How plantar fasciitis embolization works, and what the studies show

By Yosef Golowa, MD, FSIR · Published July 7, 2026 · 4 min read

If you are reading this, you are probably familiar with that sharp, stabbing pain in the heel, and with how excruciating the first step out of bed can be. You have likely tried it all: stretching, icing, new shoes, expensive custom orthotics, physical therapy, injections.

For many people those treatments work. For a significant group who do not respond, the pain becomes chronic, lasting months or years. If you are in that group, plantar fasciitis embolization (PFE) is worth knowing about.

What is actually happening in the foot

In chronic plantar fasciitis, the pain is not simply from a tight or torn ligament. The root of the problem is often a chronic cycle of inflammation, which triggers the growth of tiny abnormal new blood vessels in and around the plantar fascia, a process called angiogenesis.

Those vessels bring with them a network of equally new, highly sensitive nerve endings. The combination of abnormal blood flow and new nerves creates a hotspot of inflammation and pain.

How the procedure targets it

1. A tiny entry point. A puncture about the size of a pencil tip is made in an artery in the leg.
2. Guided by X-ray. Using fluoroscopy, a soft, thin, flexible tube about the thickness of angel hair pasta, called a microcatheter, is navigated to the small arteries in the heel feeding the inflamed area.
3. Blocking the vessels. Microscopic embolic agents are injected. They flow into and block only the tiny abnormal vessels. The main healthy arteries are left untouched.

With the blood supply to the hotspot cut off, the inflammatory cycle stops, the abnormal vessels and the sensitive nerves accompanying them recede, and the fascia can heal.

Is it safe and effective?

• Efficacy. Multiple studies and clinical series report that 80 to 90% of patients undergoing PFE experience significant pain reduction and improved function, with many reporting relief lasting years.
• Safety. PFE is considered a low-risk procedure. Because it is minimally invasive, with no large incisions or stitches, the risks associated with open surgery are avoided.
• Recovery. Most patients walk out the same day and resume light activity the next. Full activity and exercise usually return within a week or two, dramatically faster than the months-long recovery from surgery.

The most common side effects are minor and temporary: bruising or soreness at the insertion site.

Compared with surgery. The traditional surgical option, a plantar fasciotomy, involves cutting part of the ligament. Recovery can take up to three months, it carries a risk of nerve damage, and it can change the structure of the foot. PFE is increasingly seen as a safer alternative to try first.

What is used to block the vessels

You may have heard of imipenem/cilastatin as an antibiotic, so its presence in a foot procedure needs explaining. Researchers are continually looking for the safest effective embolic agent, and studies have explored the off-label use of imipenem/cilastatin as a temporary blocking agent.

When the antibiotic powder is mixed with contrast dye it does not fully dissolve. It forms tiny particles that are the right size to flow into and block the abnormal vessels causing the inflammation. Crucially, those particles are temporary: they last long enough to be effective, then dissolve, leaving no permanent blockage. That adds a margin of safety.

Other temporary materials are being studied for the same purpose, including Lipiodol, an oil derived from poppy seeds, made into an emulsion, as well as other dissolvable particles. This is a developing area, and it shows how the procedure continues to be refined.

What the published studies report

A study in the Journal of Foot & Ankle Surgery followed 66 patients with plantar fasciitis who had not improved with other treatments, for an average of 30 months after ultrasound-guided intra-arterial embolization. Patients experienced significant pain reduction and improved function, the treatment proved safe with only minor side effects such as temporary bruising or skin discoloration, and the improvements lasted for several years.

A smaller series published in the British Journal of Radiology treated 10 patients with chronic plantar fasciitis who had failed prior treatment. Technical success was achieved in 100%, patients reported significant pain reduction and improved quality of life, and no major complications were observed.

Gandhi R, Banker M. Early outcomes of transcatheter arterial embolization using imipenem/cilastatin for plantar fasciitis refractory to conservative therapy. Br J Radiol. 2024 Feb 28;97(1155):544-548. PMID: 38281074.

These are small studies, and more research is needed. But the underlying technique has been used for similar musculoskeletal conditions with good outcomes: genicular artery embolization has been shown in numerous studies to reduce pain from knee osteoarthritis.

Are you a good candidate?

This is not a first-line treatment. You are likely a candidate if you:

• Have a confirmed diagnosis of plantar fasciitis.
• Have had chronic pain for at least six months.
• Have failed to find relief from rest, physical therapy, orthotics, and steroid injections.
• Want to avoid the risks and long recovery of open surgery.

It is also important to have the procedure done by an experienced physician.

To learn more, or to find out whether you are a candidate, call our office at (212) 991-9991 or book an appointment with Dr. Golowa.