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.
Plantar fasciitis surgery recovery
Recovery time depends on the type of surgery that you undergo.
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.
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.
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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:
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.
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.
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.
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,
- 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.
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Originally published September 23, 2018, this post has been updated for republication.
Janet Pearl, M.D., M. Sc.
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