OBJECTIVE: Plantar fasciitis (PF), the most common cause of plantar heel pain, affects middle-aged individuals and comprises 15% of overall foot-related complaints. Initial treatments for PF include non-steroidal anti-inflammatory drugs (NSAIDs), custom foot orthotics and/or corticosteroid injections into the heel. When symptoms persist beyond six months it is classified as chronic PF (CPF); two options for treatment, surgical intervention and extracorporeal shock wave therapy (ESWT), exist. This analysis will determine the cost-effectiveness of ESWT in relation to surgery for the treatment of CPF. METHODS: A Markov model was constructed based on established management practices for the treatment of CPF, simulating the distribution of patients into one of five health and treatment states. Cost and probability values used to populate the model were derived from appropriate Medicare reimbursement values, retail and average wholesale prices and published peer-reviewed clinical studies. Cost and effectiveness values were accumulated monthly over a 12 month period, yielding incremental cost-effectiveness ratios (ICERs) in dollars per quality-adjusted life year ($/QALY). RESULTS: Model analysis reveals that surgery has a lower overall cost of treatment ($1912 v. $2862 respectively) and a higher overall effectiveness in comparison to ESWT (0.6742 v. 0.5750 QALY respectively). Surgery dominates ESWT due to its lower overall cost of treatment and higher effectiveness value, resulting in a lower ICER as compared to ESWT ($2836/QALY v. $4977/QALY respectively). CONCLUSION: Based on the results of this analysis, surgery is a more cost-effective option than ESWT for the treatment of chronic plantar fasciitis; however, the ICER of each of these methods fall below the commonly accepted willingness-to-pay threshold of $50,000/QALY commonly used by payers for the adoption of new technology. Therefore when surgery has failed, or is not an option, ESWT remains a viable and cost-effective alternative.