How Dr. Cikra helped a teacher take the first step without dreading it.

Our patient was a 50-year-old elementary school teacher on her feet for most of her workday. She came to the LAOSS podiatry clinic with a 14-month history of bilateral heel pain — worse in the morning, worst on the first few steps out of bed, and worst again after she sat down for lunch and tried to stand back up. She described it as a deep bruise feeling under both heels that would ease after about ten minutes of walking and quietly come back through the afternoon.

On exam she had clear tenderness at the plantar fascia insertion on the medial heel of both feet, a tight Achilles complex bilaterally on the silfverskiöld test, and no neurologic findings to suggest tarsal tunnel or radiculopathy as a confounding diagnosis. Weight-bearing X-rays showed small inferior calcaneal spurs bilaterally — a common incidental finding that does not need to be removed and is not the source of the pain. Ultrasound at the bedside showed thickened plantar fascia at the calcaneal origin bilaterally. The diagnosis was straightforward bilateral plantar fasciitis.

She had not arrived without trying. Over the prior 14 months at her primary care office and a sports-medicine clinic, she had completed nine months of night splints (faithfully, every night), eight weeks of structured physical therapy with eccentric heel raises and intrinsic foot strengthening, and two corticosteroid injections — one per foot, separated by about four months. The night splints helped a little. The PT helped a little. The first cortisone shot gave her about six weeks of meaningful relief, and the second one barely registered.

We reviewed all of it with her at the first visit and confirmed two things: she had done a real conservative trial, and she had not done a particularly unusual or low-dose one. The published data on plantar fasciitis make clear that more than 80 percent of patients improve with consistent conservative care over 6 to 12 months — but a meaningful minority do not, and at 14 months she sat in that minority. We laid out the remaining options honestly: continue conservative care (and accept slower progress), try another corticosteroid (with diminishing returns and known risks to the fat pad), consider PRP as an out-of-pocket regenerative option, or move toward surgical fascial release as a last resort. She chose PRP.

Platelet-rich plasma is a concentrate of the patient's own platelets prepared from a small blood draw, then injected at the site of injury. The biologic theory is that the growth factors carried by platelets stimulate a healing response in chronic tendon and fascia injuries that have stalled. The published evidence for PRP in chronic plantar fasciitis is moderate — better than steroid in some randomized trials, similar in others, with response rates broadly in the 70 to 80 percent range and the strongest signals in patients whose conservative care has plateaued.

She fit the patient profile that benefits most: chronic (more than 6 months), bilateral, conservatively pre-treated, no inflammatory or systemic mimic on workup, and willing to accept the trade — a single round of treatment, $700 per foot out of pocket, and a 1-in-4 to 1-in-5 chance she would not improve meaningfully. We had her sign a financial-consent form that listed those numbers explicitly. We did not want her to feel surprised by anything.

We never recommend PRP without three caveats out loud. First, it is self-pay. Insurance plans do not cover PRP for plantar fasciitis, and the out-of-pocket cost at the time of this case was approximately $700 per foot. Second, the response rate is real but not universal. Roughly 20 to 30 percent of patients in the published data do not respond meaningfully — and we have no reliable way to predict who. Third, the timeline is slower than steroid. Cortisone is a faster on-ramp; PRP is a slower one with the goal of more durable improvement.

This patient responded well. That outcome is what made this case worth writing up. We have other PRP patients who did not respond, and the conversation we had with her before the procedure is the same conversation we would have had if she had been one of those patients.

Composite case based on common LAOSS treatment outcomes. Anonymized for patient privacy.