Chronic Plantar Fasciitis: Laser, Shockwave, and PRP

You have done the stretches. You bought the good shoes and the inserts. Maybe you had a cortisone injection that helped for a month and then wore off. And your heel still hurts. If that sounds familiar, you are dealing with chronic plantar fasciitis, and it is one of the most common reasons patients come to Abacoa Podiatry & Leg Vein Center from across Jupiter, Palm Beach Gardens, Tequesta, and Juno Beach.

Chronic heel pain is not simply acute heel pain that lasted longer. After roughly three to six months, the tissue changes. Inflammation gives way to degeneration: disorganized collagen, poor blood supply, and a fascia that has lost its ability to repair itself. Treatments that calm inflammation, like rest, ice, and steroid injections, stop working because inflammation is no longer the main problem. What the tissue needs now is a signal to heal. That is exactly what the three treatments below are designed to provide.

MLS Laser Therapy

MLS stands for Multiwave Locked System. The device delivers two synchronized wavelengths of FDA-cleared laser energy into the tissue at the same time. One wavelength targets inflammation and swelling; the other targets pain. Delivered together, they penetrate deeper and act faster than a single-wavelength laser.

At the cellular level, laser energy stimulates the mitochondria in fascia cells to produce more energy, increases local circulation, and accelerates the repair cycle. Patients typically feel nothing during treatment other than mild warmth. A session takes about ten minutes, there is no downtime, and you walk out in your normal shoes.

MLS is a good fit for patients who want to avoid injections, for those who cannot take anti-inflammatory medication, and for heel pain that is still in the inflammatory phase or is combined with Achilles tendinitis. A typical course is six to twelve sessions over three to four weeks. Many patients notice improvement after the third or fourth visit.

EPAT Shockwave Therapy

EPAT, or Extracorporeal Pulse Activation Technology, is the treatment with the deepest research base for chronic plantar fasciitis. A handpiece is placed against the heel and delivers rapid acoustic pressure waves into the damaged fascia. Those pressure waves create controlled microtrauma in the degenerated tissue, which triggers the body to send new blood vessels, growth factors, and repair cells to an area it had essentially given up on.

In plain terms, shockwave restarts a healing process that stalled. Treatment takes about five to ten minutes. It is uncomfortable but tolerable, and no anesthesia is needed. Most protocols call for three sessions spaced one week apart. Improvement usually begins two to six weeks after the final session and continues for several months as the tissue remodels.

EPAT is our first choice for plantar fasciitis that has lasted more than six months, for patients who have already had one or more cortisone injections, and for athletes who need to stay active during treatment. Multiple large studies report success rates in the range of seventy to eighty percent for chronic cases, without the risks of surgery or the tissue-weakening effects of repeated steroid injections.

Platelet-Rich Plasma (PRP)

PRP takes regeneration one step further. We draw a small amount of your blood, spin it in a centrifuge to concentrate the platelets, and inject that concentrate directly into the damaged portion of the fascia under ultrasound guidance. Platelets are packed with growth factors that recruit stem cells, stimulate new collagen, and rebuild tissue.

Because PRP is made from your own blood, there is no risk of allergic reaction. Unlike cortisone, which suppresses the healing response and can weaken the fascia with repeated use, PRP stimulates healing. Studies comparing the two consistently show cortisone winning at four to six weeks and PRP winning at six months and beyond.

PRP is typically a single injection. Expect soreness for a few days and a short period in a walking boot. Results build over eight to twelve weeks. We recommend PRP for severe or long-standing cases, for partial tears of the fascia seen on ultrasound, and for patients who want the most durable non-surgical option before considering any procedure.

Which Treatment Is Right for You?

There is no single best answer, and the treatments are often combined. As a general guide:

Pain for less than three months, still inflammatory, wants no needles: MLS Laser Therapy plus orthotics and a stretching program.
Pain for more than six months, prior cortisone injection, active or athletic: EPAT Shockwave, often paired with MLS Laser between sessions.
Severe pain, partial tear on ultrasound, or failed shockwave: PRP injection, followed by a structured return-to-activity plan.
Any of the above without addressing footwear, mechanics, and calf tightness: expect the pain to come back. Custom orthotics and a home program are part of every plan.

Every plan starts with a diagnostic ultrasound so we can measure fascia thickness, look for tears, and confirm that plantar fasciitis is actually the diagnosis. Baxter's nerve entrapment, stress fractures, and fat pad atrophy are frequently mislabeled as fasciitis and do not respond to these treatments.

What About Surgery?

Fewer than five percent of plantar fasciitis patients ever need surgery. For the rare case that fails everything above, minimally invasive options such as ultrasound-guided percutaneous fasciotomy or Tenex are performed through a tiny incision with a fast recovery. But with laser, shockwave, and PRP available, we go years between plantar fascia surgeries.

Insurance and Cost

Coverage for these treatments varies by plan. Some insurers cover EPAT; most consider MLS Laser and PRP to be elective. We are transparent about cost before treatment begins and offer package pricing for laser and shockwave series. Most patients find the price reasonable compared with months of missed workouts, ongoing copays, and pain that never resolves.

Frequently asked questions

Does shockwave therapy hurt?

It is uncomfortable during the five to ten minutes of treatment, similar to a firm, rapid tapping on the sore spot. The intensity is adjustable and most patients tolerate it well without anesthesia.

Can I keep exercising during treatment?

Yes, with modifications. We generally allow low-impact activity throughout laser and shockwave treatment. After PRP, expect about two weeks of reduced activity.

How many cortisone injections are too many?

We rarely recommend more than one or two in the heel. Repeated steroid injections weaken the fascia, thin the heel fat pad, and increase the risk of a plantar fascia rupture.

Can I do laser and shockwave together?

Yes. Combining MLS Laser with EPAT is common in our office and many patients report faster relief than with either treatment alone.

Plantar Fasciitis That Will Not Go Away: MLS Laser, EPAT Shockwave, and PRP Explained