August 04, 2017
Surgery For Plantar Fasciitis? What are the Options?

Plantar fasciitis is a common foot condition that is typically, thankfully, easily resolved.  This inflammation and micro tears of the plantar (foot) fascia (connective tissue) results in a chronic ache or burning sensation on the bottom of the foot usually in the heel. 

Treatment usually consists of 4 main components:

  • Cold and massage therapy to relieve pain and stimulate blood flow
  • A brace/orthotic to support the Fascia
  • Night splint to keep proper alignment at night
  • Physical therapy to strengthen the foot and stretching for the back of the leg and calf.

After about 6 weeks of this regimen, the vast majority of people recover.  However, there are those unlucky few who do not respond to this conservative treatment.  After about 12 long weeks of pain, a physician may consider more invasive therapy.

Percutaneous Latticed Plantar Fasciotomy (PLPF)

The first option is PLPF.  This minimally invasive surgical treatment directly targets the fascia at the point that is most painful. 

To do this, a very small scalpel goes through the skin of the bottom of the foot to actually penetrate and tear a hole in the fascia.  This is repeated in a small grid pattern in the area where the fascia attaches to the heel.  After the holes are made, the foot is flexed resulting in a further opening of the fascia.

Afterward, the patient can go home with just a bandage and supportive orthotic.  Studies show that PLPF produces great results with most patients finally finding pain relief. [1]

Plantar Fasciitis Latticed  Resection

Endoscopic Release of Plantar Fascia

The endoscopic release of the plantar fascia (EPF) is similar.  In this surgery, two holes are made in the foot: one for instruments and one for visualization of the fascia.  The holes are located around the point at which the fascia attaches to the heel.

Using delicate instruments, the physician cuts through approximately one-half to two-thirds of the fascia which allows a better range of motion and importantly, relief from pain. Most patients who undergo this surgery are happy they did. [2]

Nerve Release

Sometimes, the fascia is not the only problem.  The nerves in the foot can be sending too many pain signals to the brain resulting in crippling agony. 

To remedy this, a surgeon can go into the foot at the heel, find the irritated lateral plantar nerve, and sever it.  This intense surgery requires the patient to be in a cast with crutches for 6 weeks following the surgery.  The good news that it has a success rate of 92%. [3] 

Waiting to begin or sticking with a conservative rehabilitation program can increase your need for an invasive procedure, so start or stick with a plan like found in our Plantar Fasciitis Care Kits.

If you already scheduled for one of these procedures prepare for the surgery by continuing the cold therapy, physical therapy, bracing and splinting.  Surgery can seem scary, but sometimes is the only way to finally find relief after conservative treatments fail.

 

 

[1] DOI: 10.1053/j.jfas.2015.02.008

[2] DOI:  10.1016/j.jor.2015.10.015

[3] DOI:10.1177/230949901502300226


 

Joe McClung

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