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Plantar Fasciitis

Image-guided plantar fasciitis treatment in NYC. Ultrasound diagnosis, PRP, corticosteroid injection, and shockwave by Dr. Alex Movshis.

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What to expect at your first visit

A 45-minute diagnostic consultation with Dr. Movshis. Review of any prior imaging (bring MRI, X-ray, or CT on CD or via portal). Physical exam and discussion of your history. A clear diagnosis and a treatment plan by the end of the visit.

If a procedure is indicated, it's typically scheduled within 1–2 weeks at the same office.

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Plantar fasciitis is the most common cause of heel pain in adults, affecting an estimated 2 million Americans each year and roughly 1 in 10 people over a lifetime. It is also one of the most over-diagnosed and under-treated conditions in foot care — many cases of “plantar fasciitis” are actually mimicking conditions (Baxter’s neuropathy, calcaneal stress fracture, fat pad atrophy, tarsal tunnel, S1 radiculopathy) that require completely different treatment.

At Modal Pain Management in Midtown Manhattan, Dr. Alex Movshis uses a focused clinical exam, bedside ultrasound, and an evidence-based, image-guided treatment ladder to diagnose and treat plantar fasciitis correctly the first time. PRP (platelet-rich plasma) is the preferred first-line injection for chronic cases because it addresses the underlying tendinopathy rather than just suppressing inflammation; ultrasound-guided corticosteroid injection is used selectively for acute, severe pain. Most patients are evaluated, diagnosed, and (when appropriate) treated in a single office visit.

This page covers what plantar fasciitis actually is, the conditions it is most commonly confused with, the role of ultrasound in diagnosis, the evidence-based treatment ladder, and why image guidance and PRP-first philosophy produce better long-term outcomes than the historical default of repeated blind cortisone injections.

What Is Plantar Fasciitis?

Plantar fasciitis is a degenerative injury — a tendinopathy — of the plantar fascia, the thick band of connective tissue that runs along the bottom of the foot from the heel bone (calcaneus) to the base of the toes. The injury occurs at or near the medial calcaneal tubercle, where the fascia attaches to the inside-bottom of the heel bone, and is driven by repeated tensile load (walking, running, standing) combined with insufficient recovery and (often) calf tightness or footwear problems.

Despite the historical name “fasciitis” (which implies inflammation), modern histological studies show that established plantar fasciitis is primarily a tendinosis — disorganized collagen fibers, microtears, and abnormal blood vessel ingrowth — rather than active inflammation. This is why pure anti-inflammatory treatment (NSAIDs, repeated cortisone) often provides incomplete or short-lived relief, and why treatments that stimulate tendon healing (PRP, eccentric loading, shockwave therapy) are increasingly favored in the modern evidence base.

The classic patient is a runner, dancer, retail or restaurant worker, parent on their feet all day, or someone with a recent change in activity, footwear, or bodyweight. Peak incidence is age 40–60. The hallmark symptom is sharp medial heel pain with the first steps in the morning or after prolonged sitting, which improves after a few minutes of walking, then often returns after prolonged standing or activity later in the day.

Plantar Fasciitis vs. Other Causes of Heel Pain

Heel pain has several possible causes that look similar on the surface but require completely different treatment. At Modal Pain Management we systematically rule out each one:

  • Plantar fasciitis — sharp medial heel pain, worst with the first steps in the morning, tenderness directly over the medial calcaneal tubercle.
  • Calcaneal stress fracture — diffuse heel pain that worsens with weight-bearing throughout the day (rather than improving after the first few steps), positive squeeze test, often a recent increase in running mileage. MRI confirms.
  • Fat pad atrophy — central (rather than medial) heel pain in older patients or after repeated cortisone injections; the fat pad feels thin on exam.
  • Baxter’s neuropathy (first branch of the lateral plantar nerve) — chronic medial heel pain that does not respond to plantar fasciitis treatment, positive Tinel’s sign over the nerve as it passes between the abductor hallucis and quadratus plantae. Frequently misdiagnosed as treatment-resistant plantar fasciitis.
  • Tarsal tunnel syndrome — burning, tingling, or numbness on the bottom of the foot from compression of the posterior tibial nerve at the medial ankle.
  • S1 radiculopathy (sciatica) — heel and lateral foot pain referred from the S1 nerve root, with associated low back pain, calf pain, weakness in plantar flexion, and an absent ankle reflex.
  • Retrocalcaneal bursitis or insertional Achilles tendinopathy — pain at the back of the heel rather than the bottom.
  • Posterior tibial tendinopathy — pain along the inside of the foot and ankle in patients with progressive arch collapse (acquired flat foot).

