Is Plantar Fasciotomy the Ultimate Answer to Your Heel Pain?

Plantar fasciotomy is a surgical procedure that aims to relieve pain and discomfort caused by plantar fasciitis, a common condition affecting the feet. This article will provide an in-depth look at plantar fasciotomy, its indications, the procedure itself, recovery time, and alternatives.

How Does Plantar Fasciotomy Surgery Help Plantar Fasciitis?

Plantar fasciotomy surgery helps plantar fasciitis by addressing the root cause of the pain and discomfort associated with this condition. The plantar fascia is a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. When this tissue becomes too tight due to repetitive stress it leads to plantar fasciitis and the accompanying heel pain.

The goal of a plantar fasciotomy surgery is to relieve the tension of the plantar fascia. This is done by making a small incision and cutting through the tight, inflamed tissue. By releasing the tension, the pressure on the surrounding plantar fascia is reduced, thereby alleviating pain and inflammation.

Additionally, plantar fasciotomy surgery encourages the healing process by allowing the damaged tissue to repair itself more effectively. Once the tension is relieved, the micro-tears in the plantar fascia can begin to heal, leading to reduced inflammation and discomfort over time.

When to Consider Plantar Fasciotomy

Wondering when it's the right time to consider plantar fasciotomy? It's essential to understand that this surgical procedure isn't the first line of defense against plantar fasciitis. Instead, it's typically reserved for cases where conservative treatments haven't provided the desired relief. Let's explore the factors that may lead you to consider plantar fasciotomy.

1. Exhausting conservative treatments

Before jumping into surgery, you should have tried various non-surgical treatments for a sufficient period, usually around 6 to 12 months. These conservative treatments may include:

• Rest and ice

• Stretching exercises targeting the plantar fascia and calf muscles

• Physical therapy

• Insoles

• Night splints

2. Persistent pain and discomfort

If you're still experiencing significant pain, discomfort, or swelling in your heel after giving conservative treatments a fair shot, it might be time to consider plantar fasciotomy. Persistent symptoms can negatively impact your daily activities, work, and overall quality of life, making surgery a more viable option.

3. Limited mobility and function

When plantar fasciitis starts to affect your ability to walk, stand, or perform your usual activities, it's worth discussing plantar fasciotomy with your healthcare provider. The goal of the surgery is to improve your mobility and reduce pain, allowing you to get back to your regular routine.

The Plantar Fasciotomy Procedure

Plantar fasciotomy involves cutting through the plantar fascia to relieve tightness. Usually the plantar fascia is partially cut either ⅓ or ⅔  however, sometimes the surgeon will opt to fully release the plantar fascia. 

By cutting the plantar fascia tension on the plantar fascia is reduced with the goal of relieving pain. 

Plantar Fasciotomy Approach Techniques

While the surgery itself does not change, the way the surgeon performs it can be different, this is what is referred to as the approach. 

The most popular is the endoscopic. But can also include open, and percutaneous.

Open Plantar Fasciotomy: 

This traditional surgical technique involves making an incision on the medial (inner) side of the foot or heel to access the plantar fascia. The surgeon then partially or completely releases the fascia to relieve tension and alleviate pain.

Endoscopic Plantar Fasciotomy (EPF): 

A minimally invasive procedure that uses an endoscope (a thin, flexible tube with a light and camera) to visualize the plantar fascia. The surgeon makes small incisions on either side of the heel and inserts the endoscope to guide the release of the fascia. This approach typically results in less scarring and faster recovery times.

Percutaneous Plantar Fasciotomy:

Fasciotomy: Another minimally invasive technique that involves making a small incision on the medial side of the heel. The surgeon then inserts a needle or small scalpel to partially release the plantar fascia under ultrasound or fluoroscopic guidance. This method can also lead to quicker recovery and reduced postoperative pain

The type of approach your surgeon takes is based on what they are most comfortable with and your needs. As a general rule of thumb always opt for the approach the surgeon is comfortable with as this is most likely how they were trained and what they are familiar with. 

What is the Success Rate of Plantar Fasciotomy Surgery?

Plantar fasciotomy has demonstrated favorable outcomes in treating plantar fasciitis, offering hope to those who suffer from this debilitating condition. However, rather than simply taking my word for it, it's essential to delve deeper into the available research. 

Scientific studies provide valuable insights into the effectiveness of plantar fasciotomy, shedding light on its success rate, postoperative outcomes, and overall patient satisfaction.

