Short answer
Plantar fasciitis is heel pain from an irritated plantar fascia, the band of tissue that runs under your foot from heel to toes. The good news first: more than 90% of people improve within 10 months of starting simple treatment, and most feel much better within two to three months.
The reason it feels hard to shake is that the fascia gets loaded with every step, and most people keep walking on it. Morning pain happens because your feet point downward while you sleep, which lets the fascia tighten up; the first steps stretch it again. The treatments that work are not glamorous: calf and fascia stretching, supportive shoes, a night splint, and cutting back the activity that provokes it. Shockwave therapy has supportive trials for cases that have not settled, and cortisone shots carry a real risk of weakening the fascia.
At Charleston Pain Relief Center in North Charleston, SC, we start with an exam to confirm it is the fascia and not something else, then build a plan around the basics, adding shockwave only where it makes sense.
This article is general information, not medical advice for your situation. Do not stop or change a prescribed medication on your own — talk with whoever prescribed it first.
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Where the research in this article comes from
We would rather you check our numbers than take our word for them. The facts about what plantar fasciitis is, who gets it and how it is usually treated come from the American Academy of Orthopaedic Surgeons patient guide and the Mayo Clinic patient guide. On shockwave therapy, the key study is a 2017 meta-analysis of nine randomized trials in chronic plantar fasciitis. Full citations are at the end. From here on we will refer to them as the patient guides and the shockwave review.
What plantar fasciitis is
The plantar fascia is a long, thin ligament under the skin on the bottom of your foot. It connects the heel to the front of the foot and supports the arch. It is built to absorb the stress of walking, running and standing, but too much load can damage or tear the tissue, and the body’s response is the heel pain and stiffness you feel. About 2 million people are treated for it each year in the U.S., and the research increasingly describes it as a wear-and-tear process rather than pure inflammation, which is one reason anti-inflammatory approaches alone often fall short.
Causes and risk factors
In most cases there is no single identifiable reason. The things that raise your odds include a new or increased activity, repetitive high-impact activity such as running or dancing, standing for long periods on hard surfaces (healthcare workers, factory workers and teachers come up often), flat feet or a high arch, tight calf muscles, extra body weight, and age, with most cases between 40 and 60. Worn-out shoes and the wrong shoes for the activity add to it.
Classic symptoms
- Pain on the bottom of the foot near the heel
- Sharp, stabbing pain with the first steps out of bed, or after sitting for a long time, that eases after a few minutes of walking
- More pain after exercise or activity than during it
- A tender spot just in front of the heel bone, and often limited ability to pull the foot upward at the ankle
Why morning heel pain happens
Most people sleep with their feet pointed down. In that position the plantar fascia shortens and tightens overnight. When you stand up, your body weight stretches it abruptly, and the damaged tissue protests. The same thing happens after a long drive or a long sit. That is also why a night splint, which holds the foot in a neutral position while you sleep, is so effective: the fascia stays gently stretched, so the first steps do not have to do it all at once.
Why heel pain can be slow to resolve
Three reasons come up again and again. First, the fascia is loaded with every step, and most people cannot stop walking, so the tissue keeps getting re-stressed before it heals. Second, the problem is degenerative more than inflammatory, so rest and anti-inflammatories take the edge off without fixing the tissue. Third, people often stop the boring treatments, stretching in particular, as soon as the pain eases, and it comes back. The timeline is weeks to months, not days.
Common treatment approaches, and what the evidence says
The foundation
- Cut back the provoking activity. Switch to lower-impact exercise such as cycling or swimming for a while.
- Stretch your calves and the fascia. The patient guides call this the most effective way to relieve the pain, with the fascia stretch best done in the morning before you stand.
- Supportive, cushioned shoes and heel pads or orthotics. Replace worn athletic shoes.
- A night splint. Awkward at first, very effective for morning pain.
- Ice and short-term anti-inflammatories. Do not use NSAIDs for more than a month without talking to your doctor.
