What If Plantar Fasciitis Embolization Does Not Work?

Quick Answer

In small published series, roughly one in four to one in three people did not meet the study's definition of success after plantar fasciitis embolization. If PFE does not help, the next steps are to recheck the diagnosis, look at ongoing strain on the heel, and discuss other treatments, which remain available.

Any honest conversation about plantar fasciitis embolization (PFE) has to include this question. PFE helps many of the people described in published studies, but not all of them, and the research is still young. If you are considering the procedure, or you have had it and your heel still hurts, this guide lays out what the studies show about non-response, how long to wait before judging, whether a repeat is ever done, and what choices remain.

How often does PFE not help?

Each study defines success differently, so there is no single number. Here is what the published series report.

Gill and colleagues, 2026 (prospective case series, 24 people). 17 of 24 (70.8%) met the responder definition at 6 months. That means 7 of 24, a little under a third, did not.
Kumar and colleagues, 2026 (retrospective, 12 patients). In 1 of 12, the target vessels could not be treated. Of the 11 who were treated, 8 (72.7%) had at least a 50% drop in pain at 6 months, and 3 did not.
Astani and colleagues, 2026 (retrospective, 41 legs in 34 patients). At 1 month, 57% had more than a 20% improvement in pain. At 6 months, 91.6% did. Five legs (12%) had a repeat procedure by 6 months.
Porcaro and colleagues, 2026 (retrospective, 12 patients, 13 feet). After a first, simpler needle-based treatment, 7 of 13 feet had less than a 50% drop in pain at 1 month and went on to a second procedure.

Read together, these small studies suggest that somewhere around one in four to one in three people did not reach the study's bar for success after a single procedure. That is an estimate from a handful of series with no comparison groups, not a firm rate. There is no randomized trial of PFE yet. Our page on PFE success rates explains how these figures are measured.

How long should you wait before judging the result?

The studies do not agree on a single timeline, and no source sets an official waiting period. What they do show is that relief can arrive at different speeds.

Sometimes early. In the Kumar series, average pain fell from 7.36 to 2.27 out of 10 by the day after the procedure.
Sometimes gradually. In the Gill series, typical pain scores had improved by 54.5% at 1 month and 70.5% at 6 months. In the Astani series, the share of patients with meaningful pain improvement rose from 57% at 1 month to 91.6% at 6 months. A 2021 case report describes pain that began to ease gradually a week after treatment.

Most studies set their main checkpoint at 6 months. The Porcaro group made its decision about a second step at 1 month. So a fair reading is this: a heel that is not better in the first few weeks has not necessarily failed, and a heel that is no better at several months deserves a fresh look. The timing of your own follow-up visits is set by your physician.

Is a repeat procedure ever done?

Yes, repeat treatment appears in the published series, though no study has tested how well it works compared with not repeating.

In the Astani series, 5 of 41 legs (12%) needed a repeat PFE by 6 months.
In the Porcaro series, all 7 feet that had a second, catheter-based procedure improved further, and all 13 feet showed meaningful pain reduction at 6 months. This is a very small retrospective study, and the two steps used different techniques and materials.
In a 2026 prospective study of 32 patients by Tonkaz and Bekci, 5 patients (15.6%) with physically demanding jobs had a mild return of symptoms. They were given heel insoles, and none needed a repeat embolization.
The 2021 case report from Japan planned two sessions a month apart from the start.

Whether a second procedure makes sense for you depends on why the first one fell short, which is the next question.

Questions about your treatment options? Dr. Fox can help.

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This article is part of our Heel Pain Guide.

Why PFE might not help

The pain is not coming from the plantar fascia. This is the first thing to recheck. A trapped nerve, a stress fracture of the heel bone, a thinned heel fat pad and a torn fascia can all imitate plantar fasciitis, and embolization does not treat them. A 2018 review in American Family Physician advises considering a nerve growth called a neuroma when plantar fasciitis treatment is ineffective, and a 2019 review in the same journal suggests imaging to look for another diagnosis when pain lasts beyond three months without responding. See conditions mistaken for plantar fasciitis.

