Suspect one: the right treatment at the wrong dose
The most common story: the stretching was correct but happened three times a week instead of twice daily; the 'supportive shoes' were worn to work but not around the house; the rest weeks were followed by full-speed weekends. Plantar fasciitis care works at full dose and quietly fails at half dose. Before concluding treatment failed, audit whether treatment actually happened at prescription strength.
Suspect two: it was never plantar fasciitis
Around one in ten stubborn 'fasciitis' cases is something else wearing its costume: a heel stress fracture (aches with every step, hates hopping), Baxter's nerve entrapment (burning that stretching never touches), fat pad atrophy (a deep central bruise on hard floors), or inflammatory arthritis announcing itself. Each has a different fix, which is why heel pain that ignores six weeks of proper fasciitis care has earned an exam and probably imaging.
Suspect three and four: degeneration and mechanics
Long-standing fasciitis transforms: inflamed tissue becomes degenerated tissue (fasciosis) that no longer responds to rest and anti-inflammatories because there's no inflammation left. That's the tissue shockwave therapy and similar repair-focused treatments were built for. And beneath everything sits mechanics: the tight calves, collapsing arches, or training loads that created the problem keep recreating it until they're corrected. Stubborn heel pain usually isn't mysterious; it's mislabeled, under-dosed, or mechanically unfinished.
Questions readers still ask
How long is too long for heel pain?
Six weeks of consistent, correct self-care without clear improvement is the line. Past it, you're likely feeding one of the four suspects above, and each month of delay makes the eventual fix slower. Get examined rather than cycling through another round of internet remedies.
Will an MRI show why my heel still hurts?
Sometimes, but it's rarely the first step. An exam plus in-office ultrasound and X-ray answers most stubborn-heel questions (fascia thickness, spurs, stress reactions). MRI enters when those leave a specific question standing.
This article is general education, not personal medical advice. For an evaluation in Sugar Land, call (281) 494-0572.