A focused exam plus bedside ultrasound resolves most of these on the first visit. MRI is reserved for atypical or refractory cases.

Diagnosis at Modal Pain Management

A first-visit plantar fasciitis evaluation at Modal Pain Management includes:

  1. Focused history — onset (acute vs. insidious), pain pattern (first-step pain in the morning is the hallmark), recent changes in activity, footwear, or bodyweight, prior treatments and their effect, and any back or calf symptoms that might suggest a different diagnosis.
  2. Physical examination — inspection of the foot and arch (high-arch vs. flat foot), palpation of the medial calcaneal tubercle (the classic tender point), windlass test (passive dorsiflexion of the great toe reproduces heel pain in plantar fasciitis), Tinel’s sign over the tibial nerve and Baxter’s nerve, calf flexibility (Silfverskiöld test), and a focused neurological exam to rule out S1 radiculopathy.
  3. Bedside ultrasound — visualization of the plantar fascia at the medial calcaneal tubercle. A normal fascia is 2–4 mm thick; a thickness greater than 4 mm is consistent with plantar fasciitis, and greater than 5 mm typically indicates more severe disease that benefits from injection or shockwave. Ultrasound also identifies hypoechoic areas of tendinosis, partial tears, calcaneal spurs, neovascularization, and — critically — guides the injection if one is performed.
  4. Targeted imaging — X-ray if there is concern for a calcaneal stress fracture or large bone spur; MRI for atypical presentations, suspected stress fracture, or before considering surgery.

The single-visit diagnostic workflow with bedside ultrasound is one of the main reasons patients with chronic, undifferentiated heel pain often achieve faster definitive answers at Modal Pain Management than through serial referral.

Heel pain that hasn't responded to stretching and supportive shoes? Book a plantar fasciitis evaluation with Dr. Movshis — same-week appointments at our Midtown Manhattan office. Or call (646) 290-6660.

Image-Guided Treatment Ladder

The evidence-based treatment for plantar fasciitis follows a structured ladder. About 80–90% of patients resolve in the first 1–2 steps; only a small minority need to escalate to injection or beyond.

Step 1: Conservative Treatment (Weeks 0–6)

For most patients with acute or mild symptoms, the first 4–6 weeks emphasize structured stretching, footwear correction, and activity modification:

  • Plantar fascia-specific stretching (DiGiovanni protocol) — sit with the affected leg crossed over the other, pull the toes back toward the shin until you feel a stretch in the arch, hold for 10 seconds, repeat 10 times, perform 3 times daily (especially before getting out of bed in the morning). This has the strongest single-intervention evidence base for plantar fasciitis.
  • Calf stretching — gastrocnemius (knee straight) and soleus (knee bent) stretches, 30 seconds, 3 sets, 2–3 times daily.
  • Supportive footwear — replace flat or worn-out shoes with supportive shoes appropriate for the patient’s foot type. Avoid going barefoot on hard surfaces.
  • Over-the-counter or prescription orthotics — heel cups, arch supports, or custom orthotics matched to the foot.
  • Activity modification — temporary reduction in running mileage, intensity, and standing time; cross-train with low-impact exercise (swimming, cycling, elliptical).
  • NSAIDs for short-term symptom control if you tolerate them (naproxen 500 mg twice daily for 7–10 days, with food).
  • Night splint — particularly helpful for patients with severe morning heel pain; holds the foot in a stretched position overnight.

About 80–90% of plantar fasciitis cases resolve with this approach within 6–12 weeks.

Step 2: PRP (Platelet-Rich Plasma) Injection — Preferred First Injection (Weeks 6–12+)

For patients whose pain persists beyond 4–6 weeks of structured conservative care, or for chronic plantar fasciitis on ultrasound (fascia thickness >4 mm with hypoechoic changes), PRP injection is the preferred first injection in the modern evidence base. PRP uses a small sample of the patient’s own blood, processed in-office to concentrate the platelets, then injected directly into the damaged plantar fascia under real-time ultrasound guidance. The growth factors released by the platelets stimulate genuine tendon healing rather than simply suppressing inflammation.

