You’ve tried home stretches, ice, and maybe even new shoes or OTC insoles, yet your heel pain from plantar fasciitis just won’t quit.

You’ve had heel pain for months, not days.

A doctor has said you have plantar fasciitis, or you strongly suspect it.

You have an active life or are on your feet all day (at work, at the gym, running, or parenting).

If any of this sounds like you, you may be suffering from chronic plantar fasciitis, which is when the chronic inflammation that characterizes plantar fasciitis occurs for >3–6 months despite basic care.

In this article, the Foot Specialists of Birmingham (serving Birmingham, Hoover, Vestavia Hills, and nearby communities in Alabama) detail how podiatrists approach chronic plantar fasciitis treatment options beyond “just rest and ice.” Keep reading to learn more!

Disclaimer: This content is for general education purposes only and is not a substitute for an exam performed by a podiatrist or other medical doctor.

What Makes Heel Pain ‘Chronic’ — and Why It Lingers

What Plantar Fasciitis Is + How It Causes Heel Pain

Plantar fasciitis is a condition involving inflammation or injury of the plantar fascia, causing pain flares in the heels, arches, or other foot areas. The plantar fascia is the sensitive, web-like tissue inside of each of your feet that spans from heel to toe with the primary function of sustaining impact from movement and overexertion.

When Heel Pain Counts as Chronic

Heel pain is chronic when it lasts >3–6 months, returns repeatedly despite consistent conservative care, or both.

Common risk factors for plantar fasciitis-induced heel pain include overexertion, weight gain, tight calves, flat/high arches, prolonged periods on feet, and poor footwear.

Why Basic Home Care Isn’t Always Enough

Plantar fasciitis-induced heel pain can lead to more chronic complications, even with consistent home care, for a few main reasons:

#1: The plantar fascia doesn’t heal very quickly. It is a delicate stretch of tissue and is even more fragile once inflamed or injured. The more damaged the plantar fascia tissue is, the longer the recovery time can be.

#2: You continue to do things that irritate the plantar fascia. Continual re-irritation of the plantar fascia from your regular activities (such as standing all day at work or running) can easily disrupt your healing progress and even put you back at square one, over and over again.

#3: Basic home care doesn’t address the causes or underlying mechanics (e.g., gait, arch, etc.) that worsen your plantar fascia rupture/irritation. Home care typically only addresses the symptoms of plantar fasciitis, rather than treating the underlying cause.

Confirming It’s Really Plantar Fasciitis

Podiatrists don’t treat all heel pain as plantar fasciitis. Other causes of heel pain include stress fracture, nerve entrapment, arthritis, Achilles tendon issues, and more; your podiatrist needs to rule these out to ensure you get the proper diagnosis and effective treatment. Accurate diagnosis is what makes the treatment ladder effective and safe.

Diagnosis typically begins with a podiatrist reviewing the patient’s medical history and discussing the characteristics of their heel pain, including its location, when it’s most severe (such as with the first steps in the morning or after periods of rest), and what activities or treatments worsen it or relieve pain.

The podiatrist then performs a physical exam, which includes inspecting the foot and ankle for swelling, tenderness, and alignment; palpating the plantar fascia; assessing range of motion and overall foot biomechanics; and evaluating gait and posture during standing and walking. Sometimes, podiatrists will perform imaging tests (such as X-rays or ultrasounds) if symptoms are atypical or severe.

To learn more about how our podiatrists diagnose plantar fasciitis, please visit our Heel Pain/Plantar Fasciitis Services page.

