment, especially when the device hits the most inflamed spot. That's actually a good sign — it confirms we're treating the right area. Most people describe the sensation as a firm tapping, and the intensity is adjustable throughout. I tell everyone who comes in: the name is the worst thing about this treatment. The experience is genuinely pretty mild.
Why Chronic Heel Pain Stops Responding to Treatment
The plantar fascia is the thick, bowstring-like band of tissue that runs along the bottom of your foot from your heel to 
your toes. It has a notoriously poor blood supply to begin with — and that's the root of the whole problem. When it gets injured, your body launches a healing response, but without strong blood flow delivering the necessary repair materials, that response often stalls out before the job is done.
Here's what most people don't realize: if cortisone keeps wearing off and your heel still hurts, that's not a cortisone dosing problem. That's your body telling you the tissue damage is still there, unaddressed. Cortisone suppresses inflammation, which creates real pain relief — but it supplies zero biological repair materials. The tissue stays damaged. And repeated injections actually weaken the plantar fascia over time, trading short-term relief for structural risk. Four to eight weeks of improvement followed by the pain crawling back is your body's way of telling you masking the problem isn't the same as fixing it.
What you're dealing with at this point is what we call a failed healing response — or chronic tendinopathy. Your body started repairing the injury, stalled, and the tissue got stuck in a state of permanent low-grade inflammation. It's like a construction crew that started the job and never came back to finish it. The site stays in disrepair indefinitely, sending pain signals constantly, because no one told the crew to return. Plantar fasciitis that won't heal isn't a willpower problem or a stretching-compliance problem. It's a biology problem — and that's exactly what shockwave therapy is designed to solve.
The Truth About Heel Spurs
If you've had an X-ray, there's a decent chance someone pointed out a heel spur and implied — or outright said — that 
it's causing your pain and needs to be removed. I see this confusion constantly in my practice. People come in convinced they need the spur surgically removed. What they actually need is the fascia treated — and the spur becomes irrelevant once we do.
Here's what's actually going on. Heel spurs don't cause plantar fasciitis. Plantar fasciitis causes heel spurs. The spur forms because of chronic tension on the heel bone — under a principle called Wolff's Law, bone responds to persistent stress by growing in the direction of that stress. The spur is your body's adaptation to a long-standing problem, not the problem itself. The vast majority of people with heel spurs never even know they have them because the spur produces no symptoms. Less than 5% of heel spurs ever require surgical removal.
So why does this myth persist? Because X-rays show the spur clearly and visually — it's a concrete thing radiologists report prominently, and it becomes the focal villain in a story that's actually about soft tissue. Treating the spur without addressing the Achilles tendinitis or fascial damage that caused it is like treating a symptom instead of the condition. If you've been told surgery is the only option because of a heel spur, I'd strongly encourage a second opinion before going that route.
How a Houston Podiatrist Treats Heel Pain — From First Steps to Shockwave Therapy
I don't start with the most aggressive treatment in the room. I start where it makes sense for where you are right now. And I'm going to be honest with you about what works, what doesn't, and exactly where shockwave fits in that picture. Most patients — about 95% — never need surgery. But getting there requires working through a logical progression. Here's how I actually approach it.
Level 1 — Lifestyle Changes
Sometimes, the most impactful change is also the simplest one. The #1 thing I see keeping people stuck in heel pain is what they put on their feet — specifically, what they're wearing from the bedroom to the kitchen every morning. Barefoot on hard floors during those first steps out of bed is one of the most damaging things you can do when you have plantar fasciitis. The fascia needs support the moment it bears weight. Switch to a supportive shoe before you take a single unprotected step, and you can see meaningful improvement in that morning pain within two to three weeks. For chronic cases, it's still necessary — just not sufficient on its own.
Level 2 — At-Home Care
The most effective at-home tool I recommend is a specific 60-second stretch sequence done before you ever put your foot on the floor. Twenty seconds of a gentle towel stretch, twenty seconds of a seated calf stretch, twenty seconds of toe extension — in that order. The sequence matters because it addresses the full kinetic chain, not just the foot in isolation. Night splints are also genuinely useful: they hold the plantar fascia in a gently lengthened position overnight, which dramatically reduces that searing first-step pain (the clinical term is post-static dyskinesia, but you know it as the moment you dread every morning).