PRP takes longer to work than cortisone (full effect at 6–12 weeks, with a temporary increase in soreness in the first 1–2 weeks as the healing response begins), but multiple randomized trials show 70–85% of patients with chronic plantar fasciitis achieve durable relief at 12+ months — substantially better long-term outcomes than cortisone. PRP is typically not covered by insurance and has an out-of-pocket cost, which we discuss transparently before scheduling.

Step 3: Ultrasound-Guided Corticosteroid Injection (Selected Cases)

Ultrasound-guided corticosteroid injection is appropriate in selected scenarios — typically acute, severe pain where a patient absolutely must function in the next 2–4 weeks (a critical work or athletic event). Cortisone provides faster initial relief (1–2 weeks to peak effect) but is associated with higher 6- and 12-month recurrence rates. Ultrasound guidance is essential: blind heel injections frequently miss the fascia and deposit medication in the fat pad, which both reduces effectiveness and increases the risk of fat pad atrophy and plantar fascia rupture (a small but real risk of about 2–10% in older studies of repeated blind injection). We do not repeat cortisone injections in the plantar fascia within 3–6 months and do not perform more than 2–3 injections per fascia over the patient’s lifetime.

Step 4: Extracorporeal Shockwave Therapy (ESWT) for Refractory Cases

For chronic, refractory plantar fasciitis (>6 months) that has not adequately responded to conservative care and injection, extracorporeal shockwave therapy (ESWT) is an evidence-based next step. Shockwave delivers controlled high-energy acoustic waves to the plantar fascia, stimulating a healing response without the need for injection. ESWT has good evidence in chronic plantar fasciitis, with success rates of 60–80% in patients who have failed first-line injection. It is performed in 2–3 sessions over 2–4 weeks. We coordinate ESWT referral with experienced operators in NYC and integrate it into a comprehensive treatment plan.

When Surgery Is Considered

Surgical plantar fascia release (open or endoscopic) is reserved for the small subset of patients (<5%) with chronic, severe plantar fasciitis that has not responded to 6–12 months of structured non-operative treatment including PRP and shockwave. We coordinate referrals to NYC orthopedic foot-and-ankle specialists when surgery becomes appropriate — but the great majority of patients avoid this pathway.

Physical Therapy and Self-Care

Image-guided injection accelerates pain relief, but durable recovery requires addressing the underlying fascia, calf, and biomechanics. A targeted plantar fasciitis program typically includes:

  • Plantar fascia-specific stretching (DiGiovanni protocol) — the single highest-evidence intervention; performed 3 times daily including before getting out of bed in the morning.
  • Calf stretching — gastrocnemius and soleus, twice daily.
  • Eccentric calf strengthening — heel drops on a step, slow controlled lengthening contractions, 3 sets of 15.
  • Intrinsic foot strengthening — toe scrunches with a towel, marble pickups, short-foot exercise.
  • Footwear and orthotic correction — supportive shoes with appropriate arch support, prescription orthotics for severe pes planus or pes cavus, avoidance of going barefoot or wearing flip-flops on hard surfaces.
  • Training-load management for runners — avoid sudden increases in mileage or intensity, follow the 10% rule (no more than 10% increase in weekly mileage), build in proper recovery.
  • Self-care — frozen water bottle rolling under the arch for 10 minutes after activity, ice for 15 minutes after long days on the feet, night splint for severe morning pain.

Most patients see meaningful improvement within 6–12 weeks of starting structured rehab combined with appropriate injection.

When to Seek Specialist Care

See a pain specialist for plantar fasciitis evaluation if any of the following apply:

  • Heel pain that has not improved with 4–6 weeks of plantar fascia stretching, calf stretching, supportive footwear, and activity modification.
  • Pain that is interfering with work, sleep, or daily activities (taking the first steps in the morning, walking the dog, standing at work).
  • Symptoms that have been present for more than 3 months despite home treatment.
  • A previous episode that resolved and has now recurred.
  • Pain that is atypical (central rather than medial heel pain, pain that worsens through the day rather than improving with the first few steps, associated back or calf symptoms, burning or tingling sensation) — these patterns suggest a different diagnosis that needs to be ruled out.

Red-flag symptoms — sudden severe heel pain after a “pop” while walking or running (suspicious for plantar fascia rupture), inability to bear weight, fever or warmth in the heel (concern for infection or septic joint), or numbness in the foot — require prompt evaluation rather than an outpatient plantar fasciitis workup.

