Plantar fasciitis for three years with heel spur. no help from eswt, pt, orthodics, night splints, day casts, icing helps a little. now what?

Surgery: If you feel you exhausted all non surgical options, surgery is the next option.

Heel pain in women: If you have custom orthotics made strong enough and wide enough to keep weight and pressure off your plantar fascia you will be asymptomatic after 3 months of continuous wear. Many women only wear there orthosis in certain shoes and therefore inflame their plantar fascia when not wearing their orthosis. Consistency is key a tight calf muscle must be lengthened not stretched. Do static stretches.

Radio Frequency Abla: If all has failed and pain persists i would consider finding someone in your area that does radio frequency nerve ablation (rfna). It is minimally invasive and has high success rates.

Cortisone injection : Have you tried cortisone injections. They can make a big difference especially if you are already in a good semi rigid or rigid posted functional orthotic. Did you use the night braces that are adjustable so you can continue to increase your flexibility instead of reaching a set point of no further improvement? How about rolling your arch over a frozen water bottle for a few minutes 3 times day.

Surgery : A subtotal plantar fasciotomy either open or laparoscopic will rid you of your pain.

Consider surgery: When plantar fasciitis has become truly chronic and does not respond to eswt, cortisone injections, physical therapy, and conservative measures like orthotics and shoes, a plantar fascial release may be necessary. You might also talk to your doctor about a nerve entrapment that can cause heel pain: tarsal tunnel syndrome. This may need different treatment.

You may have ...: Arthritis. Plantar fasciitis is a major feature of psoriatic arthritis, spondylitis, arthritis with inflammatory bowel disease, reactive arthritis, etc. You have not mentioned steroid injection. The absolutely should be tried. But if you have one of these conditions, you will need other medications, or it will return. See a rheumatologist before even remotely considering surgery!

My treatment: Please do not do any surgery unless your plantar fascia has a significant rupture. My treatment: increase circulation with nightly foot soaks, keep feet warm with socks at bedtime, and increase local circulation and improve pain control by activating the skin reflexes daily. (Principles of Intrinsic Medicine). Continue daily until symptoms are resolved.

THREE CAUSES: There are three general reasons people have heel pain-mechanical, neurologic, or rheumatologic. If all conservative care has failed including ESWT, and the reason is found to be mechanical, my next step is the Topaz procedure and a PRP injection. Regarding PRP, some love it, others hate it. Somewhere throughout this whole treatment, I would have gotten an MRI to measure the PF thickness. Norm=2mm.