Plantar fasciitis treatment: what it is, why it lingers, and when a small-incision procedure helps

You’ve stretched. You bought the inserts. Maybe you had a cortisone shot. Your heel still hurts with every first step. This guide explains what plantar fasciitis is, why it can linger, and where plantar fasciitis treatment goes next. That next step may be a procedure, and it may not need to be a large open operation.

What is plantar fasciitis?

The plantar fascia is a long band of tissue that supports your arch.^[1] In plantar fasciitis, it hurts near the heel. The name suggests inflammation, and that is how OrthoInfo describes the pain.^[1]

Long-standing cases can look different. Researchers studied tissue from 50 heel operations for chronic plantar fasciitis. They found the fascia breaking down, without inflammation, and argued for the name fasciosis, a degenerative condition.^[2] That’s why we think of stubborn heel pain as damaged tissue, not just swelling waiting to settle. Even years later, only 24% of people whose pain had gone had a normal-looking fascia on ultrasound.^[3]

What does plantar fasciitis feel like?

These are the classic plantar fasciitis symptoms:

• pain on the bottom of the foot, near the heel,
• pain that’s worst with your first steps after waking or after a long rest,
• pain that eases after a few minutes of walking,
• pain that’s often worse after activity than during it.^[1]

Burning, tingling or numbness points to a nerve instead, such as Baxter’s nerve entrapment (external site).

What causes plantar fasciitis?

Repeated stress can damage the fascia, though most cases have no single cause. Sudden jumps in activity, long hours on hard floors, flat feet or high arches, tight calves, obesity and age all play a part.^[1]

In one matched study, people whose ankle could not bend upward past neutral had 23 times the odds of plantar fasciitis, compared with people who had good motion. A body mass index over 30 carried 5.6 times the odds, and a workday mostly on your feet 3.6 times.^[8] A tight calf matters, and an operation can address it.

What happens if plantar fasciitis doesn’t heal?

It can last for years. In that Danish study, the risk of still having plantar fasciitis was 80.5% at one year, 50% at five years and 44% at 15 years. Those who recovered took about two years on average.^[3]

Repeating the same care may not change that:

• Exercise. After 12 weeks of heavy heel raises, only 4 of 70 people felt no need for more treatment.^[9] In a trial of 180 adults, neither exercise nor exercise plus cortisone added a clinically meaningful gain over advice and a heel cup at 12 weeks.^[10]
• Cortisone. A Cochrane review found injections may slightly reduce heel pain for up to a month, but not after that. Across 21 trials, two plantar fascia ruptures were reported in 699 people.^[11] See cortisone shots in the foot.

What is the first plantar fasciitis treatment?

Conservative care is the right start. Begin with our plantar fasciitis exercises, with videos and exact doses. Supportive shoes and inserts come next. Shockwave therapy was the one treatment that improved pain in the medium and long term in a large review.^[12] If six months of this hasn’t worked, you have refractory plantar fasciitis, and surgery can be considered.^[4] OrthoInfo uses 12 months.^[1]

When does surgery beat more conservative care?

Randomized trials answer this best.

Study	Compared	Result
Johannsen 2020, 30 patients[5]	Endoscopic release vs cortisone shots, both with strength training	Foot function was better with surgery at 1 year. At 2 years, activity pain was better, but function no longer differed significantly. More returned to running and jumping
Riiser 2024, 40 patients with tight calves[6]	Calf lengthening plus stretching vs stretching alone	At 6 years, excluding crossovers, pain was 2.5 vs 5.5 out of 10 and function 88.9 vs 78.6. Seven of 20 on stretching crossed over to surgery
Møller 2025, 8 studies[13]	Minimally invasive care vs non-surgical care or placebo	Needle-based treatments did better on pain in 5 studies; endoscopic release in 1 of 3. Risk of bias was high

Neither trial tested Tenex or TenJet, and the review’s needle treatments appear to be other techniques. They do show that, for the right patient, a procedure can beat staying on non-surgical care. A 2026 review of five randomized trials also found calf lengthening improved function and pain.^[14]

What do Tenex and TenJet do differently?

