Foot & ankle · London
Plantar fasciitis clinic, stepwise and honest.
Ninety per cent of heel pain settles without an injection or an operation. We match you to the specialist who will start on the right step of the ladder - insoles and loading, structured physio, ultrasound-guided cortisone, PRP, ESWT, or a Tenex or endoscopic release when nothing else has worked.
Why patients choose us
- 01
A foot and ankle specialist, not a general clinic
A named consultant foot and ankle surgeon or specialist musculoskeletal physician, in a unit that does high heel-pain volume.
- 02
The right step on the ladder
Most people never need an injection or surgery. We start with the step that matches your case, not the most expensive one.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private plantar fasciitis pathway costs.
Ranges across our London partner units. Send a short note about your symptoms and we quote firm figures across two or three options.
| Step | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial specialist consultation with ultrasound | £280–£450 | 30–45 min | Same visit |
| Custom orthotics (casted, three-month follow-up) | £350–£650 | 2 visits | 2–3 weeks |
| Ultrasound-guided cortisone injection | £280–£450 | 20 min | Same visit |
| Platelet-rich plasma (PRP), per session | £550–£950 | 45 min | Same visit |
| PRP course of three sessions | £1,400–£2,400 | 3 visits | 2–3 months |
| Extracorporeal shock wave (ESWT), per session | £450–£750 | 20–30 min | Same visit |
| ESWT course of three weekly sessions | £1,200–£1,800 | 3 visits | 3 weeks |
| Tenex FAST or endoscopic plantar fascia release | £4,500–£7,500 | 30–60 min | Day case |
Prices vary by unit, by which consultant sees you, and by whether imaging is added on the day. We come back with a firm quote within one working day.
The journey
From first message to a pain-free first step.
One team through the ladder - so no one keeps repeating the same failed step at the next clinic.
- 01
Before
You tell us how long, how bad, what you have tried
A short, confidential form. Duration of symptoms, morning first-step pain score, prior insoles, physio, injections and imaging.
- 02
Before
We come back with a recommendation
Within one working day: which step on the ladder fits, which centre and specialist, and an indicative price for two or three options.
- 03
Before
We arrange the assessment
Usually within one to two weeks. Ultrasound of the plantar fascia on the day. MRI added when the picture is atypical.
- 04
On the day
Clinical exam and imaging
Windlass test, gastrocnemius tightness assessment, palpation of the medial calcaneal tubercle, and bedside ultrasound to measure fascia thickness.
- 05
On the day
A written plan, in plain English
What is causing your heel pain, which step you start on, and a clear timeline. Stretching sheet, night splint prescription, insole guidance.
- 06
After
Follow-up at 6 and 12 weeks
Progress check, escalation if needed to cortisone, PRP, ESWT or a Tenex or endoscopic release. Baxter’s nerve release considered for entrapment mimics.
- 07
After
Discharge when the first-step pain is gone
A maintenance plan for calf and fascia loading, and a plan for return to running or standing work without relapse.
Assessment
What we look for - and what we rule out.
The classic picture is straightforward. What makes a good clinic is spotting the case that is not classic - a stress fracture, a nerve entrapment, or an inflammatory arthropathy.
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Classic first-step morning pain
Sharp pain under the medial heel with the first steps out of bed, easing after a few minutes of walking, worse again after prolonged sitting.
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Degenerative enthesopathy, not "inflammation"
Chronic plantar fasciopathy at the medial calcaneal tubercle: collagen disorganisation and neovascularisation more than active inflammation.
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Tight calves and a positive windlass test
Gastrocnemius tightness on Silfverskiold, and pain reproduced when the great toe is dorsiflexed - the classic windlass sign.
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Ultrasound shows a fascia over 4 mm
A plantar fascia thicker than 4 mm on ultrasound at the insertion, with hypoechoic change, confirms the clinical diagnosis.
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Atypical picture on MRI
MRI is reserved for the atypical case: to exclude a calcaneal stress fracture, tarsal tunnel syndrome, or Baxter’s nerve entrapment.
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A heel spur on X-ray is not the cause
Calcaneal spurs are common in people without heel pain and common in people with it. They do not need excising and rarely change the plan.
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Weight, footwear and load
A rise in running miles, a job on hard floors, or a recent weight gain often tips a tolerated fasciopathy into a painful one.
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Red flag: bilateral heel pain in a young adult
Bilateral heel pain with morning stiffness, back or eye symptoms needs a rheumatology work-up for seronegative spondyloarthropathy, not another injection.
The ladder
Four steps, in the right order.
The evidence base is clearest for Step 1 and Step 2. Step 3 and Step 4 exist for the resistant case - and are used sparingly.
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Step 1 - Load, stretch, unload
Off-the-shelf arch-support insoles (Superfeet, Vionic), calf and plantar fascia stretching, a night splint, and weight reduction where relevant. This alone settles most cases.
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Step 2 - Custom orthotics and structured physio
Casted custom orthotics reviewed at three months, a structured physiotherapy programme with high-load eccentric calf and fascia work, and dry needling for trigger points.
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Step 3a - Ultrasound-guided cortisone
A targeted cortisone injection gives 60–80% relief at six weeks. We avoid more than three lifetime injections because of the risk of plantar fascia rupture and fat-pad atrophy.
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Step 3b - Platelet-rich plasma (PRP)
One to three PRP sessions a month apart. Evidence is mixed but favourable for chronic cases where cortisone has failed and surgery is being considered.
