What You Need to Know About Surgery for Plantar Fasciitis

By Janet Pearl, M.D., M. Sc. | Published 7/15/2019 71

Surgeon in scrubs in OR 1280 x 853

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Severe or advanced cases of plantar fasciitis only rarely require surgical treatment. Some of the conditions where surgical intervention may become inevitable include the following:

  • when an injury is left untreated
  • in the minority of cases for which conservative treatment or regenerative medicine treatments are ineffective and damage accumulates
  • when injuries in the plantar fascia have progressed to a point where there is an accumulation of tension in the ligament that causes its gradual degeneration. 

The surgical procedure for plantar fasciitis is called Plantar Fascia Release. As its name suggests, the main goal of Plantar Fascia Release surgery is to release the tension on the plantar fascia. The goal is to restore the foot’s flexibility and relieve pain.

Plantar fasciitis surgical procedures

The procedure for Plantar Fascia Release involves making small cuts in a fraction of the fibers that make up the plantar fascia. This is done in order to relieve tension and stress in the ligament.

Plantar Fascia Release can be performed via either open surgery or endoscopic surgery:

  • In open surgery, a small area in the bottom of the foot is cut to give access to the plantar fascia to allow your surgeon to see it.
  • In endoscopic surgery, only very small incisions are made to insert an instrument equipped with a micro camera that allows the visualization of the ligament and the release of the plantar fascia.

Endoscopic surgery is usually preferred due to the shorter recovery time, but the choice of open or endoscopic surgery may depend on your anatomical and clinical characteristics.

In some advanced cases of plantar fasciitis, heel spurs may develop. When that is the case, they can also be removed during the surgery. When necessary, damaged tissues or a small portion of the heel bone may also be removed to reduce tension and stimulate healing.

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Plantar fasciitis surgery recovery

Recovery time depends on the type of surgery that you undergo.

  • Open surgery

If you undergo open surgery, you will need to wear a cast or brace for the first two or three weeks of recovery to keep your foot stable. This also minimizes the pressure on the heel and foot and allows the tissues to heal.

Recovery time for open plantar fasciitis surgery is usually between six to ten weeks. At this point, you should be able to walk without assistance.

  • Endoscopic surgery

Since only small incisions will have been made if you undergo endoscopic surgery, you will not need a cast. In fact, you can go back to wearing shoes whenever you feel comfortable doing so.

Recovery time is shorter, with most patients being able to walk normally after three to six weeks.

In both cases, full recovery and the return to high-impact activities and exercises like running or jumping may take around three months. During the recovery period, healing will also be promoted with foot strengthening stretching exercises.

Related content: Trainer Rx Helps You Take Charge of Your Physical Therapy

Plantar fasciitis surgery success rate

Plantar Fasciitis Release is successful in relieving heel pain in the majority of patients.

Complications of plantar fasciitis surgery

As with any surgery, there is always a risk of complications. It is important that you are fully aware of what may happen.

Possible complications of plantar fascia release include:

  • Infection

A small risk of infection exists in any surgery, particularly if the wound is not appropriately cleaned. Infections that are detected early can be easily resolved with antibiotics.

  • Nerve damage

There is also always a risk of nerve damage in any surgery. If damage to the nerves surrounding the fascia occurs during the procedure, you may develop numbness, weakness or tingling in your foot.

  • Excessive release

A specific and unlikely complication of this procedure is an excessive release of the plantar fascia. This can greatly reduce the height of the foot arch, which will increase the likelihood of further foot injuries.

  • Unresolved symptoms

In some cases, the surgery may not be successful and symptoms may persist.

Before considering surgery

Plantar Fascia Release is an invasive procedure that should only be considered as an option in very severe cases that can not be resolved with conservative treatments. Around 95% of plantar fasciitis patients are able to recover with non-invasive treatment options within a few months.

Surgery should be your last resort.

