JEFFREY PENG MD
SPORTS MEDICINE & FAMILY MEDICINE
PLANTAR FASCIITIS
TREATMENT IN SAN JOSE, CA
Plantar fasciitis is the most common cause of heel pain in adults, responsible for up to 15% of all foot disorders requiring medical treatment. It affects runners, people who stand for long hours, and anyone who overloads the plantar fascia through repetitive stress, poor footwear, or biomechanical issues. When the condition becomes chronic, it can severely limit your ability to walk, exercise, and perform everyday activities.
Dr. Jeffrey Peng is a board-certified sports medicine physician in Campbell, CA specializing in non-surgical treatment for chronic plantar fasciitis — including PRP injections, shockwave therapy, percutaneous needle tenotomy, and targeted rehabilitation. A meta-analysis of 13 RCTs found that PRP provides significantly better long-term outcomes than cortisone for plantar fasciitis — and unlike cortisone, PRP actually helps the tissue heal (PMID: 40913486).
What Is Plantar Fasciitis?
The plantar fascia is a thick band of connective tissue that runs along the bottom of your foot, supporting the arch and absorbing impact with every step. When it is overloaded — whether from repetitive stress, excess body weight, poor footwear, or biomechanical issues like flat feet or tight calves — it can develop microscopic tears and degeneration.
We initially thought plantar fasciitis was an inflammatory condition — the “-itis” in its name literally means inflammation. But we now have a much better understanding of what is happening at the tissue level. In chronic cases, there are actually no signs of active inflammation. Instead, we see fascial degeneration: the accumulation of microtears causes the fascia fibers to become thinned out, disorganized, and weaker over time. Blood flow decreases. The growth factors that drive healing are absent. The tissue becomes biologically stuck — unable to repair itself.
Early on, the body tries to repair this damage with inflammation, which is why most cases improve with rest, stretching, and orthotics. But when the condition becomes chronic, that normal healing process breaks down. The tissue becomes weaker, stiffer, and less capable of absorbing load. That is when plantar fasciitis turns into chronic heel pain that just will not go away — and why treatments that address the underlying tissue degeneration (PRP, tenotomy) tend to outperform those that just suppress symptoms (cortisone, NSAIDs).
Symptoms of Plantar Fasciitis
The hallmark symptom is a sharp, stabbing pain in the bottom of the foot near the heel — typically worst with the first steps in the morning or after prolonged sitting. The pain often improves with movement as the fascia warms up, but returns after long periods of standing, walking, or exercise. In severe cases, the pain can be present throughout the day and significantly limit activity.
You may also notice pain that worsens after (not during) exercise, tenderness when pressing on the bottom of the heel, stiffness in the arch of the foot, and difficulty standing or walking for extended periods. Many patients describe a cycle where the pain improves slightly with rest, then returns worse than before when they resume activity.
Dr. Peng uses diagnostic musculoskeletal ultrasound to visualize the plantar fascia in real time — measuring fascial thickness, identifying tears or degeneration, and ruling out other causes of heel pain. This allows for immediate diagnosis and a same-day treatment plan.
Non-Surgical Treatment Options for
Plantar Fasciitis
Stretching & Targeted Rehabilitation
The foundation of plantar fasciitis treatment is a targeted rehabilitation program. Calf stretching and plantar fascia-specific stretching help increase mobility and reduce tension on the fascia. Strengthening exercises — particularly intrinsic foot muscle strengthening and eccentric calf loading — help reorganize and remodel the fascial fibers. Most cases of plantar fasciitis will improve significantly with consistent rehab, arch support, and activity modification.
Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) uses acoustic energy pulses to stimulate healing in the degenerated plantar fascia. It promotes neovascularization, collagen synthesis, and pain modulation. A study comparing PRP to shockwave for plantar fasciitis at 2-year follow-up found that both were effective, though PRP showed a 0% failure rate versus 11% for shockwave, and athletes returned to sport significantly faster with PRP (PMID: 36396549).
PRP Injections for Plantar Fasciitis
If you have tried stretching, orthotics, night splints, and maybe even cortisone injections — and your heel pain keeps coming back — PRP addresses the problem that these treatments cannot: the damaged tissue itself. Instead of simply reducing inflammation or masking pain, PRP delivers a concentrated dose of your body’s own growth factors directly into the degenerated fascia, stimulating new collagen formation, restoring blood flow, and promoting real biological repair.
The evidence is compelling. A meta-analysis of 13 randomized controlled trials including 901 patients (PMID: 40913486) compared PRP to corticosteroid injections for plantar fasciitis. In the short term (about one month), both treatments provided similar relief. But by six months, the difference was clear: patients who received PRP kept getting better, while pain for those who had cortisone injections started to come back. PRP did not just calm the pain — it helped the tissue keep healing, leading to significantly better long-term outcomes.
