The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Foot & Ankle

Plantar Fasciitis

Plantar fasciitis is the single most common cause of heel pain, affecting approximately 2 million Americans every year and accounting for up to 15% of all foot complaints presenting to orthopaedic and podiatric practices. The condition arises from cumulative stress on the thick band of tissue that runs along the bottom of the foot — producing sharp, often debilitating heel pain that can interfere with everyday activities. The good news: with the right diagnosis and a structured treatment plan, the vast majority of patients achieve full relief, and the podiatry team at Maryland Orthopedic Specialists has the expertise to guide you through every step.

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What is plantar fasciitis?

### Anatomy and Biomechanics The plantar fascia is a dense, fibrous band of connective tissue that originates at the medial calcaneal tubercle (the bony prominence on the inner base of the heel) and fans out distally to insert into the bases of the proximal phalanges of each toe.

Anatomy and Biomechanics

The plantar fascia is a dense, fibrous band of connective tissue that originates at the medial calcaneal tubercle (the bony prominence on the inner base of the heel) and fans out distally to insert into the bases of the proximal phalanges of each toe. Its primary role is mechanical: it acts as a tension cable that supports the longitudinal arch of the foot during weight-bearing and provides the propulsive spring-like energy return needed for walking and running — a function described as the "windlass mechanism." Every step places repetitive tensile load on this structure; over time, when that load exceeds the tissue's capacity to recover, micro-tears accumulate at the calcaneal origin.

Pathology

Despite its name, plantar fasciitis is now understood to be a degenerative tendinopathy rather than a purely inflammatory condition. Histopathological studies consistently show collagen disorganization, fibroblastic hyperplasia, angiofibroblastic degeneration, and the near-absence of classical inflammatory cells at the affected insertion site. This distinction is clinically important: it explains why anti-inflammatory strategies alone (e.g., NSAIDs or corticosteroids) provide only partial or short-lived relief, and why regenerative and mechanical approaches are increasingly central to treatment.

Risk Factors

  • Obesity / elevated BMI — each unit increase in BMI raises mechanical load at the calcaneal insertion
  • Foot posture abnormalities — both pes planus (flat foot) and high-arched (cavus) foot types alter fascia tension
  • Prolonged weight-bearing — occupations requiring standing on hard surfaces for >4 hours per day
  • Running and high-impact sports — particularly when training load is increased rapidly
  • Tight gastrocnemius / Achilles complex — limited ankle dorsiflexion concentrates stress at the fascia origin
  • Age 40–60 — peak incidence range; collagen remodeling capacity declines with age

Epidemiology

Plantar fasciitis affects roughly 2 million Americans per year and carries a lifetime prevalence of approximately 10% in the general population. It is the most common foot complaint seen by foot and ankle surgeons and the leading cause of inferior heel pain across all age groups.

Treatment options

More than 90% of plantar fasciitis cases resolve with conservative treatment — patience and consistency are key.

Stretching and Physical Therapy

Daily plantar fascia and calf stretching is the most important step; a physical therapist can guide you through the most effective techniques and address any contributing factors in your gait or foot mechanics.

Orthotics and Footwear

Supportive shoes with cushioned heels and arch support, combined with custom or over-the-counter orthotics, reduce the stress on the fascia during daily activity.

Injections

A corticosteroid injection provides fast pain relief to break the pain cycle and allow therapy to begin; PRP (platelet-rich plasma) is an alternative with longer-lasting effects for patients who haven't responded to other treatments.

Extracorporeal Shock Wave Therapy (ESWT)

ESWT is a non-invasive office procedure that delivers acoustic waves to stimulate healing in the fascia; it is a good option for patients who have tried other treatments for 3 to 6 months without relief.

Surgical Procedure

Plantar Fascia Release

Endoscopic release of the plantar fascia at its calcaneal origin for patients who have failed six or more months of conservative treatment including stretching, orthotics, physical therapy, and injections.