If it has not settled after several months
- Cortisone injections can reduce pain, but steroid injections can weaken the plantar fascia and lead to a rupture, which can flatten the foot and cause chronic pain. Many doctors limit or avoid them for that reason.
- PRP injections do not carry the rupture risk, but they are expensive and more research is needed on whether they work.
- Shockwave therapy is covered in the next section.
- Surgery is generally reserved for people who have not improved after 12 months of aggressive non-surgical treatment, because more than 90% recover without it.
Where SoftWave shockwave therapy fits
Shockwave is the add-on we reach for most in heel pain, and the research is better here than for most of its other uses. The shockwave review pooled nine randomized trials of shockwave versus sham treatment in chronic plantar fasciitis and found higher improvement rates with shockwave, with no serious adverse events, though two of the nine trials found no difference and the authors asked for larger studies. Orthopaedic guidance calls the results mixed and treats shockwave as a low-risk thing to try before surgery. That is exactly how we position SoftWave shockwave therapy: for heel pain that has outlasted the basics, in a short series of sessions with a checkpoint after three. We may add Class IV laser therapy alongside it. Neither replaces the stretching and footwear work; they sit on top of it.
When persistent heel pain needs evaluation
See a provider if the pain has lasted more than a few weeks despite the basics, if it is getting worse, if it came on suddenly after an injury, or if you have numbness, tingling or burning in the heel, because other problems can mimic plantar fasciitis: Achilles tendinitis where it inserts on the heel, a stress fracture of the heel bone, or a trapped nerve. An exam sorts most of this out, and an X-ray is sometimes used to rule out a fracture or arthritis. If you see a heel spur on an X-ray, do not panic: most people with spurs have no heel pain, and spurs are not the cause of plantar fasciitis pain.
What a heel pain visit at CPRC looks like
- History and exam, including where it is tender, how your ankle moves, and what your shoes and routine look like.
- Ruling out look-alikes, with imaging only if something does not fit.
- A plan built on the basics (stretching, footwear, activity changes, a night splint when it fits), with shockwave or laser added where your case warrants it.
- A reassessment after a few weeks, with a referral if it is not moving.
You can read more about the foot conditions we see on our foot pain page.
Frequently asked questions
How long does plantar fasciitis take to heal?
Most people improve a lot within two to three months of starting the basics, and more than 90% are better within 10 months. The ones that drag on are usually the ones where the provoking activity never changed.
Should I get a cortisone shot for plantar fasciitis?
It can ease pain, but it can also weaken the fascia and lead to rupture. Ask your provider why it is being recommended over a night splint and stretching, and how many they would be willing to give.
Does shockwave therapy work for plantar fasciitis?
In pooled randomized trials, more people improved with shockwave than with sham treatment, and it is low-risk. Results vary between studies, so we use it with a checkpoint rather than a promise.
Do I need surgery for a heel spur?
Almost never. Heel spurs do not cause plantar fasciitis pain, and the pain can be treated without removing the spur.
Where can I get plantar fasciitis treatment near North Charleston?
Charleston Pain Relief Center is at 2294 Otranto Rd, North Charleston, SC 29406, serving North Charleston, Hanahan, Goose Creek, Ladson, Summerville, Park Circle and the wider Lowcountry. Call or text 843-604-2276.
Heel pain that will not quit? Let us look at it.
Tell us how long it has been going on and what you have already tried. Our North Charleston team will text you back with a straight answer about what is likely driving it — and what we would do first.
Sources
- American Academy of Orthopaedic Surgeons. Plantar Fasciitis and Bone Spurs. OrthoInfo. orthoinfo.org
- Mayo Clinic Staff. Plantar fasciitis: Symptoms and causes. Mayo Clinic. mayoclinic.org
- Sun J, Gao F, Wang Y, Sun W, Jiang B, Li Z. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs. Medicine (Baltimore). 2017;96(15):e6621. PMC
Charleston Pain Relief Center · 2294 Otranto Rd, North Charleston, SC 29406 · 843-604-2276 · Last updated 24 October 2026. This article is educational and is not a substitute for individual medical advice. Do not start or stop any medication without speaking to your prescriber.