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Plantar Fasciitis Embolization — for heel pain that won't let go.
When rest, physical therapy, orthotics, and injections haven’t worked, Plantar Fasciitis Embolization (PFE) offers a minimally invasive alternative to surgery — targeting the abnormal blood vessels that drive chronic heel pain, with fewer complications and a quicker recovery.
Plantar Fasciitis Embolization (PFE) is a minimally invasive, image-guided procedure for chronic heel pain that hasn’t responded to conservative care. Instead of cutting the plantar fascia, it uses an absorbable, nonpermanent embolic to block the abnormal blood vessels that perpetuate pain. Published studies report roughly 80–90% pain improvement, with benefits lasting up to a year and beyond — under local anesthesia, in about 30–60 minutes, with no downtime.
What is plantar fasciitis?
Plantar fasciitis is one of the most common causes of heel pain, affecting approximately 10% of the population at some point in their lives.
The plantar fascia is a thick band of tissue that runs across the bottom of the foot, connecting the heel bone to the toes. Plantar fasciitis develops when repeated stress and strain on this tissue lead to microtears and irritation, and it can cause sharp pain — typically felt with the first steps in the morning or after long periods of inactivity. Common risk factors include prolonged standing, higher body weight, improper footwear, and high-impact sports like running or basketball.
While conservative treatments such as rest, physical therapy, and orthotics provide relief for many people, some patients with chronic or severe plantar fasciitis find themselves in need of more advanced interventions. Embolization has emerged as a promising, minimally invasive option for treating refractory cases, offering an alternative to surgery with fewer complications and quicker recovery times.
The key insight behind embolization: in chronic plantar fasciitis, the persistent pain is driven less by ordinary inflammation and more by abnormal neovascularization — new blood vessels, carrying pain-sensing nerves, that grow into the damaged fascia. Reducing those vessels targets the source of the pain directly.1,3
What are the treatment options for plantar fasciitis?
Plantar fasciitis results from repeated stress and strain on the plantar fascia, leading to microtears and pain — particularly in the heel. First-line care is conservative and works well for most people.
Common risk factors include prolonged standing, obesity, improper footwear, and high-impact sports like running or basketball. Traditional treatments focus on reducing strain on the plantar fascia and easing symptoms. These treatments include:
- Rest and ice — reducing physical activity and applying ice can help decrease pain and swelling.
- Physical therapy — stretching exercises and strengthening the calf muscles can reduce stress on the plantar fascia.
- Orthotic devices — custom-made insoles or heel cups support the foot and reduce strain on the plantar fascia.
- NSAIDs — medications such as ibuprofen or naproxen are often used to help reduce pain.
- Steroid injections — corticosteroid injections can relieve severe symptoms, though their effects are often temporary, and repeated use can cause tissue damage.
Despite the effectiveness of these treatments for many, about 10% of individuals with plantar fasciitis will not experience relief through conservative measures and may require more aggressive treatments such as surgery or newer, minimally invasive procedures like embolization.
How does embolization treat plantar fasciitis?
Embolization is a minimally invasive procedure that treats the pain mechanism directly — by blocking the abnormal blood vessels that supply the painful tissue, without cutting the fascia.
Embolization has been in use for over 30 years, traditionally to treat conditions such as cancers, enlarged prostates, bleeding, pain, vascular disorders, and tumors, among others. More recently, the technique has been adapted to treat musculoskeletal conditions like plantar fasciitis by targeting the abnormal blood vessels that supply the affected tissue — an approach called Plantar Fasciitis Embolization (PFE).
How the PFE procedure works
Plantar Fasciitis Embolization (PFE) is performed by our double board-certified interventional radiologist under local anesthesia. The entire procedure usually takes about 30–60 minutes and is done on an outpatient basis, meaning patients can go home the same day:
A small numbing injection
The access site near the ankle is numbed. The procedure is performed under local anesthesia — no general anesthesia is needed.
Place the catheter
A tiny “IV-like” catheter is inserted into the blood vessel at the ankle, using real-time ultrasound and sometimes X-ray imaging.
Block the abnormal vessels
Once the catheter is in position, an absorbable, nonpermanent embolic is introduced to block the abnormal vessels while leaving normal vessels intact — reducing pain in the affected area.
Go home the same day
The catheter is removed and a small dressing applied. Most patients report minimal discomfort and can resume normal activities within a few days.
Because the procedure cuts off blood supply only to the abnormal vessels while sparing normal ones, it reduces pain at its source. There is no downtime for this procedure.
Dr. Allaei has seen first-hand how Dr. Yuji Okuno — who has conducted much of the early research on musculoskeletal embolization — treats plantar fasciitis patients in Japan, and has employed a similar method in our practice.
Benefits of Plantar Fasciitis Embolization (PFE)
PFE offers effective, evidence-supported pain relief with less trauma, faster recovery, and fewer complications than traditional surgery.
Unlike traditional surgery, which requires incisions and longer recovery times, embolization is performed through a small puncture in the skin. This results in less trauma to the surrounding tissues, minimal scarring, and a reduced risk of infection.