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Step 3c - Extracorporeal shock wave (ESWT)
Three weekly sessions of focused or radial shock wave, with a 60–70% response rate in resistant cases. No injection, no downtime, useful when steroid is contraindicated.
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Step 4a - Tenex FAST percutaneous fasciotomy
A percutaneous ultrasonic tenotomy that debrides degenerate fascia through a needle-sized incision. Day case, walking boot for two weeks.
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Step 4b - Endoscopic plantar fascia release
A partial release of the medial band of the plantar fascia through two small portals. Reserved for the resistant case after 9–12 months of failed conservative care.
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Step 4c - Baxter’s nerve release
When the picture is nerve-entrapment rather than fascial - burning, numbness, tenderness posterior to the medial tubercle - a Baxter’s nerve decompression is the correct operation.
Our London network
A small panel of heel-pain clinics, we picked them.
Consultant-led foot and ankle centres in London with in-house ultrasound, ESWT, PRP and surgical release pathways.
Fortius Clinic - Foot & Ankle
Sports-medicine led heel pain and Tenex service in central London.
London Foot & Ankle Centre
Consultant-only heel and hindfoot clinic at 108 Harley Street.
HCA The Wellington Hospital
Foot and ankle consultants with same-day ultrasound and injection lists.
ISEH at UCLH
Institute of Sport, Exercise and Health - shock wave and loading programmes.
Chelsea and Westminster Private Sports Medicine
MSK-physician-led plantar fasciitis clinic with PRP and ESWT.
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Consultant foot and ankle surgeons and MSK physicians with heel-pain sub-specialty volume
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Ultrasound in the consulting room, MRI same or next day when indicated
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On-site ESWT, PRP and ultrasound-guided injection lists - no external referrals
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Tenex, endoscopic release and Baxter’s nerve decompression pathways when needed
Safety and prognosis
What to expect - honestly.
Around 90% of plantar fasciitis resolves on a conservative programme within 12 to 18 months. Injections and surgery matter for the resistant 10%.
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Cortisone works, but there is a ceiling
One well-placed ultrasound-guided injection settles most cases for six weeks or more. We avoid more than three lifetime injections because of rupture and fat-pad atrophy.
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Fat-pad atrophy is permanent
Repeated cortisone can thin the heel fat pad, leaving a "walking on bone" feeling that no injection or insole reverses. This drives our step-wise approach.
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PRP evidence is mixed
PRP is a reasonable step between cortisone and surgery in chronic cases. We are honest that the evidence is mixed and that response takes 8–12 weeks.
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ESWT is safe, but not painless
Focused ESWT can be uncomfortable during the session and bruising is common. There is no downtime, and response builds over 8–12 weeks.
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Surgery is a last resort
Endoscopic release relieves 70–80% of resistant cases but can weaken the medial longitudinal arch. We only offer it after 9–12 months of failed conservative care.
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Red flags after any procedure
A sudden pop with loss of arch height after cortisone, spreading redness or fever, or new numbness in the foot - call the unit or go to A&E the same day.
Recognised by major UK insurers
Cover for plantar fasciitis pathways varies by insurer and by procedure. We confirm cover before booking.
Frequently asked
Everything we get asked about plantar fasciitis.
Quick answers on timelines, injections, PRP, ESWT and when surgery is the right call.
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How long does plantar fasciitis take to resolve?
Around 90% of people are pain-free on a conservative plan within 12 to 18 months. First-step morning pain typically settles first, and tolerance for standing and running returns last. The clinic’s job is to get you moving through those months on the right step of the ladder, not to shortcut it with an injection you do not need.
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Is a heel spur causing my pain?
No. Calcaneal heel spurs are common in people without heel pain and common in people with it. Plantar fasciitis is a degenerative enthesopathy of the plantar fascia at the medial calcaneal tubercle - the spur is a bystander. Excising it is almost never the right operation.
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When do I need an MRI?
Most people never need one. Ultrasound in clinic measures fascia thickness and confirms the diagnosis. We add MRI when the picture is atypical - to exclude a calcaneal stress fracture, tarsal tunnel syndrome, or Baxter’s nerve entrapment, all of which change the plan entirely.
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How many cortisone injections can I have?
One well-placed ultrasound-guided injection gives 60–80% relief at six weeks. We avoid more than three injections in a lifetime because of the small but real risks of plantar fascia rupture and permanent heel fat-pad atrophy. If a first injection fails, we usually move to PRP or ESWT rather than repeat it.
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Is PRP or shock wave better?
For a chronic case that has failed cortisone, either is reasonable. ESWT is quicker, needle-free and has three weekly sessions with response over 8–12 weeks. PRP is one to three injections a month apart, with a similar response window. We choose based on your tolerance for injections, your budget, and how the fascia looks on ultrasound.
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When do I need surgery?
Rarely, and only after 9–12 months of a full conservative programme has failed. The options are a Tenex FAST percutaneous fasciotomy, an endoscopic partial plantar fascia release, or - when the pain is nerve-entrapment rather than fascial - a Baxter’s nerve decompression. Choosing the right operation depends on the exam and the imaging.
Ready when you are
Get matched to a plantar fasciitis specialist in London, this week.
Send a short note about your symptoms and we come back within one working day with a named consultant, a step-of-the-ladder recommendation, and an indicative price.
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