The Center for Podiatric Care and Sports Medicine

Why is Plantar Fasciitis So Hard to Treat? Doctors May Have Been Wrong About the Cause

Posted by on Tuesday, March 12th, 2013


To those non-doctors among us, medicine may seem like a rather tough nut. We think that everyday conditions that affect millions of people are pretty well understood. After all, there have been copious chances for doctors to examine and experiment, using trial and error to find the cures that work best. But like the rest of science, medicine is always changing. Sometimes the tenets we’ve held for years slowly erode under constant scrutiny. A scientific theory is only as good as its longevity, after all. Such has been the case with plantar fasciitis, an extremely common condition that may be quite different than we thought. This has some pretty dramatic implications for treatment.


Plantar fasciitis, a condition of the plantar fasciia, that thin band of tissue that runs along the arch of the foot, tends to cause heel pain in sufferers. In many cases it is mild and responds well to rest and icing, but other times it becomes chronic, debilitating the sufferer. Plantar fasciitis is very similar to Achilles tendonitis or tennis elbow—all of these conditions have been attributed to inflammation in the tissue, the result of overuse. In fact the suffix “itis” means inflammation. While naming conditions for their cause is helpful, it can also perpetuate misinformation. Recent research has shown that plantar fasciitis is more likely caused by degeneration of the plantar fascia, not by inflammation.




Overuse injuries are not well understood and yet, they make up over half of all muscle and bone injuries. Tears in tissue are common. In fact, micro tears occur every time you work out. Without them, you wouldn’t be able to build muscle. As your body repairs the tears, it makes the muscle stronger. But sometimes in the plantar fascia those micro tears don’t heal properly. As you use your foot, more and more tears form. The tissue shreds and it hurts. Why the body can’t repair those tears when it can repair tears everywhere else is still a mystery.



This has some real implications for treatment. Traditionally doctors have treated plantar fasciitis with cortisone injections. Cortisone is a very effective anti-inflammatory. While it does make a real difference pain-wise (in one study, patients injected with cortisone reported less heel pain after four months than those who were injected with saline) it doesn’t address the underlying problem: damaged tissue. And it is unknown whether those injections have any long-term benefits, or if they’re just providing a pain prophylaxis that masks the real problem. This is why treatments like MLS laser therapy or biopuncture therapy may be so effective: somehow they are addressing the underlying pathology.

Fortunately, most sufferers will eventually heal within a few months with appropriate rest and stretching. If you’re suffering from plantar fasciitis, contact The Center for Podiatric Care and Sports Medicine.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.