The Podiatrist’s Treatment Ladder for Chronic Plantar Fasciitis / Overview

Once a podiatrist diagnoses plantar fasciitis, we refer to a “treatment ladder,” which is a range of care/treatment options from the least invasive interventions to the most advanced. This is what our treatment ladder looks like:

Home and early conservative care
Podiatrist-guided conservative care (orthotics, PT, night splints, taping)
Advanced non-surgical options (injections, shockwave)
Minimally invasive procedures (e.g., radiofrequency / Topaz)
Traditional surgery (plantar fascia release) — as a last resort

Where we start a patient on the treatment ladder depends on how long they’ve had foot pain, how much it affects their daily life, and what they’ve already tried for recovery and relief. For example, we often start a patient with early-onset plantar fasciitis and minimal symptoms at step one on the ladder: home care and early conservative treatment. Treating patients with chronic plantar fasciitis pain, on the other hand, typically (as we mentioned previously) requires more than at-home and conservative treatment options, so we usually start them at a higher rung on the treatment ladder.

Continue reading through the upcoming sections to gain a closer look at each step in our treatment ladder for plantar fasciitis patients.

Step 1: Home & Early Conservative Care (What Most People Try First)

The following strategies to treat plantar fasciitis work best for milder and short-lived cases of plantar fasciitis:

Common self-care strategies

Rest or activity modification
Stretching (calf muscle + plantar fascia stretches)
Ice massage/frozen water bottle rolling
OTC anti-inflammatories (if appropriate)
Supportive shoes, over-the-counter arch supports

When home care is appropriate

Early/mild pain, short duration
No red flags (night pain, systemic symptoms, neurological issues)

When home care isn’t enough

Pain lasting >6–8 weeks despite consistent self-care
Pain interferes with work, exercise, or sleep
This leads into: “Time to let a podiatrist take the lead.”

Step 2: Podiatrist-Guided Conservative Care

Custom Foot Orthotics and Shoe Modifications

Podiatrist-prescribed, custom orthotics are one of the first non-surgical treatments we start patients with. They support your arch and reduce strain on your plantar fascia. This treatment is most helpful in controlling biomechanical risk factors that contribute to plantar fasciitis in many patients, such as those who spend long hours standing, have flat feet, or high arches.

Custom orthotics are much different from over-the-counter insoles “made for plantar fasciitis.” The over-the-counter options wear down quickly and provide short-term pain relief and inadequate (or the wrong type of) support; they do not provide the custom-targeted relief that your podiatrist can with truly custom orthotics.

Learn more about custom orthotics and our approach by reading our dedicated orthotics posts (like this one) on our blog page.

Physical Therapy & Manual Therapy

Physical therapy is a conservative treatment for plantar fasciitis that benefits many patients with the condition. Under the guidance of a physical therapist, patients can perform therapeutic exercises to strengthen weak foot muscles and retrain their gait, as well as receive manual therapy, such as massage for soothing soreness and lymphatic drainage, soft-tissue mobilization, and taping.

Physical therapists and podiatrists can work together to craft a custom plantar fasciitis treatment plan that maximizes the benefits of combined treatments, such as physical therapy and orthotics.

Night Splints & Taping

For many patients, podiatrist-prescribed night splints can offer substantial relief, especially from the characteristic “first step in the morning” pain of plantar fasciitis. They work by gently stretching the plantar fascia overnight while you sleep.

Taping is a form of treatment similar to night splints, serving as a short-term pain relief option that helps keep arches stretched and stable. It can also be used during the daytime to provide support during activity. As we mentioned in the section above on physical therapy, your physical therapist can demonstrate how to apply the tape properly. However, your podiatrist can also help with this and may even be the one to advise your physical therapist on how you should be taping.

How long this phase usually lasts

Typically, this phase of consistent, guided conservative care should provide noticeable relief and support within 6–12 weeks. However, if these treatments provide little or no improvement after the expected period your podiatrist predicts, we will consider step 3.

Step 3: Advanced Non-Surgical Options for Stubborn Heel Pain

Corticosteroid Injections

For patients who still suffer severe heel pain from their chronic plantar fasciitis after 6–12 weeks of conservative treatments, we may suggest corticosteroid injections—a more advanced, yet still non-surgical, treatment.