Why Modal Pain Management for Plantar Fasciitis in NYC

Modal Pain Management is a focused, physician-owned interventional pain practice in Midtown Manhattan. Dr. Alex Movshis is dual board-certified in Anesthesiology and Pain Medicine, completed pain medicine fellowship training at NYU Langone, and is on staff at NewYork-Presbyterian and Lenox Hill Hospital. NPI 1942741160 — see our evidence and credentials page and the physician bio for full verification.

Three things differentiate plantar fasciitis care at Modal Pain Management:

  • Single-visit diagnosis with bedside ultrasound. A focused exam plus real-time ultrasound imaging of the plantar fascia — at the consultation visit — eliminates the back-and-forth of separate imaging appointments, measures fascia thickness objectively, and screens for the mimickers (Baxter’s neuropathy, calcaneal stress fracture, S1 radiculopathy) that are commonly missed in patients treated for plantar fasciitis without lasting relief.
  • Image-guided, PRP-first treatment philosophy. Every injection is performed under real-time ultrasound guidance — blind heel injections are substantially less accurate and carry higher risks. The evidence base for chronic plantar fasciitis now favors PRP over cortisone for long-term outcomes, and we use PRP as the preferred first-line injection for most patients with chronic disease, reserving cortisone for selected acute scenarios.
  • Coordinated medical, interventional, and rehabilitation plan. We work directly with NYC physical therapists who specialize in lower-extremity tendinopathy, coordinate ESWT referral when needed, and build out the full footwear, orthotic, and training-load plan that converts injection benefit into durable recovery.

Office: 369 Lexington Avenue, Floor 25, New York, NY 10017. Same-week appointments available. Most major insurance accepted for diagnostic visits and corticosteroid injections — verify your benefits or call (646) 290-6660 and our team will check coverage for you. PRP and ESWT have associated out-of-pocket costs that we discuss transparently before scheduling.

Treatment Options for Plantar Fasciitis

Your treatment plan will be customized based on your specific condition and goals.

Joint & Soft Tissue Injections

Ultrasound-guided PRP (preferred) and selective corticosteroid injection at the medial calcaneal tubercle

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Trigger Point Injections

Address compensatory calf and intrinsic foot muscle tension contributing to fascial load

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Nerve Blocks

Diagnostic blocks to differentiate Baxter's neuropathy and tarsal tunnel from true plantar fasciitis

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Physical Therapy

Plantar fascia-specific stretching (DiGiovanni protocol), calf flexibility, intrinsic foot strengthening, footwear/orthotic correction

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Insurance May Cover Your Plantar Fasciitis Treatment

We work with most major insurance providers. Let us verify your benefits before your first visit — at no cost or obligation.

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Why Choose Modal Pain Management?

Mount Sinai Fellowship-Trained

Board-certified with fellowship training in interventional pain medicine at the Icahn School of Medicine at Mount Sinai.

In-Office Ultrasound & Fluoroscopy

Image-guided injections performed in-suite — no hospital referral, no waiting weeks for outside imaging.

Same-Site PT, Chiro & IV Therapy

Coordinated non-surgical care under one roof at 369 Lexington Avenue — physical therapy, chiropractic, and IV therapy all on site.

Non-Opioid by Design

Treatment plans built around interventional, regenerative, and rehabilitative care — not pills.

Frequently Asked Questions About Plantar Fasciitis

Yes — when used correctly, image-guided injections are one of the most effective treatments for plantar fasciitis that has not responded to 4–6 weeks of conservative care. The two main injection options are corticosteroid (cortisone) and PRP (platelet-rich plasma), and they work very differently. Corticosteroid injection is the most studied and provides faster short-term relief — most patients notice meaningful improvement within 1–2 weeks, with peak relief at 4–6 weeks. The trade-off is that the effect tends to wear off after 3–6 months and there is a small but real risk of plantar fascia rupture (about 2–10% in older studies) and fat pad atrophy with repeated injection. PRP — a concentrated preparation of the patient's own platelets injected directly into the damaged plantar fascia under ultrasound guidance — works more slowly (full effect at 6–12 weeks) but addresses the underlying tendinopathy rather than just suppressing inflammation, and produces substantially better long-term outcomes at 6–12 months in multiple randomized trials. The single most important factor in injection success is ultrasound guidance — blind injections frequently miss the target or deposit medication in the fat pad rather than the fascia, dramatically reducing both effectiveness and safety. At Modal Pain Management, every injection is performed under real-time ultrasound to confirm needle placement at the medial calcaneal tubercle and to monitor medication distribution within the plantar fascia.