The heel is still being overloaded. PFE does not change the forces on your foot. The 2019 review lists limited ankle flexibility, higher body weight and prolonged standing as risk factors, and in the Tonkaz study the patients whose symptoms returned were those with physically demanding jobs. If the load that irritated the fascia continues, symptoms can persist or come back. Our article on why plantar fasciitis keeps coming back covers this.

Anatomy and technique. In one series, the target vessels could not be reached in 1 of 12 patients. A 2026 study of 38 patients found that the size of the small heel artery relative to the main ankle artery was linked to how well pain relief lasted, although the authors say this needs to be confirmed in larger studies. The Porcaro authors suggest some patients have a more widespread pattern of abnormal vessels that a simpler first treatment may not fully reach.

The abnormal vessels may not be the main driver. Embolization is built on the idea that extra vessels and the nerves that travel with them feed chronic pain. In some heels, other sources of pain may matter more. Research has not yet shown how to identify these patients ahead of time.

A checklist before deciding it has not worked

Has enough time passed? Ask your physician what they expect at your stage.
Is the pain the same as before, or is it a different kind or in a different place? New burning, numbness or pain at rest suggests something else is going on.
Have you kept up calf and plantar fascia stretching and supportive footwear?
Has anything changed in your daily load, such as more hours standing, a new job or new shoes?
Has the diagnosis been confirmed with imaging?

What options remain afterward

PFE does not cut or remove any tissue in the heel. Whether it changes the results of later treatments has not been studied, so ask each specialist. The options people commonly discuss next include:

A renewed course of conservative care. Stretching, strengthening, inserts and night splints remain the foundation, and the American Academy of Orthopaedic Surgeons (AAOS) reports that more than 90% of patients recover with nonsurgical treatment.
Shockwave therapy. The AAOS describes its results as mixed, and notes it is sometimes tried before surgery because the risk is low.
Injections or tissue-focused procedures such as platelet-rich plasma or ultrasonic treatment of the fascia, offered by foot and ankle specialists.
Calf-lengthening surgery for people with a tight calf muscle. In a randomized trial of 40 patients with heel pain for more than 12 months, those who had this surgery plus stretching improved more at 12 months than those who only stretched.
Plantar fascia release. The AAOS says surgery is generally saved for people who have not improved after 12 months of aggressive nonsurgical treatment, and cautions that surgery can itself result in chronic pain and dissatisfaction.

Our guide to alternatives to plantar fasciitis surgery compares these in detail.

When to call sooner

Lack of improvement is not an emergency. These are different. Contact the office promptly, or seek urgent care, if after the procedure you have a foot that turns cold, pale or blue, new numbness, skin color changes or a sore on the foot, bleeding or expanding swelling where the artery was entered, or fever with redness. Published series report no major adverse events, but a 2026 case report describes a blocked artery in the lower leg after PFE. Our page on PFE risks and side effects has more.

Going in with honest expectations

No physician can promise that PFE will work for a particular heel. What a careful physician can do is confirm the diagnosis first, explain what the studies do and do not show, and tell you ahead of time what the plan would be if you do not improve. Dr. Fox, a board-certified vascular surgeon, discusses this at the consultation, including when he would suggest returning to a foot and ankle specialist.

You can read about the procedure itself on the plantar fasciitis embolization page. The heel pain guide gathers the full series, and the embolization guide covers other joints.

Frequently Asked Questions

What percentage of patients do not respond to PFE?

There is no single figure. In one prospective series, 7 of 24 people were not responders at 6 months, and in a retrospective series 3 of 11 did not reach a 50% drop in pain. These are small studies with no comparison group.

How long does it take to know if PFE worked?

Studies show relief can come within days for some people and build over months for others. Most studies judged results at 6 months. Your physician will tell you what to expect at each follow-up.

Can PFE be repeated?

Repeat procedures appear in published series. In one, 5 of 41 legs had a repeat by 6 months. No study has tested how well a repeat works, so the decision is individual.

Can I still have surgery or other treatments if PFE does not help?

Other treatments remain options to discuss. PFE does not cut the plantar fascia, though its effect on later treatments has not been studied.

Why would embolization fail?

The most important reasons to check are a different diagnosis, such as a trapped nerve or stress fracture, and ongoing overload of the heel from long standing, tight calves or body weight.

Keep Reading

Sources

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.

What If Plantar Fasciitis Embolization (PFE) Does Not Work?