Plantar fasciitis is a common orthopedic condition that results in significant heel pain, often described as a stabbing sensation. It occurs when the plantar fascia, a thick band of tissue running along the bottom of the foot from the heel bone to the toes, becomes inflamed and irritated. While most individuals find relief through non-surgical interventions, a small percentage of those with persistent symptoms may consider surgery. This surgical approach aims to reduce tension in the plantar fascia, alleviating discomfort and promoting healing.
Considering Surgical Intervention
Surgery for plantar fasciitis is a last resort, considered after conservative treatments have failed. Individuals undergo non-surgical management, often lasting six to twelve months, before surgery becomes an option. These methods include rest, ice, physical therapy, orthotics, and injections like cortisone or platelet-rich plasma. Surgery is an option when chronic heel pain significantly impacts daily activities, work, or quality of life despite consistent conservative care.
Surgical Approaches for Plantar Fasciitis
Various surgical procedures can address plantar fasciitis. The goal is to reduce tension in the plantar fascia, either directly or indirectly. The choice of procedure depends on an individual’s condition and symptoms, aiming to alleviate pain and allow the tissue to heal.
A common surgical procedure is a plantar fasciotomy, which involves cutting the plantar fascia to release tension. This can be performed using two main techniques: open fasciotomy or endoscopic fasciotomy. Open fasciotomy involves a small incision, about one to two inches long, in the heel to directly access and release the plantar fascia. During this procedure, the surgeon may also address any trapped nerves or remove heel spurs if they are contributing to the pain.
Endoscopic fasciotomy is a less invasive approach, involving smaller incisions, about half an inch long, on the heel. An endoscope, a thin tube with a camera, and specialized instruments are inserted through these incisions to guide the surgeon in releasing the plantar fascia. This method offers benefits such as smaller incisions, a reduced risk of complications, and potentially faster recovery times.
Another surgical option, sometimes performed in conjunction with or instead of a fasciotomy, is a gastrocnemius recession, also known as calf lengthening. This procedure addresses tightness in the calf muscles, specifically the gastrocnemius, which can contribute to increased tension on the plantar fascia and exacerbate heel pain. By lengthening the calf muscle, the procedure aims to improve ankle flexibility and reduce strain on the plantar fascia. This can be particularly beneficial for individuals who have persistent difficulty flexing their feet despite consistent calf stretches.
What to Expect During Recovery
The recovery process after plantar fasciitis surgery varies depending on the specific procedure, but certain aspects are common. Immediately following surgery, patients may experience discomfort for the first few days. Oral pain medication is prescribed to manage this initial pain.
Weight-bearing is restricted, with some endoscopic procedures allowing limited weight-bearing within the first 24 hours, focusing weight on the ball of the foot with crutches. For open surgery, a walking boot may be recommended for two to three weeks to minimize pressure on the foot. Sutures are removed around two weeks after surgery, after which a shoe with adequate shock absorption, such as a tennis shoe, is worn.
Physical therapy is important for rehabilitation, beginning around the third week after surgery. A therapist develops a personalized plan to regain strength and flexibility in the foot and ankle, preparing for a return to activity. While some recovery occurs within three to six weeks, full recovery and a return to high-impact activities like running or jumping can take several months, around three months.
Understanding Potential Complications
While considered safe, plantar fasciitis surgery carries potential risks and complications. One issue is persistent pain, which can occur in a notable percentage of patients. This continued pain might be due to nerve damage during the procedure or if the fascia release does not address the cause.
Other potential complications include infection at the surgical site and slow wound healing, particularly in individuals with underlying conditions like diabetes. Nerve damage, such as nerve entrapment or the formation of a neuroma (a benign tumor of nerve cells), is possible. In some cases, an excessive release of the plantar fascia can lead to weakening or flattening of the foot arch, potentially causing changes in gait or foot deformity. Conversely, an insufficient release may result in persistent pain due to fibrosis or reattachment of fibers, sometimes necessitating follow-up procedures.