A study by Bader in 2012 showed promising success rates for plantar fasciotomy researchers evaluated the outcomes of patients who underwent plantar fasciotomy. Out of 49 feet treated, pain resolved in 37 feet, decreased in 11 feet and increased in only 1 foot. 

Furthermore, the average postoperative American Orthopaedic Foot & Ankle Society score, a measure of foot function, improved by 39 points.

El Shazly and El Betagy 2010 study looked at how well endoscopic plantar fasciotomy combined with drilling and removing a bone spur worked for 22 patients. They used different tools to measure pain and foot function before and after the surgery and found that patients experienced a significant decrease in pain and improvement in foot function after the surgery. Most of the patients (85%) were satisfied with the results of the procedure, and there were no major complications.

In another study by Ogilvie-Harris in 2000, the researchers looked at the success of plantar fasciotomy surgery in 53 patients. They measured the patients' pain and ability to perform daily activities, sports, and how they felt in the morning. 

After the surgery, most patients experienced a significant improvement in all these areas. Almost 90% of them reported no pain during daily activities, 95% had no morning stiffness or pain at rest, 71% had no pain during sports, and 76% could return to their previous level of sports activity.

In conclusion, all the studies showed a high success rate for endoscopic plantar fasciotomy surgery in treating foot pain and improving function for patients with plantar fasciitis. Most patients experienced significant pain relief and could return to their daily activities and sports after the procedure.

Recovery After Plantar Fasciotomy

Recovery time following plantar fasciotomy can vary depending on the surgical approach and individual factors. 

The recovery period following plantar fascia release surgery usually ranges from 6 to 10 weeks before patients can walk comfortably without assistance. It may take up to 3 months before engaging in strenuous activities and exercises can be considered.

For those who undergo open or percutaneous plantar fasciotomy surgery, wearing a cast, walking boot, or brace for several weeks is often necessary to alleviate the weight on the heel and foot, promoting proper healing of the tissues. 

On the other hand, patients who opt for endoscopic surgery tend to experience a quicker recovery. They may be able to walk normally within 3 to 6 weeks post-surgery.

It is essential to follow the surgeon's post-operative instructions and engage in rehabilitation exercises to ensure a successful outcome.

Potential Risks and Complications of Plantar Fasciotomy Surgery

As with any surgical procedure, plantar fasciotomy comes with certain risks and complications, such as:

• Infection

• Nerve damage

• Scarring

• Recurrence of symptoms

• Failure to alleviate pain

A collective analysis of 8 studies, including 261 feet, identified the following complication rates:

• Transient lateral heel pain: 1.86% (5/269)

• Numbness: 2.60% (7/269)

• Stress fractures (3rd & 4th metatarsal and 3rd metatarsal): 0.74% (2/269)

• Infections: 1.12% (3/269)

• Pain syndromes: 1.12% (3/269)

• Lateral heel pain: 0.74% (2/269)

The risk of complications associated with plantar fasciotomy, as presented in the study, appears to be relatively low. With complication rates ranging from 0.74% to 2.60%, the likelihood of experiencing adverse effects is minimal. 

It is important to note, however, that any surgical procedure carries some inherent risks, and individual outcomes may vary. Nevertheless, these findings suggest that plantar fasciotomy is a relatively safe procedure for patients seeking relief from plantar fasciitis or related conditions.

But What if I Don’t Want Surgery?

I feel you – nobody's thrilled about going under the knife. It's a nerve-wracking, painful ordeal, not to mention the downtime needed for recovery.

The secret to dodging the surgical bullet lies in a rehab program that tackles the root of plantar fasciitis. You'll want a plan that zeroes in on hip and arch strengthening while also focusing on calf and plantar fascia stretching.

Well, you're in luck! I've got just the ticket – a simple, step-by-step rehab program to help you kick plantar fasciitis to the curb, all packed in an ebook. Say goodbye to time-consuming PT sessions 2-3 times a week for 6 weeks, and hello to healing from the cozy confines of your own home.

Give it a try – you won't regret it.

Conclusion

Plantar fasciotomy is an effective surgical option for patients suffering from chronic heel pain due to plantar fasciitis, particularly when conservative treatments have failed to provide relief. The procedure, whether performed using an open or minimally invasive approach, can significantly reduce pain and improve overall quality of life. However, it is essential to weigh the potential risks and complications against the benefits before deciding on surgery. Consult with a qualified healthcare professional to determine the best course of action for your specific situation and explore alternative treatments if plantar fasciotomy is not the right choice for you.