Several studies have shown that embolization can significantly reduce pain in patients with chronic plantar fasciitis. Okuno et al. reported that roughly 80% of patients experienced substantial pain relief after embolization, with many reporting long-lasting benefits even after one year of follow-up.3 A separate report in the Journal of Vascular and Interventional Radiology described up to a 90% reduction in pain for patients with refractory plantar fasciitis.3,4 Dr. Allaei has seen first-hand how Dr. Okuno treats patients in Japan with plantar fasciitis and has employed a similar method.
Compared to surgical options such as plantar fasciotomy, embolization offers a quicker recovery time. Most patients are able to return to their normal activities within a few days, whereas recovery from surgery can take several weeks to months.
Embolization has been shown to have fewer complications than traditional surgery. Because there is no need for incisions or cutting of the plantar fascia, the risk of nerve damage, infection, or weakening of the foot’s support structures is significantly reduced. Patients undergoing embolization also avoid the long-term risks associated with steroid injections, such as tendon weakening or rupture. Additionally, Dr. Allaei uses an absorbable, nonpermanent embolic rather than a permanent particle, which further reduces the risk of the procedure.
For individuals who have not found relief through conservative treatments but wish to avoid surgery, embolization provides an attractive alternative. It offers effective pain relief without the need for invasive surgical procedures.
How effective is embolization for plantar fasciitis?
Clinical studies have reported high success rates for embolization as a treatment for chronic plantar fasciitis.
In the study by Okuno et al., about 80% of patients experienced significant improvements in pain and quality of life following the procedure.3 Similarly, a retrospective study of patients with chronic heel pain found a success rate of over 85% in reducing pain and improving function, with sustained benefit on long-term follow-up.5
These success rates are comparable to — if not better than — those reported for traditional surgical interventions such as plantar fasciotomy, which has a success rate of around 70% to 90% but carries a higher risk of complications and longer recovery times.2
What are the potential risks of embolization treatment?
While embolization is generally considered safe and well tolerated, as with any medical procedure there are some potential risks — most of them minor and short-lived.
These may include:
- Infection — although rare, there is a small risk of infection at the catheter insertion site.
- Non-target embolization — in some cases, the embolic may affect vessels that were not intended to be targeted, potentially causing tissue damage. Dr. Allaei uses an absorbable, nonpermanent embolic, which significantly reduces this risk; this follows Dr. Okuno's approach, who has done much of the early research on this treatment.
- Temporary pain— some patients may experience a temporary increase in pain during or just after the procedure, which subsides. We typically do not need to prescribe any pain medication.
Overall, the risks associated with embolization are minimal — especially when compared to the potential risks of surgery or long-term steroid use.
Who is a good candidate for plantar fasciitis embolization?
PFE is best suited for patients with chronic or severe heel pain that hasn't responded to conservative care, and who want to avoid surgery.
You may be a candidate if you:
- Have chronic or severe plantar fasciitis that has persisted despite treatment
- Have not found relief from rest, physical therapy, orthotics, NSAIDs, or steroid injections
- Want to avoid surgery or are not an ideal surgical candidate
- Prefer minimal downtime and a faster recovery
Embolization is generally not used for new or mild cases that are still improving with conservative care. A consultation with imaging review helps determine whether you’re a good fit.
How does PFE compare to plantar fasciitis surgery?
PFE offers comparable pain relief to surgery, but through a small puncture instead of cutting the fascia — with lower risk and a recovery measured in days, not months.
- Small skin puncture — no cutting of the fascia
- Local anesthesia only
- Same-day, outpatient · no downtime
- Return to activity in days
- Lower complication risk
- Cuts or releases the plantar fascia
- Requires anesthesia
- Recovery of weeks to months
- Risk of nerve damage, infection, arch weakening
- Success rate ~70–90%
| Feature | Embolization (PFE) | Surgery |
|---|---|---|
| Invasiveness | Small needle puncture | Open / endoscopic release |
| Anesthesia | Local | Regional or general |
| Procedure time | ~30–60 min | Varies |
| Recovery | Days (no downtime) | Weeks to months |
| Pain relief | ~80–90% | ~70–90% |
| Fascia cut? | No | Yes |
| Repeatable | Yes | Limited |
Why embolization for plantar fasciitis?
Embolization is an innovative, minimally invasive option for patients with chronic plantar fasciitis who have not found relief through conservative measures.
By targeting the abnormal blood vessels that contribute to chronic pain, embolization can provide significant and long-lasting relief with minimal risks and quicker recovery times compared to traditional surgery. As more research continues to support its effectiveness, embolization may become a more widely accepted alternative to surgery for treating plantar fasciitis — offering hope to those suffering from this painful condition.
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Why CVI?
Our center specializes in embolization, and our staff is uniquely trained to care for these procedures from the pre-op through the post-op period.
Our specialist performs a high volume of embolization — not only for the foot, knee, and shoulder, but also in more complex, higher-risk organs such as the kidney, thyroid, liver, lung, uterus, and prostate. Dr. Allaei has employed a similar technique to that of Dr. Okuno, who first discovered the benefits of embolization for musculoskeletal issues, and brings this experience from Japan to our practice. Patients are often surprised at how quick and simple the procedure was for them — a result that comes from the experience of a specialist who performs a wide variety of complex embolizations safely. This diversity of experience enables our specialist to treat complex cases safely and effectively.
