What Does Plantar Fasciitis Surgery Entail?

Plantar fasciitis surgery is a procedure performed to address the symptoms of plantar fasciitis, a condition characterized by irritation and inflammation of the plantar fascia ligament that supports the arch of the foot.

There are two main types of surgical procedures for plantar fasciitis: plantar fasciotomy and plantar fasciectomy. The primary difference between the two lies in the extent of tissue removal. A fasciotomy involves detaching the fascia from the heel bone without removing any tissue, while a fasciectomy involves making an incision and excising scarred or inflamed tissue.

Plantar fasciitis surgery is typically reserved for cases where other conservative treatments have failed to provide relief. Non-invasive therapies such as orthotic arch supports, splints, taping, physical therapy exercises, icing, massage, medications, injections, and shockwave therapy are usually attempted first. It is estimated that about 90 percent of people respond positively to these conservative treatments within 12 months.

However, if chronic heel pain persists despite these efforts and significantly impacts daily activities, surgery may be considered. The goal of the surgery is to alleviate pain and improve foot mobility, allowing individuals to resume their regular routines.

Suitability for plantar fasciitis surgery depends on various factors, including the severity and duration of symptoms, the failure of non-surgical treatments, and the absence of alternative diagnoses. Candidates for surgery may have persistent severe pain for over six months, an inability to participate in physical activities, or interference with work due to heel pain. However, individuals with certain underlying health conditions like diabetes, peripheral neuropathy, or venous insufficiency may have a higher risk of complications and slower healing.

The surgical procedure can be performed using either an open or endoscopic approach. Open surgery typically takes place in a hospital setting under general anesthesia or regional block with sedation. A small incision is made to expose the plantar fascia, detach it from the heel bone, and address any associated nerve entrapment or bone spurs. Endoscopic surgery, on the other hand, can be performed with local anesthesia and mild sedation. It involves two small incisions under the ankle bone, through which an endoscope and a small knife are used to release the plantar fascia.

Following surgery, post-operative instructions will be provided, and discomfort or minor pain can be expected for several days. Recovery times vary depending on the type of surgery. After open surgery, patients may need a walking boot, cast, or special shoe for several weeks, and full recovery may take 6 to 10 weeks. With endoscopic surgery, limited weight-bearing is possible soon after the procedure, and patients may be able to wear regular shoes within 1 or 2 days. Recovery typically lasts 3 to 6 weeks for endoscopic surgery.

It is crucial to follow post-operative guidelines and attend follow-up visits as recommended by the healthcare provider. Wearing supportive shoes, particularly during physical activities, is advised to prevent future issues. While plantar fasciitis surgery can be successful in relieving chronic heel pain, there are potential risks and side effects such as adverse reactions to anesthesia, infection, slow wound healing, nerve injury, recurring heel pain, or a flattening of the foot’s arch. Any increasing pain or signs of infection should be reported to the doctor promptly.

If conservative treatments have been unsuccessful and plantar fasciitis significantly impairs daily life, consulting with a healthcare professional can help determine if surgery is a suitable option.