Plantar Fasciitis Treatment Without Surgery: Embolization for Chronic Heel Pain

Plantar fasciitis, an inflammation of the tissue band along the sole of the foot, is one of the most common causes of heel pain. For most people the pain resolves with conservative treatment, but for some it continues for many months and interferes with walking, work and sleep. Embolization is a catheter procedure performed by an interventional radiologist: a thin catheter is guided through the blood vessels to small vessels around the heel that are linked to the inflammatory process and to pain. The goal is to reduce blood flow to the area of chronic inflammation, which may help reduce pain in suitable patients.

In chronic inflammation of tendons and connective tissue, small abnormal blood vessels can develop, accompanied by tiny nerve fibers. They are thought to contribute to ongoing pain and local tenderness. During embolization, the physician identifies these vessels with imaging and blocks them selectively. The treatment is not intended to affect the normal blood supply of the foot. It targets only the small inflammatory vessels.

The treatment may be suitable for patients with:

• A diagnosis of plantar fasciitis.
• Heel pain that has lasted many months.
• Pain with the first steps in the morning or after prolonged sitting.
• Difficulty standing or walking for long periods.
• Insufficient improvement after insoles, stretching and physiotherapy.
• Insufficient improvement after injections or shockwave therapy.
• A wish to explore an option before surgery.

Suitability is determined only after a medical evaluation, a review of your medical history and imaging, and an understanding of the treatments you have already tried.

Not all heel pain is plantar fasciitis. The treatment may not be suitable when the source of pain is:

• A stress fracture of the heel bone.
• Nerve compression, or pain that originates in the lower back.
• A tear of the plantar fascia.
• An active infection or wound on the foot.
• Significant peripheral arterial disease in the legs.
• A medical condition that raises the risk of a catheter-based procedure.

This is why the diagnostic stage matters. Before deciding on treatment, it is important to confirm that the procedure fits the patient.

The procedure takes place in an angiography suite under imaging guidance, usually with local anesthesia at the vessel access site. The procedure includes:

• Inserting a thin catheter into a blood vessel.
• Navigating the catheter to the vessels around the heel.
• Identifying the small inflammatory vessels.
• Injecting a controlled amount of embolic material.
• Completing the procedure and a period of observation.

The procedure does not involve an incision in the foot, and it is not orthopedic surgery.

The procedure is usually performed under local anesthesia, sometimes with light sedation at the physician’s discretion. You may feel pressure or mild discomfort at the access site. Afterwards, mild local pain or tenderness at the puncture site is possible and is usually temporary.

• Treatment without surgery and without an incision in the foot.
• A minimally invasive approach.
• A procedure targeted at inflammatory vessels.
• Possible pain reduction in suitable patients.
• A gradual return to walking and activity, according to instructions.
• An option when conservative treatment has not been enough.

Results are not guaranteed, and the response to treatment varies between patients.

Embolization for musculoskeletal pain is a field that has developed in recent years, and the largest body of experience is in the knee and the shoulder. For plantar fasciitis, the data published so far come mainly from small patient series, and long-term follow-up is still limited. For this reason the treatment is considered only after established treatments have been tried, and the consultation includes an open explanation of what is known and what is not yet known.

After the procedure you remain under observation as medically required, and usually go home the same day. Return to routine is gradual, according to the physician’s instructions. After embolization it is usually important to continue stretching, appropriate footwear and tailored exercise. Improvement may be gradual and is not always immediate.

As with any medical procedure, embolization carries possible risks. These may include:

• Local pain at the puncture site.
• A small bruise or hematoma.
• Temporary skin discoloration or tenderness in the foot.
• A reaction to contrast material.
• Unintended effect on nearby blood vessels.
• The need for further treatment if the response is insufficient.

Before the procedure, the risks, benefits and alternatives are explained in a medical consultation.

An interventional radiologist specializes in image-guided, minimally invasive catheter procedures. The vessels of the foot are very small, so precision in identifying the vessels associated with pain, and in blocking them selectively, is essential. Dr. Adam Farkas, a specialist in interventional radiology, performs embolization treatments for joints and soft tissue, tailored to each patient’s condition, diagnosis and imaging findings.

An assessment usually includes:

• A review of your symptoms and how long the pain has lasted.
• The treatments you have already tried.
• A review of existing imaging.
• Risk factors and background conditions.
• An explanation of the benefits, limitations and alternatives.

After that, it is possible to decide whether embolization is a suitable option or whether a different approach is needed.

Contact us to schedule a consultation with Dr. Adam Farkas and check whether plantar fasciitis embolization is right for you.

• Plantar fasciitis: symptoms, diagnosis and treatment options
• Patient guide: before and after plantar fasciitis embolization
• Book a consultation with Dr. Adam Farkas