The main advantage of corticosteroid injections for many patients with chronic or recurrent cases of plantar fasciitis is rapid pain relief. However, not all patients have these results; for some, they only provide temporary pain relief.

Repeated corticosteroid injections can increase the risk of plantar fascia weakening or rupture, so we usually only administer a limited number of shots as part of a combined treatment plan; they’re not a stand-alone fix.

PRP (Platelet-Rich Plasma) and Other Biologic Injections

In more severe plantar fasciitis cases, where the patient is experiencing chronic pain and is still looking for non-surgical treatments, some podiatry offices can administer PRP (platelet-rich plasma) injections. These are plantar fascia injections that use the patient’s own platelets to promote healing.

Shockwave Therapy (ESWT)

Extracorporeal shock wave therapy (ESWT) is a non-invasive, non-surgical treatment in which a handheld transducer device is placed onto the skin, emitting high-energy, high-frequency acoustic shock waves to promote therapeutic benefits. More specifically, the shockwaves target soft tissue, boosting collagen synthesis and stimulating growth.

Many podiatrists offer ESWT to treat chronic plantar fasciitis, as it may stimulate healing of the plantar fascia. It is a low-risk, non-surgical treatment, but it typically involves multiple sessions with varying results. Some patients receive a course of ESWT either as a last resort before procedures (e.g., Topaz, surgery) or in conjunction with them as part of a combined treatment plan.

Step 4: Minimally Invasive Procedures (Including Topaz)

Why Consider a Minimally Invasive Procedure?

If you have chronic plantar fasciitis that has lasted 6– 12 months or longer, and your condition has either worsened or not responded to stretching, orthotics, PT, injections, and/or shock wave therapy, it’s time to ask your podiatrist about a minimally invasive procedure, like Topaz. Although there is an (ever so slightly) elevated risk compared to non-surgical treatments, many patients who have had this type of procedure to stimulate healing report their satisfaction with how they relieved pain without a major open surgery.

Radiofrequency Coblation / Topaz Procedure (High-Level)

The Topaz radiofrequency coblation procedure is designed to stimulate healing for patients with plantar fasciitis by targeting specific points of excess scar tissue that could be impeding the healing of the plantar fascia and causing pain.

In the preoperative stage, your podiatrist will mark the target areas of your foot where you experience pain. During the actual procedure, your podiatrist will use small needles to gently puncture each of these designated target points. With the needles (shallowly) embedded in your foot, the connected machine will emit radiofrequency energy (“Topaz”), applying it directly to the affected plantar fascia.

Similar to extracorporeal shock wave therapy, Topaz is an outpatient procedure in which you’ll be numbed to a comfortable level with local or regional anesthesia, so you shouldn’t feel a thing during it and should get to go home the same day.

The benefits of Topaz include its minimally invasive nature and its ability to preserve the plantar fascia structure while stimulating it, rather than manipulating and targeting it more aggressively with a procedure like plantar fascia release. However, like any medical procedure, it carries risks and isn’t the answer for every patient with chronic plantar fasciitis; you should always carefully weigh your options and try more conservative treatments first, whenever possible.

Who is (and isn’t) a Candidate

For Topaz and similar procedures for chronic plantar fasciitis, the best candidates are adult individuals with a documented history of chronic plantar fasciitis and months of unsuccessful trials with conservative treatment options.

Like with all medical procedures, this minor surgery for plantar fasciitis isn’t always the best option for all patients with heel pain. If there’s a chance your heel pain could be due to a condition comorbid with your plantar fasciitis, another condition entirely, or you already possess certain systemic conditions or contraindications, Topaz might not be the best choice for you.

Step 5: Traditional Surgery as a Last Resort

Plantar Fascia Release (Open or Endoscopic)

Plantar fascia surgery can be an open or endoscopic procedure as a last resort for patients whose chronic plantar fasciitis causes them severe plantar heel pain and who have exhausted all other evidence-based treatment options. In essence, the surgery involves making one or more small incisions in the tight plantar fascia, releasing pain-causing tension.

