She pointed to her neighbor across the street, a woman in her nineties, up on a ladder trimming trees.

“I wanna be her,” she said. “That’s my goal.”

She was in her early seventies, still working out with a personal trainer twice a week, significantly stronger than many people half her age. She had been an active person her whole life. The foot pain was what was slowing her down. She used to walk a couple miles a day. She could not do that anymore. “This foot pain is kind of keeping me from being able to do what I wanna do.”

What she had already tried was extensive: rolling the foot on a ball, stretching the Achilles, a long list of different shoes, work with a personal trainer, prior chiropractic with dry needling. Everything helped a little. “It helps, but it comes back.”

She had a resigned belief that arthritis explained everything and that this was just how it was now. “I’m [my age]. Aren’t I supposed to be feeling this?”

No. You are not.

What she needed (and what a significant portion of chronic plantar fasciitis patients need) was a treatment that addresses the actual biological problem in the tissue, not just the symptom. That treatment is shockwave therapy.

 

What Is Actually Happening in Chronic Plantar Fasciitis

Plantar fasciitis is an overuse injury to the plantar fascia, the thick band of connective tissue that runs along the bottom of the foot from the heel to the toes. The classic presentation is sharp heel pain that is worst with the first steps in the morning and after prolonged sitting.

In the acute phase, plantar fasciitis involves genuine inflammation of the tissue. This is where standard approaches (rest, ice, stretching, orthotics) have their best effect. The tissue is inflamed, and anti-inflammatory inputs help.

The problem is that most patients who are still dealing with plantar fasciitis after three to six months are no longer in an inflammatory state. The tissue has moved into a degenerative phase. The condition is more accurately called plantar fasciopathy at this stage. The tissue structure has changed, the organized collagen fibers of a healthy tendon or fascia have been replaced by disorganized, poorly vascularized scar tissue. Inflammation is largely absent.

This distinction matters enormously for treatment. Rest and ice address inflammation. They do not address tissue degeneration. Cortisone injections suppress inflammation that is no longer the primary driver. Orthotics redistribute load but do not change the tissue quality. None of these approaches stimulate the body to rebuild healthier tissue.

That is what shockwave does.

 

How Shockwave Therapy Works for Plantar Fasciitis

Extracorporeal shockwave therapy (ESWT) delivers high-energy acoustic pulses directly into the affected tissue. Those pulses do several things at the cellular and structural level.

First, they trigger the growth of new blood supply into tissue that had been starved of it. Degenerated fascia and tendon tissue is poorly vascularized, which is part of why it cannot heal on its own. Shockwave initiates the growth of new blood supply, which is required for tissue repair.

Second, shockwave activates the cells responsible for producing new collagen (cells that had gone dormant in the degenerative tissue). The acoustic energy triggers a biological cascade that restarts the healing process the tissue had stalled out of. This is not a temporary pain mask. It is an instruction to the tissue to begin rebuilding.

Third, shockwave modulates pain through neuromodulatory effects, reducing the sensitivity of local pain receptors and breaking the chronic pain cycle that has often developed by the time a patient reaches this stage.

Multiple randomized controlled trials and systematic reviews support the use of shockwave for plantar fasciitis. A 2005 study in the Journal of Orthopaedic Research and subsequent research consistently shows meaningful reductions in pain and functional improvement at three and twelve month follow-up. For chronic cases that have failed conservative management, shockwave is one of the most evidence-supported interventions available.

 

Who Is the Right Candidate

Shockwave is not appropriate for acute plantar fasciitis. For a new injury that has been present for a few weeks, the standard approach (load modification, stretching, appropriate footwear, and progressive loading) is still first-line and often sufficient.

Shockwave is the right conversation for patients who have had plantar fasciitis for three to six months or longer, have tried the standard conservative measures, and have not achieved lasting resolution. In my experience, this is a large percentage of the patients I see for foot pain. They are frustrated. They have tried everything the internet suggested. They have been through stretching protocols that help temporarily and stop helping. They are being told to just live with it.

The patient I described at the start was a clear candidate. She had been dealing with it long enough and with enough trials of conservative care to indicate that the tissue was in a degenerative state and needed a different input.

 

The Full Protocol at COSJ

Shockwave is never the only piece of treatment at COSJ. It is one part of a complete protocol.

Repair

Shockwave to the plantar fascia, heel, and in most cases the calf complex (particularly the gastrocnemius and soleus). The protocol typically involves three to five sessions spaced one week apart. Patients may notice increased soreness for twenty-four to forty-eight hours after each session, this is a normal part of the healing response being initiated.

Dry needling of the calf trigger points that refer pain into the heel addresses the muscular component that almost always accompanies plantar fasciitis. The gastrocnemius and soleus frequently develop trigger points that contribute to heel pain and that standard stretching does not resolve.

Retrain

Once the tissue is healing, the next priority is restoring normal load distribution through the foot and lower leg. A significant contributor to plantar fasciitis recurrence is insufficient eccentric calf strength, the Alfredson protocol and its variations are evidence-based loading approaches that rebuild the tissue’s capacity to handle normal gait demands.

We assess how load is moving through the lower kinetic chain and address any hip or lumbar contributors that are putting excessive demand on the foot.

Reinforce

The Reinforce phase is progressive loading that builds calf and foot intrinsic strength to the level the patient’s life actually requires. For the woman who wants to walk two miles a day and stand on a ladder at ninety, the loading goal is different than for someone who lives more sedentarily. We build toward the specific demands.

“Rest is rust,” she told me in our conversation. She had figured this out herself. She felt better on days she moved. We built her plan around that understanding.

 

FAQ

Does shockwave therapy hurt?

The treatment involves discomfort, particularly in areas with active trigger points or significant tissue degeneration. Most patients describe it as intense pressure rather than sharp pain. The discomfort during the session is brief, and most patients find it manageable when the anticipated relief is explained. Post-treatment soreness for one to two days is normal and is a sign the healing response has been initiated.

How many shockwave sessions does plantar fasciitis require?

The standard protocol is three to five sessions spaced one week apart. Most patients notice meaningful improvement by the second or third session. Results continue to develop for four to twelve weeks after the final session as the tissue remodels.

Can I keep walking and exercising during shockwave treatment?

Generally yes, with some load modifications depending on severity. Completely stopping activity is not necessary and often counterproductive. We will give you specific guidance based on your presentation.

What if shockwave doesn’t work?

Shockwave produces meaningful improvement in approximately 75 to 80 percent of chronic plantar fasciitis cases based on published evidence. For those who do not respond, the conversation shifts to other interventions. But for a chronic case that has failed standard conservative management, shockwave is the evidence-based next step before considering more invasive options.

Is shockwave covered by insurance?

Coverage varies. Shockwave is sometimes covered as part of a chiropractic or physical therapy benefit, but coverage is not universal. Our team can walk you through your specific plan before beginning treatment.

 

If You Have Been Told to Just Live With It

You have not. Chronic plantar fasciitis is not a permanent sentence. There is a reason the standard approaches worked temporarily and stopped working, and there is a treatment that addresses the underlying biology that explains that pattern.

If you are in Westerville or Central Ohio and your foot pain has been going on for months, come in. We will assess what stage the tissue is in and tell you honestly whether shockwave is the right intervention for your case.

The woman who wants to be on the ladder at ninety is not an unreasonable goal. It is an appropriate one. Let’s build toward it.

Schedule at cospineandjoint.com/schedule-appointment.

In your corner,
Dr. Blake Richard, DC
Central Ohio Spine and Joint | Westerville, OH
cospineandjoint.com/schedule-appointment