Plantar fasciitis is a common foot condition characterized by inflammation of the plantar fascia, a thick band of tissue running along the bottom of the foot from the heel to the toes. This fibrous tissue supports the arch of the foot and absorbs shock during movement. While many cases resolve with non-surgical approaches, persistent heel pain may lead to considering surgical intervention. Surgery is typically reserved for individuals who have not found adequate relief through conservative treatments.
Identifying the Surgical Procedure
The most common surgical procedure for plantar fasciitis is known as a plantar fasciotomy or a plantar fascia release. This procedure involves cutting a portion of the plantar fascia ligament. Its primary objective is to relieve tension within the plantar fascia, reducing pain and inflammation and promoting healing.
When Surgery Becomes an Option
Surgical intervention for plantar fasciitis is considered a last resort. It is recommended for patients with persistent heel pain, often for 6 to 12 months, without relief from non-surgical treatments. These conservative treatments include:
Rest
Icing the painful area
Specific stretching exercises for the plantar fascia and Achilles tendon
Physical therapy
Orthotics or arch supports
Night splints
Corticosteroid injections
What Happens During the Procedure
Plantar fasciotomy can be performed using different approaches, primarily open surgery or endoscopic (minimally invasive) surgery. In open surgery, the surgeon makes a larger incision, often on the inner side or sole of the foot, to directly access the plantar fascia. This method allows for a clear view of the area and may be chosen if additional procedures, such as heel spur removal, are needed.
Endoscopic plantar fasciotomy (EPF) is a minimally invasive technique that uses smaller incisions, typically about 1 cm each, on either side of the heel. An endoscope, a small camera, is inserted through one incision to provide a direct view of the plantar fascia on a monitor. Specialized instruments are then guided through the other incision to release a portion of the fascia. This approach aims to minimize trauma to surrounding tissues and can lead to a quicker recovery. In both methods, a segment of the fascia is cut to alleviate pressure on the inflamed tissue.
The Recovery Journey
Following plantar fasciitis surgery, immediate post-operative care involves bandaging the foot and managing pain with prescribed medications. Patients are advised to elevate their foot and apply ice to reduce swelling. The timeline for weight-bearing varies depending on the surgical approach; with endoscopic procedures, limited weight-bearing may begin soon after surgery, sometimes within 24 hours, while open surgery may require a period of non-weight-bearing, often for two weeks.
Physical therapy is an important component of the recovery process, starting a few weeks post-surgery. A physical therapist guides patients through exercises designed to restore flexibility and strength in the foot and ankle. Full recovery can take several months, with most patients gradually returning to normal activities within three to six months. High-impact activities like running or jumping are restricted for at least three months after surgery.