Plantar fasciotomy was carried out in 32 patients who had typical heel pain that had persisted for three months or longer. Following induction of local anesthesia, an 18-gauge needle was guided toward and into the plantar fascia by real-time sonography. The criterion for operative success was the appearance of an acoustic window within the plantar fascia. Pain intensity was graded on an 11-point visual analog scale (VAS). Questionnaires combining the VAS and a 0–100 point Daly score were filled out after treatment to determine the effectiveness of the procedure. The follow-up averaged 13.5 months. 78% were overweight (BMI>25). The mean pain score decreased by 6.72 points, a 73±21% improvement ( P <0.001). The mean post-operative Daly score was 88.3±16.2. There were no complications during or after the procedure. Sonographically-guided needle fasciotomy is a safe and effective method for the relief of conservatively unmanageable heel pain due to plantar fasciitis.