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Plantar fasciitis is one of the most common causes of foot pain, affecting approximately 10% of the population at some point in their lives. The good news is that in the vast majority of cases, a well-planned conservative treatment resolves the problem without surgery.
At our orthopaedic practice in Palma de Mallorca, we are firmly committed to a conservative, multimodal approach. As a specialist in orthopaedics and sports traumatology, I have treated hundreds of cases of plantar fasciitis in athletes, active individuals and patients with chronic pain.
What Is Plantar Fasciitis?
Plantar fasciitis is the inflammation of the plantar fascia, a thick band of connective tissue that runs along the sole of the foot from the heel to the toes. This structure acts as a natural shock absorber and supports the arch of the foot during walking and running.
When the plantar fascia is repeatedly overloaded, micro-tears develop at its insertion on the calcaneus (heel bone). This causes:
- Stabbing pain in the heel, especially with the first steps in the morning
- Stiffness in the sole of the foot
- Pain that worsens after standing for long periods or after exercise
- Tenderness when pressing on the heel area
Heel Spur: Cause or Consequence?
Many patients arrive worried about a “spur” detected on X-ray. It is important to know that the heel spur is a consequence of chronic traction of the plantar fascia on the bone, not the cause of the pain. In fact, many people have spurs without any symptoms. Treatment focuses on the fascia, not the spur.
Causes of Plantar Fasciitis
Understanding the causes is essential for effective treatment and preventing recurrence:
- Mechanical overload: excessive exercise, running on hard surfaces, sudden change of footwear
- Biomechanical abnormalities: flat feet, high arches, excessive pronation
- Excess weight: greater load on the fascia with every step
- Tight posterior chain: tight calves and Achilles tendon
- Age: the fascia loses elasticity over the years
- Inappropriate footwear: shoes without support, excessive heels
- Occupations requiring prolonged standing: chefs, surgeons, hairdressers, shop assistants
During our assessment at the specialist foot clinic, we perform a complete biomechanical analysis to identify the specific causative factors for each patient.
Conservative Treatment of Plantar Fasciitis
Our therapeutic approach follows a stepped protocol, starting with the least invasive measures and progressing according to the patient’s response.
1. Extracorporeal Shockwave Therapy
Shockwave therapy is currently one of the most effective treatments for chronic plantar fasciitis. The shockwaves:
- Stimulate neovascularisation: creating new blood vessels in the damaged area
- Activate growth factors: accelerating tissue repair
- Break down calcifications: helping to dissolve calcium deposits
- Modulate pain: reducing the transmission of pain signals
The standard protocol consists of 3-5 sessions at 1-2 week intervals. Shockwave therapy is described in published studies as an established conservative option for chronic plantar fasciitis that has not responded to other treatments — indication and outcome are assessed individually.
2. Custom Orthopaedic Insoles
Custom orthopaedic insoles are a fundamental pillar of treatment. A well-designed insole:
- Redistributes pressure across the sole of the foot
- Supports the longitudinal arch
- Cushions impact on the heel
- Corrects biomechanical abnormalities (pronation, supination)
At our practice, we perform a gait and pressure analysis to design insoles specific to each patient. Not all insoles are equal: a generic pharmacy insole rarely resolves the problem.
3. Platelet-Rich Plasma (PRP) Therapy
In cases that do not respond to initial treatments, PRP injection offers a promising biological alternative. A small blood sample is taken from the patient, centrifuged to concentrate the platelets, and injected into the damaged fascia area.
The platelets release growth factors that:
- Accelerate repair of damaged tissue
- Reduce local inflammation
- Stimulate collagen production
4. Whole-Body Cryotherapy
Cryotherapy at -110°C complements plantar fasciitis treatment by reducing systemic inflammation and providing immediate pain relief. Particularly useful during acute phases of intense pain, cryotherapy enables the patient to begin active rehabilitation sooner.
5. Physiotherapy and Exercises
Stretching and strengthening exercises are essential for complete recovery:
- Plantar fascia stretches: rolling a frozen water bottle under the foot
- Calf and soleus stretches: against a wall, with knee extended and flexed
- Arch strengthening: toe-grip exercises
- Eccentric calf exercises: on a step, slow heel lowering
6. Complementary Measures
- Functional taping for immediate relief
- Night splints to maintain the stretch during sleep
- Appropriate footwear with good support and cushioning
- Manual therapy: fascia massage and myofascial release
- Acupuncture: can help manage pain
When Is Surgery Necessary?
Surgery for plantar fasciitis is a last resort and is only considered after 6-12 months of conservative treatment without improvement. Fewer than 5% of patients require surgical intervention.
At our practice, the philosophy is clear: avoid surgery whenever possible. With a multimodal conservative approach combining the best techniques from conventional and complementary medicine, the vast majority of our patients achieve a complete recovery without going to the operating theatre.
Prevention: How to Avoid Plantar Fasciitis
Once the episode has resolved, prevention is key to avoiding recurrence:
- Daily stretching of the posterior chain (calves, plantar fascia)
- Appropriate footwear for each activity, with good arch support
- Orthopaedic insoles if biomechanical abnormalities exist
- Gradual training increases (never more than 10% per week)
- Maintain a healthy weight to reduce the load on the feet
- Strengthen the intrinsic foot muscles with regular exercises
- Vary training surfaces
Frequently Asked Questions About Plantar Fasciitis
How long does plantar fasciitis take to heal?
With appropriate conservative treatment, most patients experience significant improvement within 6-12 weeks. Chronic cases may require 3-6 months. The key is to start treatment early and follow the protocol consistently.
Can I continue exercising with plantar fasciitis?
It depends on the severity of symptoms. Generally, we recommend temporarily reducing impact activities (running, jumping) and substituting low-impact exercise (swimming, cycling). As symptoms improve, normal activity is gradually reintroduced.
Is shockwave therapy effective for plantar fasciitis?
Multiple published clinical studies describe good response rates in chronic plantar fasciitis with shockwave therapy, especially in patients who have not responded to simpler treatments such as stretching and insoles. Indication and outcome are assessed individually.
What is the difference between plantar fasciitis and a heel spur?
Plantar fasciitis is the inflammation of the plantar fascia (the tissue). A heel spur is a bony growth on the heel that forms as a consequence of chronic traction. The pain originates in the fascia, not the spur, which is why treatment focuses on the tissue inflammation.
If you are suffering from heel or sole pain, do not wait for it to become chronic. Call us on +34 971 68 43 45 or book an appointment at our practice in Palma de Mallorca, Avinguda Mexico, 15.