Our specialist continually keeps up with the research to ensure he brings the best and newest technology and technique to our center. We are also always collecting feedback from patients and refining how we provide care, so that patients have the best possible experience.
Plantar fasciitis embolization: common questions
Is plantar fasciitis inflammatory or degenerative?
Plantar fasciitis begins with repeated stress and microtears of the plantar fascia. In chronic cases it behaves as a largely degenerative process: researchers consistently observe abnormal neovascularization (new blood vessels) growing into the fascia, accompanied by pain-sensing nerve fibers that perpetuate pain. This is why anti-inflammatory treatments often provide only short-term relief — and why treating the abnormal vessels directly with embolization can help.
What is plantar fasciitis embolization (PFE)?
PFE is a minimally invasive, image-guided procedure that treats chronic heel pain by blocking the abnormal blood vessels supplying the painful tissue. An absorbable, nonpermanent embolic is delivered through a tiny catheter placed at the ankle, reducing abnormal blood flow and pain while leaving the plantar fascia intact.
How effective is embolization for chronic plantar fasciitis?
Published studies report high success rates. Okuno et al. reported about 80% of patients experiencing substantial pain relief, with a separate report describing up to a 90% reduction in pain for refractory cases and a retrospective study finding a success rate over 85%. These results are comparable to, or better than, surgery (70–90% success) but with lower complication risk.
Is plantar fasciitis embolization safe?
PFE is generally considered safe and well tolerated. Reported risks are usually minor and short-lived: rare infection at the insertion site, the small possibility of non-target embolization, and a temporary increase in pain that subsides. Using an absorbable, nonpermanent embolic significantly reduces the risk of non-target embolization. The procedure uses local anesthesia only.
How long is recovery after the procedure?
There is no downtime. The procedure takes about 30–60 minutes, is done on an outpatient basis, and most patients return to normal activities within a few days. By contrast, recovery from plantar fasciotomy surgery can take weeks to months.
Who is a good candidate for PFE?
PFE is best for patients with chronic or severe plantar fasciitis that hasn’t responded to rest, physical therapy, orthotics, NSAIDs, and steroid injections, and who want to avoid surgery or aren’t ideal surgical candidates. It’s not typically used for new or mild cases still improving with conservative care.
How does PFE compare to plantar fasciitis surgery?
PFE is performed through a small puncture under local anesthesia, same-day, with no cutting of the fascia and recovery in days. Surgery cuts the fascia, requires anesthesia, carries higher risk of nerve damage, infection, and arch weakening, and recovery takes weeks to months. Pain relief is comparable — about 80–90% for PFE versus 70–90% for surgery.
What embolic is used, and why does it matter?
Dr. Allaei uses an absorbable, nonpermanent embolic rather than a permanent particle. Because the material is temporary, it blocks the abnormal vessels feeding the painful tissue and then resorbs, which further reduces the risk of non-target embolization and the overall risk of the procedure. This follows the approach used by Dr. Okuno, who has conducted much of the early research on this treatment.
Other musculoskeletal conditions we treat
What do you need to do next?
Request an appointment to meet with our embolization doctor, who will review your imaging, labs, and history to determine whether you’re a candidate for the procedure and the outcomes you can expect. Appointments are available via online video telehealth or in person at one of our offices in Los Angeles, Orange County, or San Diego, depending on the doctor’s availability.
Sources
- Buchbinder R. Plantar fasciitis. N Engl J Med. 2004;350(21):2159–2166. doi:10.1056/NEJMcp032745
- Davies MS, Weiss GA, Saxby TS. Plantar fasciitis: how successful is surgical intervention? Foot Ankle Int. 1999;20(12):803–807. doi:10.1177/107110079902001207
- Okuno Y, Matsumura N, Oguro S. Transcatheter arterial embolization using imipenem/cilastatin sodium for tendinopathy and enthesopathy refractory to nonsurgical management. J Vasc Interv Radiol. 2013;24(6):787–792. doi:10.1016/j.jvir.2013.02.033
- Gandhi R, Banker M. Early outcomes of transcatheter arterial embolization using imipenem/cilastatin for plantar fasciitis refractory to conservative therapy. Br J Radiol. 2024;97(1155):544–548. doi:10.1093/bjr/tqae012
- Sasaki T, Shibuya M, Miyazaki K, et al. Clinical results of ultrasound-guided intra-arterial embolization targeting abnormal neovessels for plantar fasciitis: 66 cases with up to 4 years of follow-up. Foot Ankle Surg. 2024. doi:10.1016/j.fas.2024.07.009
- Epelboym Y, Glaser C, Lan Z, et al. Transcatheter arterial tendinopathy embolization as a treatment for painful and refractory tendinopathy: a systematic review and meta-analysis. Skeletal Radiol. 2024;53:2429–2435. doi:10.1007/s00256-024-04649-9