What doesn't work: aggressive stretching the instant you wake up. Your fascia is already in a shortened, contracted position after hours of rest. Forcing it to stretch hard and fast causes microtears. And ice, not heat — heat feels good temporarily but actually increases inflammation. Twenty minutes on, forty minutes off with an ice pack. Most people do this backwards and wonder why they're not improving. Now, for some of you, these swaps may be enough for early, mild cases. But if you've been dealing with this for three months or longer, we need to do more.
Level 3 — Conservative In-Office Treatment
When at-home care isn't holding, my first in-office recommendation is almost always custom orthotics molded to your specific foot — not the generic insoles from a drugstore, which are made for average feet, not yours. Think of them like eyeglasses: a prescription calibrated to correct your specific mechanics, not a one-size-fits-all approximation. At $700, they're an investment — but they address the mechanical forces that caused the injury in the first place. Most people see significant pain reduction within four to six weeks. And they're what keeps you healed once we get you there.
Cortisone injections ($120) have a legitimate role — but a limited one. I use them strategically, once or twice, as a short-term bridge when pain is severe enough to interfere with compliance with everything else. The relief is real and it's fast. But cortisone doesn't repair tissue, and repeated injections weaken the plantar fascia over time. If you've already had two or three cortisone shots and your pain keeps returning, we've hit the ceiling of what cortisone can do for you. That's not a failure on anyone's part — it's just biology telling us it's time for a different approach. Physical therapy can also play a useful adjunct role, particularly when tight calves or hip weakness are contributing to the overload on your fascia.
Level 4 — The Third Option: Regenerative Medicine
This is where the conversation gets genuinely exciting — and where I think most practices are leaving people behind. If you've done everything in Levels 1 through 3 and you're still hurting after three to six months, you don't have to choose between living with the pain and having surgery. There's a third option.
Shockwave Therapy ($300 per session | $750 for a package of three): Three sessions, once a week, 10 to 15 minutes each. I use shockwave therapy for heel pain on my own heel. I'm not recommending something I wouldn't do myself. More than 82% of people with chronic plantar fasciitis — more than four in five — find their pain resolved after the full course. One important note: stop anti-inflammatories in the days before treatment. Shockwave works by activating an inflammatory healing response, and we need that response. This treatment almost makes surgery obsolete for plantar fasciitis.
PRP — "Liquid Gold" ($850): Platelet-Rich Plasma therapy starts with a simple blood draw from your arm. We process it in a centrifuge to concentrate the healing growth factors — the biological repair materials your body normally has too few of at the injury site — then inject that concentrated solution directly into the damaged fascia under ultrasound guidance for precision. You'll feel some soreness for a day or two after, which is completely normal and means it's working. On its own, PRP carries a 70–80% success rate for chronic tendon problems. PRP injections are as close to "liquid gold for healing" as anything I've seen in 25 years of practice.
Combined Shockwave + PRP — The Seeds and Soil Protocol: When we combine the two, the results are the best non-surgical outcomes I can offer. PRP delivers the seeds — the concentrated growth factors. Shockwave prepares the soil — breaking up barriers, opening pathways, and creating the biological environment where those growth factors can actually do their job. The sequence matters: PRP first, then shockwave begins within a few days, once weekly for three weeks. The combined protocol carries an 85–95% success rate for chronic cases. Most people begin noticing improvement within two to four weeks; full benefit develops over three to six months. Results are lasting.
A word on insurance: most plans, including Medicare, don't cover shockwave or PRP. These are cash-pay services, though FSA and HSA accounts typically qualify. Before the cost gives you pause, consider what you've already spent on months of co-pays, cortisone shots, and PT visits — and what surgery and post-surgical rehabilitation would cost. Our regenerative medicine approach often turns out to be the more economical path, not just the more effective one.
Level 5 — Surgery (When Genuinely Necessary)
Look, I know foot surgery sounds scary. But only about 5% of plantar fasciitis cases ever actually reach this point — and for those that do, surgery works. The most common procedures are a plantar fascia release, which relieves tension on the damaged tissue, or the Tenex procedure, a minimally invasive, ultrasound-guided approach that removes damaged tissue with a small needle-like device without a large incision. Most people who need plantar fascia surgery are walking in a boot within the first week and transitioning to regular shoes by weeks three to six, with return to full activity by months two to three.