They go straight to the damaged area seen on ultrasound, under local anesthetic. Tenex breaks up and suctions out the tissue with ultrasonic energy through a probe the size of an 18-gauge needle.^[15] TenJet uses high-pressure saline.^[16] Both devices are FDA-cleared.^[17,18] Our Tenex and TenJet article explains each one.

What is the Tenex plantar fasciitis success rate?

Series	Patients	Follow-up	Result
Mayo Clinic 2025[7]	58 procedures	6.6 years	Pain 6.8 to 0.7; 91% successful; 90% would recommend it
Kruse 2024[19]	67	1 year	Pain improved 5.87 points; 94% satisfied
Patel 2015[15]	12, four after a failed release	2 years	All 12 reported being essentially pain-free
Encinas 2025[20]	56 (Tenex)	27 months	Better pain, function and mobility scores
Fick 2021[21]	80	6 or 12 weeks	36 of 57 who answered were satisfied

Encinas, Fick and Patel used Tenex. The Mayo and Kruse abstracts don’t name their device.

What is the Tenex plantar fasciitis recovery time?

In the Iowa series, patients could walk as tolerated in a boot for one to two weeks. They avoided running and jumping from weeks two to six. Full activity came at six weeks at the earliest, and most people returning to sport or manual work needed about 12 weeks.^[21] In the early series, pain relief came between 5 and 13 weeks.^[15]

How does Tenex compare with open or endoscopic release?

We found no study in the foot that compares them head to head. The figures below come from different patients, so they show the general picture only:

Approach	Published complication rate
Open release	11%[22]
Endoscopic release	5% in one review, 8.9% in another[22,23]
Ultrasonic tenotomy	0.7% across 289 procedures at several body sites; none reported in the Mayo or Kruse series[21,7,19]

Pain along the outer foot is a reported problem after release.^[22] In a randomized trial of calf release versus open release, results matched, but its authors chose calf release first to avoid the biomechanical problems linked to open release.^[24]

The closest direct test of Tenex against an open operation comes from the elbow, where outcomes were similar in 33 people.^[25] That doesn’t show it is better.

How we decide

Dr. Efe Ozturk is a Foot and Ankle Surgeon and podiatrist who offers Tenex and TenJet. We confirm the diagnosis with an exam and in-office ultrasound, and we check your calf. A tight calf may do better with calf lengthening, and nerve pain needs a different plan. If the damaged area can be targeted, a small-incision procedure comes before an open release. Open surgery is handled through our Center for Lower Extremity Surgery (external site). See our heel pain page.

The limits. No randomized trial has tested Tenex or TenJet for plantar fasciitis.^[26] The series above had no comparison group, and we found no study comparing these devices with injections, PRP, shockwave, or open or endoscopic release in the foot. A 2026 network review of 21 studies found endoscopic surgery improved scores more than open or percutaneous techniques, and calf lengthening gave better pain scores, though the evidence had moderate to high risk of bias.^[27] In a trial for stubborn heel pain, shockwave and endoscopic release did not differ significantly.^[28] In 2018, the American College of Foot and Ankle Surgeons rated ultrasonic debridement “uncertain.”^[4] The Patel study’s author advised Tenex’s maker.^[15] We found no published TenJet results in the foot. Its evidence is lab work on cow tendon, 100 elbows, and an industry-sponsored hip study.^[16,29,30] Some insurers call Tenex investigational.^[31,32] Please call our office at 908-215-5953 to inquire about your insurance.

Common questions

Can plantar fasciitis go away on its own?

Often, but it can take a long time. In the Danish study, about half had recovered by five years, and those who recovered took about two years.^[3]

Is Tenex better than open surgery for plantar fasciitis?

We can’t say that yet, because no foot study has compared them. Tenex has low published complication rates.^[21]

Does TenJet work for plantar fasciitis?

It works on the same idea, but we found no published patient results in the foot. A 2025 review found no TenJet study that met its criteria.^[26]

When to see a Foot and Ankle Surgeon or podiatrist