Patients who undergo this surgery will have a longer recovery than those who try Topaz, shock wave therapy, or other more conservative treatments. There’s also a risk of excessive plantar fascia release, which can cause altered foot mechanics. These downsides make plantar fascia release relatively uncommon compared to the number of people who get better with non-surgical or minimally invasive care. Ultimately, the choice of plantar fascia release is between the patient and their podiatrist, but it should be made with careful consideration.

How Podiatrists Decide What’s Next for Chronic Heel Pain

Key factors in the treatment decision

Duration of symptoms.
Severity (pain level, impact on work/sport).
What you’ve already tried (and for how long).
Exam findings and imaging results.
Your overall health and activity goals.

What a “plan” often looks like in real life

Here’s just an example progression of the ladder of treatment for plantar fasciitis in action (will vary for every patient; no two patients follow the exact same timeline):

Confirm diagnosis, optimize conservative plan (stretching, orthotics, PT).
Reassess at 3-6 months → if still significant pain, add injections/shockwave.
Reassess again after 6-12 weeks → consider minimally invasive procedures if the condition is still chronic.
Only then discuss traditional surgery if symptoms remain severe.

Getting Help for Chronic Heel Pain in Birmingham, AL

If your heel pain has been going on for months and you’ve already tried the basics, you’re not out of options. Our podiatrists in Birmingham treat heel pain every day using this step-by-step approach, helping patients find lasting relief.

Whether you’re in Hoover, Homewood, Vestavia Hills, or somewhere else in the Birmingham Metro area, Foot Specialists of Birmingham can assess where you are in the treatment ladder and design a plan that may include:

Updated conservative care
Orthotics/PT
Advanced options, such as injections, shockwave, or minimally invasive procedures (like Topaz), when appropriate

Don’t let heel pain hold you back from work, exercise, or other things you enjoy in daily life—contact us today and schedule a heel pain evaluation at our Birmingham podiatry office.

You can also click here to learn more about our heel pain treatment options in Birmingham.

FAQs About Chronic Heel Pain & Plantar Fasciitis Treatment

How long does plantar fasciitis usually take to heal?

Many patients’ plantar fasciitis improves over several months with consistent conservative treatments (i.e., stretching, footwear changes, orthotics, and activity modification). However, if you’ve tried all of these measures and your plantar heel pain persists for more than 3–6 months anyway, we consider it chronic, which will make the healing timeline unpredictable. Ultimately, your podiatrist will help you estimate how long it will take you to heal.

When should I see a podiatrist for heel pain?

You should see a podiatrist if your heel pain lasts more than a few weeks, interferes with work, exercise, or daily life, isn’t improving with basic home care, or you present any “red flag” symptoms (night pain, numbness, fever, disabling pain).

Do I really need orthotics for plantar fasciitis, or are shoe inserts enough?

We say this as a provider of educational resources, not to sell you orthotics: over-the-counter shoe inserts are not enough to give you proper support or pain relief for plantar fasciitis. Learn more about how they compare here.

When is it time to consider an injection or shockwave therapy?

It is time to consider advanced plantar fasciitis treatments like injections or shock wave therapy after 6-12 weeks of conservative treatments that don’t result in noticeable pain relief or improvement of the condition.

What is the Topaz procedure for plantar fasciitis?

The Topaz procedure is a minimally invasive, non-surgical treatment for plantar fasciitis that involves targeting the painful points of the plantar fascia with shallowly embedded needles that emit radiofrequency energy (“Topaz”) to stimulate tissue turnover and promote rapid healing.

When do you actually need surgery for plantar fasciitis?

We podiatrists only recommend surgery for plantar fasciitis when home care, conservative treatments, and advanced non-surgical procedures have failed to help the patient recover.

Can I keep working or running while I’m being treated?

That depends on the type of treatments you’re undergoing; always be sure to consult with your podiatrist to determine any restrictions that may be involved during your treatment.