This makes biological sense. Cortisone reduces inflammation quickly but does not repair the damaged tissue — and worse, repeated steroid injections carry risks like plantar fascia rupture and fat pad atrophy. PRP, on the other hand, delivers growth factors that stimulate new collagen formation and tissue regeneration. Across all 13 studies, there were no major side effects from PRP — no infections, no worsening pain, and no fascia ruptures.
A separate RCT comparing PRP to shockwave therapy (PMID: 33824779) with 110 patients found that PRP produced significantly greater pain reduction than shockwave at every follow-up point. Both treatments worked, but PRP consistently outperformed.
Percutaneous Needle Tenotomy for
Plantar Fasciitis
For chronic plantar fasciitis that has not responded to rehabilitation, shockwave, or PRP alone, percutaneous needle tenotomy offers a minimally invasive alternative to surgical plantar fascia release. Using real-time ultrasound guidance, an FDA-cleared powered device mechanically fragments and removes the degenerated scar tissue and disorganized collagen fibers preventing the fascia from healing.
The procedure converts a chronic, stalled injury into an acute one the body can actually repair — triggering fresh bleeding, growth factor release, and new collagen production. A meta-analysis (PMID: 37148349) of 35 studies and over 1,600 patients across multiple tendon and fascial conditions found that tenotomy significantly reduces pain at every time point, with benefits that continued to improve at long-term follow-up. A separate prospective study (PMID: 33727517) including plantar fascia cases found nearly 80% pain reduction by one year.
Dr. Peng often combines tenotomy with PRP for chronic plantar fasciitis: tenotomy clears out the damaged tissue, and PRP delivers concentrated growth factors directly into the freshly cleared space to amplify the healing response. The entire procedure takes about 20-30 minutes in the clinic under local anesthesia. No incisions, no stitches, same-day discharge.
Insurance note: Most insurance plans, including Medicare, PPOs, and HMOs, cover the ultrasound-guided tenotomy portion. PRP is currently self-pay. Tenotomy alone has strong standalone evidence (PMID: 37148349).
Why Dr. Peng Limits Cortisone for
Plantar Fasciitis
Cortisone injections have traditionally been the go-to treatment for stubborn plantar fasciitis. They provide fast pain relief by suppressing inflammation. But the evidence increasingly shows that this relief comes at a cost.
A meta-analysis of 13 RCTs (PMID: 40913486) found that while both PRP and cortisone provided similar short-term relief, PRP produced significantly better outcomes by 6 months — because PRP helped the tissue continue healing while cortisone’s effects faded. Cortisone does not repair the degenerated fascia; it just quiets the symptoms temporarily.
More concerning, repeated cortisone injections into the plantar fascia carry well-documented risks: plantar fascia rupture and fat pad atrophy — both of which can cause worse pain and disability than the original condition. Dr. Peng may still use a single cortisone injection in specific situations for acute pain management, but for long-term treatment of chronic plantar fasciitis, he recommends PRP, shockwave, or tenotomy — treatments that promote actual tissue healing rather than masking symptoms.
Do I Need Surgery for Plantar Fasciitis?
Surgery for plantar fasciitis — typically a partial plantar fascia release — is rarely needed. Over 90% of cases resolve with non-surgical treatment, and surgery is generally reserved for patients who have failed 6-12 months of comprehensive conservative management.
With the advent of PRP injections and percutaneous tenotomy, the threshold for surgery has moved even further. In the 2-year comparative study of PRP vs. shockwave (PMID: 36396549), no patients in either group required surgery. PRP and tenotomy provide minimally invasive options that address the underlying tissue degeneration — the same problem surgery aims to solve — but without the incision, general anesthesia, prolonged immobilization, or 3-6 month recovery timeline.
If you have been considering surgery for chronic plantar fasciitis, Dr. Peng recommends exhausting all non-surgical options — including PRP, shockwave, and tenotomy — before committing to an operation.
Watch: Plantar Fasciitis PRP vs Shockwave
Dr. Peng compares how PRP injections compare to shockwave therapy and discusses which might make sense for you.
Frequently Asked Questions
Frequently asked questions
Why Choose Dr. Jeffrey Peng for Plantar Fasciitis Treatment in San Jose?
Dr. Jeffrey Peng is a board-certified sports medicine and family medicine physician specializing in non-surgical treatments for sports injuries and orthopedic conditions. He completed his residency with the Stanford Family Medicine Residency Program and his sports medicine fellowship with the Stanford Primary Care Sports Medicine Fellowship in San Jose.
Dr. Peng has co-authored peer-reviewed research on platelet rich plasma with leading orthobiologics researchers and clinicians — no other PRP provider in the San Jose, Los Gatos, and Campbell area combines published research credentials with this level of clinical experience. He is an active faculty member training the next generation of sports medicine physicians and runs a popular YouTube channel with over 400,000 subscribers, making complex PRP research accessible to patients worldwide.
Every PRP injection is performed under real-time ultrasound guidance to ensure accurate placement into the targeted tissue. Studies show that ultrasound-guided injections are significantly more accurate than blind injections, which directly impacts treatment effectiveness.