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Frequently Asked Questions

Will plantar fasciitis go away on its own?
Plantar fasciitis is often described as a "self-limiting" condition, and many mild cases do improve over time — but the key word is time, often 12–18 months without intervention. Without treatment, many patients develop compensatory gait changes that cause knee, hip, or back problems. Early, structured treatment dramatically shortens recovery time and prevents these secondary issues. We strongly recommend evaluation rather than watchful waiting.
I was told I have a bone spur — is that causing my pain?
Not necessarily. Heel spurs (calcaneal enthesophytes) are present in approximately 50% of patients with plantar fasciitis, but they are also found in up to 15–20% of people with no heel pain at all. The spur is a calcified response to chronic traction at the fascia origin — a consequence of the underlying tendinopathy, not the primary pain generator. Treatment is directed at the fascia and its biomechanical causes, not the spur itself. Surgery to remove the spur is generally not indicated.
Should I get a cortisone shot?
A corticosteroid injection can be very helpful for short-term pain relief when stretching and physical therapy have not provided adequate improvement. However, it is not a cure — it does not address the underlying degenerative pathology. Cortisone injections are best used as a bridge to allow more active rehabilitation, and they should not be repeated more than 1–2 times given the risk of fascia rupture. Patients seeking a more durable solution, or those who have already received one or more cortisone shots without lasting relief, are better candidates for PRP.
What is PRP, and is it right for me?
Platelet-Rich Plasma (PRP) is created by drawing a small sample of your own blood, then spinning it in a centrifuge to concentrate the platelets and the growth factors they contain. When injected into the degenerated plantar fascia tissue, these growth factors actively stimulate healing, new collagen formation, and tissue remodeling. Multiple RCTs confirm that PRP produces more durable pain relief than corticosteroid at 6 and 12 months. PRP is an excellent option for patients with chronic plantar fasciitis (symptoms >3–6 months), those who want to avoid repeated cortisone injections, athletes, and anyone seeking a biological approach to healing.
When is surgery actually necessary?
Surgery is considered only after at least 6–12 months of comprehensive, supervised conservative management — including stretching, orthotics, physical therapy, and at least one injection — has failed to provide adequate relief. This represents a small minority of patients. When it is needed, minimally invasive endoscopic plantar fascia release is safe and effective, with high patient satisfaction rates. Our podiatric surgeons will review all indications with you in detail before any surgical recommendation is made.

Meet the specialists

Gary Feldman, DPM, FACFAS

Gary Feldman, DPM, FACFAS

Podiatry (Foot & Ankle Surgery)

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Medically reviewed by Gary Feldman, DPM, FACFAS, DPM, FACFAS
Last reviewed May 1, 2026

References

  1. DiGiovanni, B.F., Nawoczenski, D.A., Malay, D.P., et al. (2006). "Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis: a prospective clinical trial with two-year follow-up." Journal of Bone and Joint Surgery Am, 88(8):1775–1781. DOI: 10.2106/JBJS.E.01281. https://pubmed.ncbi.nlm.nih.gov/16882901/ (Level II prospective trial; establishes plantar fascia-specific stretching as superior to Achilles-only stretching at 2-year follow-up.)
  2. Monto, R.R. (2014). "Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis." Foot & Ankle International, 35(4):313–318. https://pubmed.ncbi.nlm.nih.gov/24419823/ (RCT demonstrating PRP is more effective and durable than corticosteroid injection at 12 months for recalcitrant plantar fasciitis.)
  3. Tsikopoulos, K., Vasiliadis, H.S., Mavridis, D. (2020). "Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials." PMC / Foot & Ankle International. https://pmc.ncbi.nlm.nih.gov/articles/PMC7222276/ (Systematic review of RCTs confirming PRP significantly reduces plantar fasciitis pain vs. corticosteroid at 6 months.)
  4. Rompe, J.D., Furia, J., Weil, L., Maffulli, N. (2006). "Shock wave therapy for chronic plantar fasciopathy." American Journal of Sports Medicine, 34(4):592–596. DOI: 10.1177/0363546505281811. https://pubmed.ncbi.nlm.nih.gov/16556754/ (RCT; Level I evidence for long-term efficacy of ESWT vs. sham for chronic plantar fasciitis.)
  5. Kaiser, P.B., Keyser, C., Crawford, A.M., et al. (2022). "A Prospective Randomized Controlled Trial Comparing Physical Therapy With Independent Home Stretching for Plantar Fasciitis." Journal of the American Academy of Orthopaedic Surgeons, 30(14):682–689. DOI: 10.5435/JAAOS-D-21-00009. https://pubmed.ncbi.nlm.nih.gov/35797682/ (JAAOS RCT comparing physical therapy vs. home stretching; supports structured stretching-based management.)
  6. Maffulli, N., et al. (2016). "Long-Term Outcome of Open Plantar Fascia Release." Foot & Ankle International / PubMed. https://pubmed.ncbi.nlm.nih.gov/26351156/ (Long-term surgical outcomes data for open plantar fascial release; success rates and patient satisfaction.)
  7. American Academy of Orthopaedic Surgeons. "Heel Pain (Plantar Fasciitis)." OrthoInfo — AAOS. https://orthoinfo.aaos.org/en/diseases--conditions/heel-pain/ (AAOS patient education resource; clinical overview of diagnosis and non-surgical treatment options.)