There are many options for the conservative management of plantar fasciitis, including,

  • rest
  • stretching exercises
  • ice massage
  • deep tissues massage
  • over-the-counter or custom-made orthotics
  • night splints

There are also additional alternative therapeutic options with good results in plantar fasciitis that you may also consider. These include extracorporeal shock wave therapy and ultrasound-guided platelet-rich plasma injections.

Before you consider Plantar Fascia Release surgery, be sure you have exhausted all other possibilities.


Related content: 6 Standing Desk Tips That Help You Avoid Pain

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Originally published September 23, 2018, this post has been updated for republication.

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Janet Pearl, M.D., M. Sc.

Website: http://fasciitis.com/

Janet Pearl, M.D., M. Sc., Member of the American Pain Society, The Massachusetts Medical Society, the Massachusetts Society of Anesthesiologists, the Massachusetts Society of Interventional Pain Physicians and more. Received her M.D. from the Columbia College of Physicians and Surgeons and received an M. Sc. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine.
Medical Director at The Center for Morton's Neuroma and
Faciitis.com

Comments:

  • So I had PF surgery done on one foot done a few yrs ago. It got rid of 80 percent of the pain. Now, it’s beginning to hurt again like it did in the first place. I met a new podiatrist who is suggesting doing nerve surgery instead, in my leg, saying that they need opened up. Sure enough, when he gives me shots in those nerves the PF pain does go away. So, he believes it’s more of a nerve damage problem, and if he goes in and fixes that, that I won’t have OF problems any longer. He seems VERY knowledgeable. Has anyone else ever heard of this?

  • I had endoscopic plantar fasciotomy and gastrocnemius recession three weeks a ago. I had issues with both feet and successfully treated one foot with orthotics, steroid injections, stretching, etc. However the other foot did not respond and progressively got worse (to the point pain was unbearable). The decision to have surgery was not made lightly but at this moment I can say I have no regrets. Week one, (in soft cast) I could put NO weight on that foot. Week two put in a walking cast (boot) 23 hours a day. Of course there was pain (mostly in the calf) when I started walking but nothing that was unbearable. I used a cane for the first 3-4 days. Today stitches were removed and I was able to walk out of the doctors office with my own shoe on, only minor pain. I’m hopeful this was a very successful surgery.

  • I have been though PF surgery, the pains in the toes were the worst. It’s definitely not a fun procedure. And contrary to what is said it’s NOT an instant fix. I did everything I was told for recovery and more. The reason I say this is my surgery was a success but it was a long road to fully recovering. I had painful numbness in my toes for almost a year. But it finally subsided. To elaborate on my extra therapy I started walking as soon as they told me I cold. Once I was doing 2-3 miles on a light rolling hill set I moved to hiking in rough terrain, some really steep climbs here and there through a 3 mile hike. While I was doing this I was wearing my custom hard orthotics. 3 months after surgery I went for a 1 mile walk jog. It wasn’t perfect and was a little sore but not too bad. Now bear in mind I and a large guy I weigh 220 lbs, so my feet take a pounding. By the 1 year mark I was back to 6 mile runs a couple times a week. It’s now been 3 years since the surgery and while I get light aches after being very active for a long time i would have to say it was a success. But a word of advice try everything else first and stay consistent because to recover from the PF is No cake walk. Good luck everyone.

  • I had surgery done almost 4 years ago and am so happy that I did. Never had any pain during recovery and went back to work and have had no problems until a couple of days ago. I’m having pain in my foot and am hoping that it is not starting again. I would love to know if it’s possible to have it come back again and what is going to happen.

    • I’m currently p.o 9 days and still can’t bare weight. On what day post op did you find walking was bearable? Ty Sw

  • I am 2 weeks post surgery and I wanted to come back here and relate my experience thus far, particularly because I was TERRIFIED after reading all of these comments before my surgery. There is hope!

