Shockwave · Heel pain

Shockwave Therapy for Plantar Fasciitis

Plantar fasciitis is one of the most common reasons people ask about shockwave. Here is what the condition is, what usually helps first, and what the research on shockwave says.

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In short

Plantar fasciitis causes pain under the heel that is often worst with the first steps in the morning. Most people start with stretching, supportive shoes, taping, night splints and physical therapy. Shockwave is usually discussed when heel pain has lasted for months despite that care. In a large placebo-controlled trial, heel pain fell by an average of 69.2% after focused shockwave versus 34.5% after a sham treatment, but guideline bodies still call the overall evidence inconsistent. Results vary, and not everyone responds.

Updated October 30, 2026 · Educational information, not medical advice. Results vary, and not everyone is a candidate.

What plantar fasciitis is

The plantar fascia is a thick band of tissue that runs along the bottom of your foot, from your heel to your toes. It helps support your arch every time you stand, walk or run. When it becomes irritated where it attaches to the heel bone, the result is plantar fasciitis, sometimes called plantar heel pain or plantar fasciopathy.

Despite the name, long-lasting cases are not mainly about inflammation. The tissue is overloaded and slow to adapt, which is part of why anti-inflammatory medicine alone often does not settle it.

Typical symptoms and common causes

Plantar fasciitis is more likely when:

The pain is on the bottom of the foot, around the heel and arch
It is much worse with the first steps after sleeping or sitting
It eases a little once you get moving, then returns after long periods of standing, walking or running
Stretching the sole, such as lifting your toes or climbing stairs, is painful

Things linked to it include limited ankle flexibility (a tight calf), a higher body weight, running, and jobs that keep you on your feet on hard surfaces. Shoes with little cushioning or support can add to the load.

First-line care: what guidelines recommend

Most heel pain improves with simple, consistent care. The 2023 heel pain guideline from the American Physical Therapy Association's orthopaedic academy, published in JOSPT, recommends:

Stretching the plantar fascia and the calf muscles
Manual therapy to the joints and soft tissues of the foot and leg
Taping the foot for short-term relief, alongside other treatment
A night splint for 1 to 3 months if the first steps in the morning are consistently painful
Strengthening exercises for the foot and ankle
Shoe inserts (orthoses) used together with other treatments, rather than on their own
Support with weight management where it applies

Cushioned shoes with good arch support, avoiding flat or backless footwear, and switching some running or long walks for lower-impact exercise can also help while the tissue settles. Our blog post on why plantar fasciitis lingers covers home care in more detail.

Many people do well with a structured program from a physical therapist. See physical therapy.

Where shockwave fits

Shockwave is not a first step. Clinical reviews describe it as an option for plantar fasciitis that has not responded to standard care, often after several months of symptoms. The American Academy of Family Physicians says shockwave may have a role in chronic plantar fasciitis that does not respond to conservative therapies, while noting the evidence is inconsistent.

The 2023 JOSPT guideline did not grade shockwave, because it treated shockwave as outside physical therapist practice for that update. It did report low-quality evidence that plantar fascia stretching combined with shockwave did better in the short term than shockwave alone, which is one reason shockwave is usually paired with an exercise program rather than used instead of one.

How shockwave might work is still debated. Proposed mechanisms include effects on blood flow and on the pain-sensing nerve fibers in the area. None of these is settled, and none tells you how your own heel will respond.

What the research shows

The evidence is better for plantar fasciitis than for most other uses of shockwave, but it is not one-sided.

Supportive: in a multicenter, double-blind trial of 250 people with chronic heel pain, three weekly sessions of focused shockwave reduced heel pain more than a placebo treatment. Twelve weeks after the last session, heel pain scores had fallen by an average of 69.2% in the shockwave group, compared with 34.5% in the placebo group (Gollwitzer et al., Journal of Bone and Joint Surgery, 2015). Temporary pain and swelling were the side effects reported.
Mixed: NICE in the UK found no major safety concerns but called the evidence on effectiveness inconsistent, and asks clinicians to make sure patients understand that uncertainty.
Cautious: the American Academy of Orthopaedic Surgeons describes results as mixed and says it is not clear the treatment helps, though it is noninvasive and low risk.

Put simply: some well-run trials found an average benefit over placebo, other studies did not, and an average is not a promise. Results vary, and not everyone responds.

What a visit at Innovare Tx looks like

You start with an evaluation by a provider, Charles Ortega, PA-C, or Rowena Calleja, PT, a Texas-licensed physical therapist. They ask how long you have had heel pain and what you have tried, examine your foot, and look for other causes of heel pain that need a different approach. If shockwave seems appropriate, the provider sets the plan, often alongside a stretching and strengthening program or physical therapy.

Trained medical staff perform the sessions. They locate the most tender area, apply gel and focus the waves there for about 15 to 30 minutes. Mild, temporary discomfort is common and usually settles quickly. Your provider sets the number and spacing of sessions; in studies, courses were commonly 3 to 5 sessions about a week apart. During the course your provider may ask you to avoid anti-inflammatory medicines and high-impact activity. Do not stop a prescribed medicine without asking the prescriber.

Most insurance plans do not cover shockwave therapy, so the sessions are self-pay, while your office visit may be billable to insurance. See cost and memberships and what to expect.

When to get checked promptly

Heel pain is usually not an emergency, but see someone soon if:

The pain is severe or stops you doing normal activities
It keeps getting worse, or keeps coming back
You have tingling, numbness or loss of feeling in your foot
You have diabetes and foot pain, since foot problems can be more serious with diabetes
The pain started after a fall or injury, or you cannot put weight on the foot

If your heel is red, hot and swollen and you feel feverish or unwell, seek care the same day.

Frequently asked questions

No. Guidelines start with stretching, supportive footwear, taping, night splints and strengthening, often with a physical therapist. Shockwave is usually discussed when heel pain has lasted for months despite that care.

Some placebo-controlled trials found that focused shockwave reduced heel pain more than a sham treatment on average. In the largest U.S. trial, heel pain scores fell by 69.2% with shockwave versus 34.5% with placebo, 12 weeks after treatment. Other studies found no clear benefit, and NICE describes the evidence as inconsistent. Results vary, and your provider can talk through whether it is a reasonable option for you.

Usually, yes. The 2023 JOSPT guideline reported that plantar fascia stretching plus shockwave did better in the short term than shockwave alone. Your provider will tell you which exercises to keep doing.

Your provider sets the number and spacing of sessions. In studies, courses were commonly 3 to 5 sessions about a week apart.

Most insurance plans do not cover shockwave therapy, so the sessions are self-pay. Your office visit with a provider may be billable to insurance. Ask our team for details.

Sources

Keep reading

See everything in the shockwave guide

Wondering whether shockwave fits your pain?

Book a consultation at our Addison clinic. A provider examines the area, explains your options, and tells you plainly whether focused shockwave makes sense for you.

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