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What is plantar fasciitis
ICD-10 code: M72.2
Plantar (plantar) fasciitis is a degenerative lesion of the plantar aponeurosis at its attachment to the calcaneus. The most common cause of heel pain — up to 10% of the population over a lifetime. Characteristic symptom: sharp pain with the first steps in the morning, which decreases after "walking it off".
Causes and Risk Factors
Overload
Prolonged standing (teachers, surgeons, hairdressers), running (especially on hard surfaces), sudden increase in load. Load on the fascia during walking — up to 2 times body weight, during running — up to 3.
Biomechanics
Flat feet (foot pronation), high arch (rigid foot), shortening of the Achilles tendon and gastrocnemius muscle, leg length discrepancy. Any biomechanical disorder increases the load on the fascia.
Excess Weight
BMI > 30 — independent risk factor. Each extra kilogram increases the load on the fascia with every step.
Age
Peak 40-60 years. With age, the thickness of the heel fat pad decreases and fascia elasticity diminishes.
Fasciitis vs Heel Spur
Common Misconception
Heel spur (osteophyte) is a consequence, not a cause of pain. 50% of people with heel spurs have no pain. Conversely, fasciitis can occur without a spur. The fascia must be treated, not the spur. Removal of the spur without fasciitis treatment does not solve the problem.
Diagnosis
Clinical Presentation
Pain in the medial part of the heel with the first steps in the morning — pathognomonic symptom. Tenderness on palpation of the medial tuberosity of the calcaneus. Increased pain with dorsal flexion of the foot (fascia stretch).
Ultrasound
Fascia thickening > 4 mm (normal 2-4 mm) — main criterion. Hypoechogenicity at the attachment site. Doppler — neovascularization in chronic process. Allows detection of partial tears.
MRI
For unclear diagnosis or ineffective treatment. Visualizes fascia, bone marrow edema of the calcaneus, perifascial edema. Rules out stress fracture, tumor.
X-ray
To assess heel spur (if present). However, presence or absence of spur does not determine fasciitis treatment strategy.
Plantar fasciitis: treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Well studied, recommended |
| Braces, splints, insoles | Offload and stabilise, reduce pain under load | Moderate evidence |
| Shockwave therapy | A course of 3–5 sessions; helps some patients with chronic pain | Moderate evidence |
| Corticosteroid injection | Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable | Limited or conflicting evidence |
| PRP / CGF | Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown | Limited or conflicting evidence |
| Partial fascia release (rarely) | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In tendinopathies the basis of treatment is graded loading of the tendon: specific exercises over 3–6 months. Shockwave therapy helps some patients. Evidence on PRP is conflicting: there are studies showing benefit in tennis elbow and plantar fasciitis, but no convincing evidence for other tendons. Corticosteroids relieve pain quickly, but the effect is often short, and repeated injections into a tendon are undesirable.
When surgery is discussed. Surgery is discussed for a complete tendon rupture or if pain persists for more than 6–12 months despite proper treatment.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Good to know: diagnosis, self-help, outlook
How to tell plantar fasciitis from similar conditions
In plantar fasciitis the bottom inner heel hurts, especially with the first steps in the morning and after rest; pain eases as you walk. A heel spur on X-ray is also found in people without pain and is not the cause in itself. Burning and numbness along the sole point to tarsal tunnel syndrome, pain at the back of the heel to the Achilles tendon, and pain on squeezing the heel from the sides in runners to a stress fracture.
What you can do yourself
Stretch the plantar fascia and calf muscles several times a day, especially before the first steps in the morning. Wear well-cushioned shoes, heel cups or insoles and avoid walking barefoot on hard floors. Temporarily reduce running and prolonged standing and lose weight if needed.
Outlook and timelines
In most patients pain resolves within 6–12 months of conservative treatment. Shockwave therapy helps chronic pain; a corticosteroid injection gives short-term relief and carries a risk of fascia rupture and fat pad atrophy. Surgery is rarely discussed.
Recovery and timelines
After an outpatient injection procedure, most patients return to normal activity within 1–3 days. Sport and heavy loads are resumed according to the physician’s plan, usually after 2–6 weeks, alongside therapeutic exercise. The effect is assessed after 6–12 weeks. After surgery, rehabilitation takes longer and depends on the operation.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Monto RR. Platelet-rich plasma and plantar fasciitis. Sports Med Arthrosc Rev, 2013.
- Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Questions about plantar fasciitis
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request