Heel pain with the first steps every morning
StemWave plus ultrasound-guided PRP at FirstCall DPC, Santa Rosa Beach
See if I'm a candidateFor a heel, that means we measure the plantar fascia and the Achilles on ultrasound, look for a tear, and make sure the pain is not coming from a nerve or a stress fracture that PRP would do nothing for. A thick, worn fascia on ultrasound is what tells us you are a candidate.
Is this you?
- The first steps out of bed feel like walking on a stone. It eases after a few minutes, then comes back after you sit.
- You have bought the inserts, the night splint and the roller. Six months later you are still limping.
- Your morning run has turned into a morning walk, and the walk hurts too.
- You had a cortisone shot in the heel. It helped. It wore off.
- You are standing on it all day for work and there is no way around that.
If this has been going on for under three months, you do not need PRP yet. Most heels settle with calf loading and time, and I will tell you that if it applies.
How it works
1.Exam and ultrasound
I examine the heel and the calf, then measure the fascia and the Achilles on ultrasound. Over four millimeters thick with a change in texture is the picture we are looking for. We also check for a partial tear, which changes the plan.
2.StemWave sessions
Three StemWave sessions over about two weeks before the injection. Plantar fasciitis is the condition focused acoustic wave was first built for. Fifteen minutes with Ronna each time, sore for a few hours afterward, nothing that keeps you off your feet.
3.PRP under ultrasound
We draw your blood, spin it, and inject the platelet layer into the thickened fascia or tendon while watching the needle on screen. It is sore for a few days. A numbing block beforehand keeps the procedure itself tolerable.
4.Loading plan
Heavy, slow calf raises start within a week, plus a plan for your shoes. The fascia and the Achilles both respond to load. The injection restarts the repair. The loading tells the tissue what to become.
For plantar fasciitis and Achilles tendinopathy we use the Reset package: three StemWave sessions, then one ultrasound-guided PRP injection within two or three days of the last session, then the calf program. A partial tear on ultrasound moves you to Rebuild. Expect two to three months before you trust the heel again.
What the evidence says
For plantar fasciitis that has lasted more than six months, PRP has beaten cortisone in several trials at six and twelve months, because cortisone fades and carries a small risk of weakening the fascia. For the Achilles the evidence is weaker, and loading alone does most of the work. I will tell you which side of that line you are on.
“If I ever have to exaggerate the evidence to justify offering something, I probably shouldn't be offering it.”Dr. Petersen
What it costs
- Rebuild6 StemWave sessions + 1 ultrasound-guided PRP injection$1,895
- Elite Recovery10 StemWave sessions + 2 ultrasound-guided PRP injections$2,995
FirstCall DPC members get 15% off every package.
Both sides or a second site: add $600 per PRP site and $500 per StemWave region.
The exam and the ultrasound are included. HSA and FSA accepted. Financing available.
Dr. Petersen chooses the package at the exam based on what the ultrasound shows. If a single ultrasound-guided PRP injection without StemWave is the right call for you, that is offered through the main practice and he will say so.
Heel pain is one of the most over-treated and under-examined problems I see. People get a cortisone shot in an office that has never looked at the fascia, feel better for a month, then get another one. By the third shot, the fascia is thinner and the problem is worse.
We look first. If the fascia is thick and worn, PRP plus a calf program is a reasonable plan. If it is something else, you should not be paying for PRP.
Meet the physicians
Erik Petersen, DO
Board-certified in Internal Medicine. Twenty years of emergency medicine, and the person holding the ultrasound probe.
Co-founder of FirstCall DPC. Former All-American football player who still thinks a loading program beats a shortcut.
Will Carlson, MD
Board-certified in Internal Medicine. Emergency medicine experience, and the slower, more careful half of this partnership.
Co-founder of FirstCall DPC. He is the one who asks what happens if we are wrong, which is why we rarely are.