Surgery for Plantar fasciitis

Surgery for plantar fasciitis

Heel pain is one of the most common disorders that foot and ankles physicians treat and fortunately conservative treatment) is successful in roughly 90% of patients seeking treatment with plantar fasciitis.

When patients do not respond to conservative therapies, surgical options may be considered.  Surgical treatment for plantar fasciitis has been shown to be effective with good results throughout literature. (1-17)

Please note that surgery should be considered after 6 months of quality conservative treatment.

Benefits of surgery

You should have no or a minimal discomfort in the heel after surgery.

Are there any alternatives to surgery

  • Stretching
  • Footwear/activity modification
  • Custom orthotics
  • Night Splint
  • Steroid injection
  • Platelet-rich protein(PRP) injection
  • Radiofrequency ablation (Rhizotomy)
  • Extracorporeal shockwave therapy

 

What does the operation involve?

The operation for plantar fasciitis is usually day-case procedure and can be done under local anaesthesia, twilight sedation or general anaesthesia.

The operation usually takes around 20-30 minutes.

A small incision(usually 2-3 cm in length) is made directly under the arch of the foot.

Once plantar fascia is identified with careful dissection, a part of the medial plantar fascia is released to reduce the tightness. Once the tightness in the plantar fascia is lessened, skin is closed with one or two sutures.

Postoperative courses

Immediate weight-bearing is allowed in a surgical shoe with limited activities.

Sutures are removed between 10-14 days postoperatively.

Patients return to comfortable tennis shoes gradually between 2 -3 weeks.

When can I work?

  • Sedentary – 1 week
  • Manual labour – 3 weeks

 

Postoperative pain

Severe pain after plantar fasciotomy is rare. Many patients need mild postoperative analgesics only after plantar fasciotomy.

Risks and complications  

As with any other surgical procedures, plantar fasciotomy is not without complications.

Possible complications of plantar fasciotomy are;

  • Scarring
  • Persistent pain
  • Arch pain
  • lateral column pain
  • burning or tingling in the ball of the foot

 

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner

References;

  1. Brown JN, Roberts S, Taylor M, Paterson RS. Plantar fascia release through a transverse plantar incision. Foot Ankle Int. 1999;20:364–7.
  2. Davies MS, Weiss GA, Saxby TS. Plantar fasciitis: how successful is surgical intervention?. Foot Ankle Int. 1999;20:803–7.
  3. Fishco WD, Goecker RM, Schwartz RI. The instep plantar fasciotomy for chronic plantar fasciitis. A retrospective review. J Am Podiatr Med Assoc. 2000;90:66–9.
  4. Boyle RA, Slater GL. Endoscopic plantar fascia release: a case series. Foot Ankle Int. 2003;24:176–9.
  5. Vohra PK, Giorgini RJ, Sobel E, Japour CJ, Villalba MA, Rostkowski T. Long-term follow-up of heel spur surgery. A 10-year retrospective study. J Am Podiatr Med Assoc. 1999;89:81–8.
  6. Baxter DE, Thigpen SV. Heel pain: operative results. Foot Ankle 1984;5:16-25. 6.
  7. Anderson RB, Foster MD: Operative treatment of calcaneal pain. Foot Ankle 1989;9:317-23. 7.
  8. Perelman GK, Figura MA, et al. The medial instep plantar fasciotomy. J Foot Ankle Surg 1995;34:447-57. 8.
  9. Boberg JS. Heel pain. In: Reconstructive Surgery of the Foot and Leg: Update ’95.
  10. Tucker (GA): The Podiatry Institute; 1995. 9. Barrett SL, Day AV, et al. Endoscopic plantar fasciotomy: a multisurgeon prospective analysis of 652 cases. J Foot Ankle Surg 1995;34:400-6. 10.
  11. Sammarco GJ. Surgical treatment of recalcitrant plantar fasciitis. Foot Ankle Int 1996;17:520-6. 11.
  12. Brekke MK, Green DG. Retrospective analysis of minimal-incision, endoscopic, and open procedures for heel spur syndrome. J Am Podiatry Med Assoc 1998;88:64-72.
  13. Benton-Weil W, Borrelli AH, et al. Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis. J Foot Ankle Surg 1998;37:269-72.
  14. Stone PA, McClure LP. Retrospective review of endoscopic plantar fasciotomy-1994 through 1997. J Am Podiatry Med Assoc 1999;89:89-93.
  15. Lundeen OL, Aziz S et al. Endoscopic plantar fasciotomy: a retrospective analysis of results in 53 patients. J Foot Ankle Surg 2000;39:208-17.
  16. Barrett SL, Day SV, Brown MG. Endoscopic plantar fasciotomy: preliminary study with cadaveric specimens. J Foot Surg 1991;30:170-2.
  17. Barrett SL, Day SV. Endoscopic plantar fasciotomy for chronic plantar fasciitis/heel spur syndrome: surgical technique – early clinical results. J Foot Surg 1991;30:568-70.