Plantar fasciitis is one of the most common causes of foot and heel pain, affecting runners, people who stand for long hours, and anyone who’s had a sudden change in activity. It happens when the plantar fascia—the thick band of tissue that connects your heel bone to your toes—becomes irritated or inflamed. It can be caused by tightness in the calf or foot musculature or stiffness in the ankle and foot joints or instability or decreased balance/proprioception in the foot and ankle. 

While many cases improve with conservative care, some stubborn cases need more than just rest and stretching. That’s where combining physical therapy with extracorporeal shockwave therapy (ESWT) can make a big difference. Research indicates that medium and higher intensities of ESWT have the biggest improvement on symptomatic improvement of plantar fasciitis. 

What Is Extracorporeal Shockwave Therapy (ESWT)?

Extracorporeal shockwave therapy uses high-energy sound waves to stimulate healing in damaged tissue. The treatment works by:

* Increasing blood flow to the affected area

* Stimulating cell regeneration and collagen production

* Breaking down scar tissue and calcium deposits

* Reducing pain by desensitizing nerve endings

ESWT is non-invasive, doesn’t require medication, and is typically performed in a clinic setting in a series of short sessions.

The Role of Physical Therapy

Physical therapy focuses on correcting the underlying causes of plantar fasciitis. A skilled physical therapist will design a personalized program that may include:

Manual therapy: Hands-on techniques to mobilize tight tissues and improve foot mechanics, and may include other modalities like dry needling, radial shockwave and laser therapy in addition to the manual treatment. 

Stretching, mobility and strengthening exercises: Especially for the plantar fascia, Achilles tendon, and calf muscles. 

Gait retraining: Addressing improper walking or running mechanics

Why Combining Both Might Work Better

ESWT jumpstarts tissue healing at a biological level, especially when inflammation and microtears have become chronic. Physical therapy addresses biomechanics and movement patterns, ensuring that once the tissue heals, your muscles work to keep the joint moving well and reduce the persistent irritation/inflammation. 

Together, they create a synergistic effect: faster pain relief, improved function, and lower recurrence rates.

What to Expect from a Combined Treatment Plan

1. Assessment: Your physical therapist evaluates your foot mechanics, activity level, and pain history. 
2. Focal Shockwave sessions: Usually performed weekly for 4–6 sessions, depending on severity. This can be combined with radial pressure wave as well for even better results. 
3. Strengthening/Home Exercise Program: Between and after sessions, you’ll follow a guided exercise and mobility routine.
4. Long-term prevention: As healing progresses, the focus shifts to strengthening and long term recommendations to prevent re-injury.

Most people begin to notice improvement within a few weeks, with continued gains over several months. At Release Physical Therapy we pride ourselves on not giving you the same “cookie cutter” exercises. We strive to achieve the best results through a combination of manual therapy, and modalities including ESWT to help push you past the pain and get you back to your goals. 

If you’ve tried rest, stretching, or orthotics with little success, it might be time to talk to your physical therapist about adding ESWT to your treatment plan. Call Release Physical Therapy today to get scheduled and try out our focal shockwave machine (ESWT).