It depends on the type of injection and on whether the underlying biomechanical drivers are addressed alongside the procedure. Corticosteroid (cortisone) injection typically provides 3–6 months of meaningful relief, with the maximum effect at 4–6 weeks. About 40–60% of patients have a single injection that ends their plantar fasciitis episode entirely (when combined with proper rehabilitation and footwear changes); the other 40–60% experience partial or temporary relief and may benefit from a second injection or escalation to PRP. We do not repeat cortisone injections in the plantar fascia within 3–6 months because of the small but real risk of plantar fascia rupture and fat pad atrophy with repeated steroid exposure. PRP injection takes longer to work (full effect at 6–12 weeks) but produces longer-lasting relief — multiple randomized trials show PRP outperforming cortisone at 6 and 12 months. About 70–85% of patients with chronic plantar fasciitis have durable relief at 12+ months after a PRP injection, particularly when paired with structured plantar fascia-specific stretching, calf flexibility work, and footwear correction. Recurrence is common when the underlying cause — calf tightness, training error, footwear, weight, or biomechanics — is not corrected, regardless of which injection is used.

Yes — you can walk immediately after a plantar fasciitis injection, but you should stay off the foot for high-impact activity for the first 24–48 hours. Most patients walk out of the office and drive themselves home. The injection site may be sore for the first 1–3 days because of needle trauma and (with cortisone) a temporary post-injection flare in about 5–10% of patients. We recommend the following after-care protocol: ice the heel for 15 minutes 3 times in the first 24 hours; avoid running, jumping, and prolonged standing for 48 hours; wear supportive shoes (no flip-flops or going barefoot); and continue the prescribed plantar fascia and calf stretching program. Resume normal walking immediately, return to low-impact exercise (swimming, cycling, elliptical) at 48–72 hours, and return to running or jumping after 1–2 weeks if pain has improved. After PRP, we ask patients to avoid NSAIDs and corticosteroids for 2 weeks because these blunt the healing response that PRP is designed to trigger. We also ask patients to avoid weight-bearing exercise for the first 48 hours to allow the platelet matrix to settle into the fascia.

There is no single "permanent solution" because plantar fasciitis is fundamentally a load-management and biomechanics problem — the durable cure is identifying and correcting the underlying cause, not just treating the inflamed fascia. The most reliably permanent outcomes come from a multimodal approach: (1) structured eccentric calf and plantar fascia-specific stretching (the DiGiovanni protocol — towel-assisted plantar fascia stretching before getting out of bed) — has the strongest single-intervention evidence base; (2) footwear correction — supportive shoes with appropriate arch support and cushioning, prescription orthotics where indicated; (3) training-load and bodyweight management — sudden increases in mileage, intensity, or bodyweight are the most common triggers; (4) image-guided injection (PRP for durable healing or cortisone for fast short-term relief) for cases that have not responded to 4–6 weeks of conservative care; (5) extracorporeal shockwave therapy (ESWT) for chronic refractory cases, and surgical plantar fascia release as a last resort in the small subset (<5%) who fail all of the above. Most patients who go through this sequence have permanent resolution. The cases that recur almost always do so because the original biomechanical driver was never corrected — most commonly calf tightness, training error, or footwear that does not match the patient's foot type.

For most patients with chronic plantar fasciitis, the long-term answer is yes — but the right choice depends on your timeline and goals. Cortisone (corticosteroid) injection works faster (1–2 weeks to relief, peak at 4–6 weeks), is covered by most insurance, and is the right choice when a patient absolutely needs to function in the next 2–4 weeks (a wedding, a critical work commitment, an athletic event). The trade-offs are a shorter duration of relief (3–6 months), a higher recurrence rate at 6–12 months, a small risk of plantar fascia rupture (about 2–10% in older studies, lower with single ultrasound-guided injections), and fat pad atrophy with repeated injection. PRP (platelet-rich plasma) injection uses a concentrated preparation of the patient's own platelets to deliver growth factors directly into the damaged plantar fascia, addressing the underlying tendinopathy rather than just suppressing inflammation. PRP takes longer to work (6–12 weeks for full effect, sometimes with a temporary increase in soreness in the first 1–2 weeks), but multiple high-quality randomized trials show 70–85% of patients with chronic plantar fasciitis achieve durable relief at 12+ months — substantially better than cortisone at the same time point. PRP is typically not covered by insurance and has an out-of-pocket cost, which we discuss transparently before scheduling. At Modal Pain Management, Dr. Movshis uses PRP as the preferred first-line injection for most patients with chronic plantar fasciitis (>3 months) and reserves cortisone for selected acute scenarios.

