Chronic plantar fasciitis that won’t go away: causes, treatments and a new minimally invasive solution

Plantar fasciitis is one of the most common causes of heel pain. In most cases, it involves inflammation of the plantar fascia, the fibrous structure that supports the arch of the foot.

In chronic forms, the condition becomes more complex because the painful area develops:

• small abnormal blood vessels that sustain inflammation;
• excessive nerve fibers that amplify and maintain pain over time.

“This explains why some patients continue to experience pain even after months or years, despite orthotics, physiotherapy, injections, or shockwave therapy,” explains Prof. Sconfienza.

“Embolization for plantar fasciitis is a minimally invasive interventional radiology procedure that selectively shuts down the small pathological vessels responsible for chronic inflammation and pain,” continues Sconfienza.

What transarterial embolization is

Through an ultrasound-guided puncture at the ankle, tiny temporary particles are injected that:

• reduce blood flow in diseased vessels;
• preserve circulation in healthy tissues.

This reduces inflammation and, consequently, pain.

Embolization is mainly indicated for patients with chronic heel pain due to plantar fasciitis that has not responded to conservative treatments such as:

• physiotherapy
• orthotics
• anti-inflammatory medications
• injections.

“It is particularly useful for patients who are not yet candidates for surgery or who wish to avoid or postpone it. Each case is carefully evaluated through clinical assessment and imaging studies,” the specialist explains.

“The procedure takes place in an interventional radiology suite. After local anesthesia, we perform a puncture at the ankle under ultrasound guidance. Through this access, we reach the vessels responsible for inflammation and treat them with embolizing material,” describes Prof. Sconfienza.

The procedure:

• is quick, usually lasting 5–10 minutes;
• requires no surgical incisions;
• ends with a simple dressing.

During needle insertion, the patient feels only mild discomfort similar to a standard injection.

During embolization, patients may experience:

• a sensation of warmth;
• mild foot discomfort.

In the following days, mild pain or heaviness may occur, easily managed with common painkillers.

“After a short observation period, the patient can return home,” explains Sconfienza. Patients receive precise instructions regarding:

• pain management;
• dressing care;
• activities to avoid during the first 24–48 hours.

In general:

• light daily activities resume within a few days;
• more intense activities are gradually reintroduced;
• pain improvement occurs progressively over several weeks.

“The goal is to significantly reduce chronic heel pain and improve the ability to walk and stand,” emphasizes Sconfienza.

After embolization, many patients experience:

• progressive improvement over weeks or months;
• reduced use of pain medication;
• recovery of daily activities.

It is important to note that embolization targets the inflammatory and vascular components of pain but does not correct mechanical causes such as overload, altered foot biomechanics, or excess weight. Therefore, it should be combined with:

• physiotherapy;
• orthotics;
• appropriate lifestyle measures.

“As with all invasive procedures, embolization carries risks, although they are rare,” explains Sconfienza. Possible complications include:

• small hematomas or pain at the access site;
• temporary inflammatory reaction in the foot.

In very rare cases, non-selective reduction of blood flow to small areas of healthy tissue may occur, causing temporary skin color or sensitivity changes.

Before the procedure, the benefit-risk balance is carefully evaluated for each patient.

“Interventional radiology represents one of the most advanced expressions of precision and minimally invasive medicine. At an IRCCS institution such as Galeazzi-Sant’Ambrogio, which combines research, technology, and high-level clinical expertise, we can offer innovative solutions based on the best scientific evidence.

Embolization for plantar fasciitis is a concrete example of how interventional radiology can avoid or delay surgery, reduce recovery times, and improve patients’ quality of life,” concludes Sconfienza.