Plantar fasciitis is a common source of heel pain, arising from irritation and inflammation in the thick band of tissue running along the bottom of the foot, known as the plantar fascia. This fibrous tissue connects the heel bone to the toes and helps support the arch. For the vast majority of people, this condition resolves using non-surgical methods over time. Surgical intervention for plantar fasciitis is available, but it is considered a last resort, typically reserved for only about five to ten percent of chronic cases.
When Conservative Care Fails
Surgical treatment is only considered after all non-operative measures have failed to relieve persistent symptoms. Patients must typically endure chronic pain for a minimum of six to twelve months before surgery is discussed, allowing the body every opportunity to heal naturally.
Initial conservative treatments focus on reducing strain on the fascia and managing symptoms. These methods commonly include daily calf and foot stretching exercises, utilizing supportive orthotic shoe inserts, and wearing a night splint to keep the foot stretched while sleeping. Other non-surgical options may involve corticosteroid injections to reduce inflammation or extracorporeal shock wave therapy, which delivers energy pulses to the painful area to stimulate healing.
If a person has exhausted several different non-surgical approaches over this prolonged period and still experiences severe pain impacting daily life, they may then be considered a candidate for a surgical evaluation. Surgical procedures are not a first-line therapy because conservative treatments are highly successful, resolving symptoms in up to 90% of cases.
Surgical Procedures for Plantar Fasciitis
The primary surgical treatment is a plantar fascia release, or fasciotomy, which aims to reduce tension in the ligament. This involves cutting a small portion of the plantar fascia where it attaches to the heel bone, allowing the tissue to lengthen and relieve pressure. The procedure can be performed using either an open or an endoscopic approach.
An open plantar fasciotomy involves the surgeon making a small incision (one to two inches long) to directly visualize and partially detach the ligament from the heel bone. This traditional method offers maximum visibility, allowing for the simultaneous removal of heel spurs or the release of trapped nerves. It may also be favored if the fascia is severely thickened or damaged.
The less invasive endoscopic plantar fasciotomy utilizes a tiny camera (endoscope) inserted through one or two small incisions. Using the camera for guidance, a specialized instrument cuts the tight portion of the fascia. This technique results in less scarring and may offer a faster initial recovery time compared to open surgery.
In some cases, a gastrocnemius recession may be performed when tight calf muscles contribute significantly to foot tension. This involves surgically lengthening the calf muscles or their tendons to reduce the pull on the heel bone and the plantar fascia. This procedure is considered when a patient has a confirmed equinus contracture, restricting the ankle’s ability to flex upwards.
Patient Suitability and Risks
Strict criteria are required to ensure plantar fasciitis surgery is beneficial. Patients must have a confirmed diagnosis and demonstrate symptoms persisting for a minimum of one year, despite rigorous non-operative care. Imaging or clinical evaluation must indicate chronic damage or thickening of the fascia, confirming the structural cause of the pain.
Specific underlying health conditions, such as diabetes, peripheral neuropathy, or venous insufficiency, can increase the risk of complications and may influence the decision to proceed with surgery. Surgeons must carefully weigh the potential benefits of pain relief against the potential for negative outcomes.
Risks associated with plantar fasciitis surgery include general surgical complications. The most significant concern is the excessive release of the plantar fascia, which can lead to a flattening of the foot’s arch. This arch collapse can alter a person’s gait and cause new, long-term pain in other areas of the foot.
Specific Risks
- Infection and delayed wound healing.
- Nerve injury or entrapment, potentially causing numbness, weakness, or chronic nerve pain in the heel or sole of the foot.
Post-Operative Recovery and Expectations
Following a plantar fascia release, the initial recovery phase involves limited or non-weight-bearing on the operated foot, typically lasting two to three weeks to allow the surgical site to heal and stabilize the released fascia. Patients often use crutches or a knee scooter during this time to maintain mobility.
After this initial period, the patient transitions to wearing a specialized walking boot or a cast for several weeks. Recovery time varies significantly by surgical method: endoscopic procedures often allow a return to weight-bearing within three to six weeks, while open surgery typically requires six to ten weeks before full weight-bearing is advised.
Physical therapy is a necessary post-operative component, focusing on restoring strength, flexibility, and range of motion. While patients may return to light exercise within two to three months, a full return to high-impact activities (such as running or jumping) is not recommended until three to six months after the procedure. Complete healing and maximal pain improvement often continue for up to a year.