The most successful approach is not a single treatment but a structured, evidence-based ladder applied in the right order. About 80–90% of plantar fasciitis cases resolve with a combination of structured plantar fascia-specific stretching (the DiGiovanni protocol — sit, cross the affected leg over the other, pull the toes back toward the shin and hold for 10 seconds, repeat 10 times, perform 3 times daily — this is the single highest-evidence intervention), calf flexibility work (gastrocnemius and soleus stretches), supportive footwear and prescription orthotics matched to the patient's foot type, and activity and load modification. For cases that have not responded to 4–6 weeks of this conservative protocol, image-guided corticosteroid or PRP injection is the next step. Bedside ultrasound at the diagnostic visit grades severity (fascia thickness >4 mm is abnormal; >5 mm typically requires injection or shockwave), which determines the optimal treatment. For chronic refractory cases (>6 months), extracorporeal shockwave therapy (ESWT) has good evidence for stimulating tendon healing without injection. Surgery (plantar fascia release) is reserved for the small subset (<5%) who have failed all of the above. The single most predictive factor for success is consistent stretching combined with addressing the underlying biomechanical driver — the injection accelerates pain relief but does not substitute for fixing the cause.

The right specialist depends on the stage of the condition and what has already been tried. For acute or mild plantar fasciitis (less than 6 weeks of symptoms, mild functional limitation), starting with a primary care physician, podiatrist, or sports medicine physician is reasonable — the first line is conservative care with stretching, footwear correction, and activity modification. For persistent plantar fasciitis (more than 6 weeks of symptoms, or symptoms not responding to home care), an interventional pain management specialist or sports medicine specialist with image-guided injection capability becomes the highest-yield referral. The key question is whether the physician you see can perform ultrasound-guided injection — blind heel injections are substantially less accurate (the medication frequently lands in the fat pad rather than the fascia), less effective, and carry higher risks of complications including plantar fascia rupture. For chronic, refractory plantar fasciitis (more than 6 months of symptoms despite multiple treatments), a comprehensive evaluation by an interventional pain physician who can also coordinate ESWT and surgical referral when needed becomes essential. At Modal Pain Management, Dr. Alex Movshis is dual board-certified in Anesthesiology and Pain Medicine and performs image-guided plantar fascia injection (corticosteroid and PRP) at the diagnostic visit when appropriate.

Not directly — true plantar fasciitis is a localized degenerative tendinopathy of the plantar fascia at the medial calcaneal tubercle, and is not caused by spinal nerve compression. However, several conditions that cause heel pain are mistaken for plantar fasciitis and do involve the lumbar or local nerve supply, which is why a focused exam is essential before treating any case as plantar fasciitis. S1 radiculopathy (sciatica from the S1 nerve root, typically from a herniated disc at L5-S1) can produce heel and lateral foot pain that is sometimes mislabeled as plantar fasciitis — the giveaway is associated low back pain, calf pain, weakness in plantar flexion, an absent ankle reflex, and pain that worsens with sitting and improves with walking (the opposite of true plantar fasciitis, which is worst with the first steps in the morning). Baxter's neuropathy (compression of the first branch of the lateral plantar nerve as it passes between the abductor hallucis and quadratus plantae) presents with chronic medial heel pain that does not respond to plantar fasciitis treatment and has a positive Tinel's sign over the nerve. Tarsal tunnel syndrome (compression of the posterior tibial nerve at the medial ankle) can also mimic plantar fasciitis. We systematically screen for all three at the diagnostic visit, because the treatment is completely different — a patient treated for plantar fasciitis when the actual diagnosis is S1 radiculopathy or Baxter's neuropathy will not improve, and may be subjected to unnecessary plantar fascia injections.

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