Plantar fasciotomy is a surgical procedure for chronic heel pain from plantar fasciitis, typically considered when conservative treatments have failed. Its primary goal is to release tension within the plantar fascia, a thick band of tissue in the foot.
Understanding Plantar Fasciitis
Plantar fasciitis involves inflammation of the plantar fascia, a thick band of tissue stretching along the bottom of the foot, connecting the heel bone to the toes. This tissue plays a role in supporting the foot’s arch and absorbing shock during movement. When this ligament-like structure experiences excessive tension or stress, small tears can develop, leading to irritation and inflammation.
Symptoms include a stabbing pain in the heel, often most pronounced with the first steps in the morning or after periods of rest. The pain may lessen with initial activity but can worsen after prolonged standing or walking. Factors contributing to plantar fasciitis include overuse from activities like long-distance running, improper footwear, and certain foot mechanics such as flat feet or high arches. Obesity and occupations requiring extensive standing or walking on hard surfaces also increase the risk. This chronic condition can significantly hinder daily activities.
The Plantar Fasciotomy Procedure
Plantar fasciotomy involves surgically detaching a portion of the plantar fascia from the heel bone to reduce tension. This procedure aims to promote new growth of connective tissue, encouraging the fascia to lengthen. The surgery is typically performed under local or general anesthesia.
Two primary approaches exist: open surgery and minimally invasive techniques. Open surgery involves making a larger incision, typically 1 to 2 inches long, near the heel to directly access and release the fascia.
Minimally invasive options include endoscopic plantar fasciotomy (EPF) and percutaneous plantar fasciotomy. Endoscopic procedures utilize smaller incisions, often around 0.5 to 1 cm, and a tiny camera (endoscope) to guide the surgeon in cutting part of the fascia. Percutaneous methods involve even smaller incisions, sometimes less than 2mm, to release tension. These less invasive techniques generally aim for reduced trauma and potentially quicker recovery times compared to traditional open surgery. Regardless of the approach, surgeons typically release a portion of the fascia to maintain foot stability.
Recovery Following Surgery
Immediately after plantar fasciotomy, patients can expect their foot to be dressed and elevated to manage swelling and pain. Pain medication is typically prescribed. For the first 24 hours, complete rest and elevation are recommended, with efforts to avoid weight-bearing on the heel.
Weight-bearing activities can often begin with crutches, placing weight on the ball of the foot, within the first 24 hours to a few days for endoscopic procedures. For open surgery, non-weight-bearing may extend for two weeks. A walking boot is commonly used for several weeks. Physical therapy is a crucial component of recovery, focusing on regaining strength and flexibility, with exercises often starting a few weeks after the procedure. Return to normal activities can range from 6 to 12 weeks, though strenuous activities like running may take up to three months.
Potential Outcomes and Considerations
The procedure has a success rate that often ranges from 87% to 95% in relieving pain and improving function. Many patients experience significant pain relief and can return to their daily activities.
While the surgery is effective for many, there are potential considerations. These include the possibility of residual pain, nerve damage, or infection, though these are not common. In rare instances, changes in foot mechanics, such as a flattening of the arch, might occur if too much of the fascia is released. Patient selection, precise surgical technique, and a structured post-operative rehabilitation program contribute to favorable outcomes.