Direct answer: Chronic heel pain along the bottom of the foot that's worse with the first steps in the morning is the hallmark of plantar fasciitis — and when it persists past the usual stretching, night splints, and orthotic phase, dense fibrous adhesion within the plantar fascia itself is often part of why it isn't resolving. The fascia's normal fibers become disorganized and less able to glide and absorb load, keeping the tissue irritated even after rest. At Novo Soft Tissue in the Denver Tech Center, an exam determines whether adhesion is present and whether radial or focused ESWT — or both — fits the case.
By the time someone reaches out about chronic heel pain, they've usually already tried calf and plantar fascia stretching, night splints, over-the-counter or custom orthotics, ice, and often a cortisone injection or two. These can quiet symptoms temporarily, but none of them directly reorganizes fascia tissue that has already thickened and adhered.
The plantar fascia — the thick band of connective tissue running from the heel to the base of the toes — thickens and develops disorganized, poorly aligned collagen in chronic cases, which is part of why imaging in long-standing plantar fasciitis often shows a measurably thicker fascia than a healthy foot. On exam, this shows up as a fascia that feels dense and non-pliable under direct pressure, rather than pain that's purely positional or purely a first-step phenomenon.
Because the plantar fascia is a broad, relatively superficial band rather than one small deep structure, both radial and focused ESWT have solid support here, and the exam typically favors whichever is better tolerated at the heel — a sensitive area — while still reaching the depth needed.
A 2024 trial of 112 plantar fasciitis patients split between radial and focused shockwave treatment, each run for three weeks, found both produced significant pain and function improvement from baseline with no statistically significant difference between them at any point, including long-term follow-up — meaning the choice between the two often comes down to tolerability and what the exam finds, not one being clearly superior.
A new-patient comprehensive exam is $270 and includes a full history, physical examination, and an explanation of the diagnosis; no treatment is performed on the first visit. Follow-up visits are $90 for a single-region treatment. $180 for focused shockwave treatment. Novo Soft Tissue does not bill insurance directly, but accepts cash, check, major credit cards, HSA, and FSA, and provides documentation you can submit for possible reimbursement.
Request an appointment to have chronic heel pain evaluated for adhesion, or read more about how focused and radial shockwave differ and the four tools used across all conditions.
Last reviewed: September 2026