I have heel pain from plantar fasciitis. They tell me it will go away on its own, but what if it doesn’t? Then what?

Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes called a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation.

Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead. Acute plantar fasciitis is defined as inflammation of the origin of the plantar fascia and fascial structures around the area. Plantar fasciitis or fasciosis is usually just on one side. In about 30 per cent of all cases, both feet are affected.

The natural history of this condition is that left alone (untreated), it will eventually go away on its own. Another term for this kind of response is to say that plantar fasciitis is usually self-limiting. That’s why many studies using a placebo (pretend treatment) get good results no matter how it’s treated.

But sometimes, the problem lasts a long time. When it doesn’t go away, doctors say it’s recalcitrant, which means it’s chronic. The painful symptoms limit movement and function, which can reduce quality of life. Finding a way to treat patients with chronic plantar fasciitis is important.

There are many ways to treat this problem. Some of the conservative (nonoperative) approaches include antiinflammatory drugs and pain relievers. Nonpharmacologic intervention include steroid injection, stretching, night splints, ultrasound, ice, massage, electrotherapy, and/or orthotics (shoe inserts).

The use of radial extracorporeal shock wave therapy (rESWT) has been studied, too. Shock wave therapy is a newer form of nonsurgical treatment. This form of treatment can help ease pain, while improving range of motion and function. It uses a machine to generate shock wave pulses to the sore area. Radial shock waves spread the force of the vibration out over a larger area compared with deeper, more focused ESWT.

Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for plantar fasciitis. It’s possible that the shock waves disrupt the plantar fascial tissue enough to start a healing response. The resulting release of local growth factors and stem cells may cause an increase in blood flow to the area, which in turn, fosters a healing response.

If your painful symptoms don’t start to resolve on their own, ask your doctor about trying some of these ways to treat the problem. Finding the right method or combination of treatment approaches may take a period of trial and error before success is achieved.