I'll be direct with you: most people who end up needing surgery tell me they wish they hadn't waited as long as they did out of fear. The anticipation is almost always worse than the procedure itself. But we don't get anywhere near surgery without genuinely exhausting every option before it — and in my practice, that's a high bar to clear.
If this sounds like where you are right now — tried stretching, tried cortisone, still hurting — I want to talk with you. Call 713-785-7881 or request your appointment online.
Who Is a Good Candidate for Shockwave Therapy?
After treating thousands of patients with heel pain, I can usually tell within the first appointment whether shockwave is the right next step. The strongest candidates are people who've had pain for three to six months or longer, haven't gotten lasting relief from stretching, orthotics, and cortisone, and want to avoid surgery. Athletes and runners who need to stay active are also excellent candidates — shockwave doesn't require downtime the way surgery does, and it doesn't interfere with running injuries management the way repeated cortisone can.
There are some situations where we need to pause before starting. If you've had a cortisone injection within the past 11 weeks, I'll ask you to wait — cortisone suppresses the inflammatory response that shockwave depends on, and treating too soon after an injection undermines the whole mechanism. Pregnancy, an active infection in the treatment area, and certain cardiac conditions or pacemakers also require a conversation before we proceed. None of these are permanent barriers in most cases; they're just factors I need to know about.
One more thing worth saying directly: shockwave doesn't work for everyone. The 82% success rate is real — but that means about 18% of people don't get full resolution from shockwave alone. If you're in that group, we haven't run out of options. That's where the combined PRP protocol comes in, and in rare cases, surgery. My job is to figure out where you fall and build the right plan — not to push one treatment regardless of fit.
What to Expect When You Come In
When you come in, I'll start by watching you walk. Not examining your foot in isolation — watching how your whole body moves, because plantar fasciitis doesn't happen in a vacuum. Your gait, your hip mechanics, your calf tightness — all of it contributes to what's happening at your heel, and I need to see the full picture before I can give you an honest assessment. Then I'll examine the foot directly: feeling for the specific location and quality of tenderness, checking range of motion, and reviewing your complete treatment history so I understand exactly what you've already tried and what it did or didn't do.
If I think X-rays are warranted — to rule out a stress fracture or check the degree of calcification — we can do that in the office the same day. I may also recommend a digital gait analysis, which gives us a precise map of how weight moves across your foot with every step. That matters when custom orthotics are part of the plan, because it means we're correcting your specific mechanics, not making an educated guess. I've been doing this for more than 25 years, and I'm going to be straight with you about what I'm seeing and why I'm recommending what I'm recommending.
I'm not going to steer you toward the most expensive option. I'm going to tell you what I think gives you the best shot at getting out of pain. If you're coming in early — pain under three months, haven't tried orthotics yet — we'll start conservatively and see where that gets us in four to six weeks. If you've got six months or more of failed conservative care behind you, Dr. Andrew Schneider may recommend shockwave from the very first appointment. And I won't judge you for how long you waited to come in. What matters is that you're here now. When you're ready, schedule an appointment and we'll figure out exactly what your heel needs.
Keeping Heel Pain From Coming Back
Getting out of pain is one thing. Staying out of it is another. The #1 reason I see people relapse after treatment is going back to unsupportive footwear — the same habits that created the injury in the first place. Custom orthotics are the ongoing foundation here. Once you've corrected the underlying mechanics, wearing them consistently is what keeps the plantar fascia from being overloaded again. Think of it as maintenance, not a crutch.
Gradual return to activity matters too, especially for runners. Houston athletes training on the concrete surfaces around Memorial Park or the Galleria area put significant repetitive stress on the plantar fascia — especially in our heat, when muscles fatigue faster and footwear choices get more casual. Don't go from your final shockwave session straight into marathon training. Build back over four to six weeks, keep the morning stretch sequence as a permanent habit (not just something you do when it hurts), and pay attention to early warning signs before they become a full relapse. Sports injuries that get caught early are almost always easier to manage than ones that have been grinding along for months.
If you want to support ongoing tissue health beyond the acute phase, I'm also seeing strong results from BPC-157 peptide therapy and red light therapy as adjunct options. These aren't required for most people, but for athletes or anyone dealing with recurring soft tissue issues, they're worth a conversation.