    I have PF in both feet, it started out 3 years ago in just the left foot and at some point progressed to the both.
    I have tried shockwave therapy, custom orthotics, night splints, taping, golf balls, water bottles, massage therapy, and many, many cortisone injections.
    I was scared that the surgery would be unsuccessful. I was scared the recovery would be horrible. I was scared to take the necessary time off work.
    It is probably too soon for me to say if the surgery was successful, however, I am extremely optimistic. Today when walking I could feel that awful burning/stabbing sensation in the right foot (which I have not had surgery on), and to my delight the left foot had no pain! I wanted to cry with happiness at the idea that something finally WORKED. I am trying not to get my hopes up, but the important thing I wanted to mention is that at NO point have I been in any pain. There have been times of discomfort or soreness when I walked around the first few days, but if you suffer from PF I can assure you that at no point have I felt anything as bad as PF pain. Occasionally I have been “aware” of the incision sites, I’ve had a bit of tingling here and there from what I assume is tissue regeneration, but all things I expect to feel as I heal. Since we are offering up personal experiences here I would like to say that so far I highly recommend surgery for PERSISTENT and/or chronic cases.

    If you’re wondering what my recovery has been like, I’ll go into detail here:

    9/11 – Surgery at 7:30 AM. I chose to go completely under. Came home around 11. Surgeon applied a nerve block and I was in no pain, although my throat was sore from intubation during anesthesia.
    9/12 – I was on “bed rest” for the first 48 hours, only walking to go to the bathroom or to get something to eat when no one was around to help out. I was instructed to keep my foot elevated above heart level as much as possible. I highly recommend a walker with the seat. When I did walk, it was tender but not worse than PF.
    9/13 – Still on bed rest but cheating a little as I got bored being in bed all day and would sit on the seat of the walker to roll myself to the couch or dinner table for a change of scenery.
    9/14 – At this point I’m hobbling around pretty good, but slooowly easing into weight bearing for more than bathroom trips, but dr did tell me no stairs for at least two weeks (we live in a two story home). I decide to attempt to shower and make myself presentable. That was tricky. Strongly recommend a shower chair (amazon – $30) so that you can sit and not have to balance precariously on your good foot. Note – I don’t have a “good foot”, my other has PF also so this first shower was the worst part. Also you will need duct tape and plastic bags to cover your incision for any bathing prior to suture removal.
    9/15 – First follow up appointment. At this point I was pretty mobile but I didn’t know if full weight bearing would damage anything or be good for me. I used crutches and drove myself to the appointment. Doctor changed bandages and inspected incision sites. He suggested mobility stretching and actually encouraged that I increase weight bearing quite a lot.
    9/16-9/19 I gradually increased the weight bearing. It was a little weird, some days I had pain that mirrored PF pain but I couldn’t be sure if it was PF or just normal healing. When it hurt, I rested. When it felt good, I moved around. I was still relying on the walker as you are not supposed to stand for more than 5 minutes at a time. I was careful not to overdo it. If I felt achy or sore, I knew I had done too much.
    9/20-9/23 (today) – Barefoot is a little uncomfortable but if I am in the surgical shoe (not a boot, just a dorky looking velcro open shoe) I have NO PAIN in that foot! The shoe slows me down a bit because the sole does not flex light normal shoes do but I am FULLY mobile. I don’t need crutches or a walker and I am STOKED. The right foot hurts quite badly but that does allow me to feel optimistic that the surgery was a success in the left foot. I am optimistic that in a few days I will be in normal shoes! I plan to have the surgery in my right foot as soon as the doctor allows me to. I took a leave of absence from work in order to have both feet done back to back. I finally decided enough was enough and I was taking back my health and happiness. I hope this review helps someone who is feeling desperate and discouraged. This procedure is very minor and you can do it!

    • Thank you, Ashley, I am having surgery on both feet at once. This is due to being off work at this time and the company I am employed with might not survive the pandemic. (comes down to money for me, since insurance company is requiring 90 days between if I have surgeries separately; new year new deductible ) Your input was marvelous to come across. I am scared, but unable to bare the pain any longer. I appreciate your contribution from the positive side of surgery!

    • Hi Katherine, wondering if it pushed thru you having surgery on both feet at once as I’m contemplating my situation. Would like to know how hard it was to recover. I’d love some advice. Thanks

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