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If you have chronic plantar fasciitis that has not responded to conservative therapy, your doctor may recommend surgery for plantar fasciitis.
A plantar fasciotomy surgery is a procedure that involves cutting a portion of the plantar fascia, thus relieving pain.
The plantar fascia is the thick ligament that runs along the bottom of the foot. The plantar fascia helps with shock absorption. When it becomes inflamed or irritated, it can cause heel pain.
Plantar Fasciotomy Procedure- What to Expect
The surgery can be done in the outpatient setting at a hospital or surgery center. This means that you can go home immediately after the procedure.
The actual procedure takes 30 minutes to complete. The surgery will be done under sedation anesthesia. You will be sleeping the entire time during the surgery.
Once you are asleep, your surgeon will make a small incision on your heel. Then a portion of the plantar fascia will be cut. The incision will be closed using sutures (thread), and a dressing will be applied to the foot. A post-operative surgical shoe will be applied to your foot.
You will be discharged home after the procedure.
Plantar Fasciotomy Recovery- What to Expect
When you get home, you should elevate your foot on two pillows to help reduce swelling and pain.
You should ice your foot for 20 minutes on and 20 minutes off to help reduce pain. Your doctor will prescribe pain medication to help keep your pain under control.
You will need to remain non-weight bearing in the post operative surgical shoe for 3-4 weeks after the procedure. Use crutches or a knee scooter to help you keep pressure off of your heel.
Sutures will be removed at your doctor’s office after 2 weeks.
Most people can transition into athletic shoes around 6 weeks and begin walking comfortably. When you transition into athletic shoes, make sure you are wearing an orthotic in your shoes to help keep your arch elevated. This can help relieve pressure along the surgical site.
Custom orthotics are ideal because they are customized to your foot structure. If you don’t have custom inserts and are looking for an over-the-counter brand, I recommend Powerstep Protech inserts.
Powerstep Protech inserts work well for mild to moderate flatfoot structures. These inserts have a stable supportive arch and will last 6-12 months.
Physical therapy may be needed after the surgery to help reduce pain, relieve scar tissue, and help you walk.
If your doctor recommends physical therapy, they will recommend you complete therapy 3 times a week for 1 month.
Complications From Plantar Fasciotomy Surgery
Like with any foot surgery, complications can happen.
Some of the complications that can occur from a plantar fasciotomy surgery include:
- Infection: Infection is a complication that can occur from an open plantar fasciotomy surgery. If you notice redness, heat at the incision site, swelling, and pain, contact your doctor immediately. You may need antibiotics.
- Nerve damage: Nerve damage can occur during surgery. This can result in numbness, tingling, and burning sensation in the feet. Nerve damage can be temporary or permanent. If you have pain from nerve damage, your doctor will prescribe pain medication to help reduce the pain or perform a nerve block to alleviate symptoms.
- Scarring: Since the incision is made in the heel (where there is thick skin and a lot of fatty tissue) the incision site will leave a scar. However, some people develop more scar tissue than others. If the scar is painful, your doctor may suggest injecting the scar with a corticosteroid to help soften it.
- Lateral column pain: If too much of the plantar fascia is released, you may experience pain on the outside of your foot. This discomfort can usually be alleviated with custom orthotics that can help redistribute pressure away from the outside of the foot when you walk.
How Long Will I Be Off Work After Plantar Fasciitis Surgery?
If you have a sit-down job, you can return to work 1-2 weeks after surgery. You must keep your leg elevated while seated to help control swelling. You must also be off narcotic pain medications when you return to work. If you stand or walk all day long, you will need to be off work for 4 weeks.
When Can I Drive After Plantar Fasciitis Surgery?
If you had surgery done on your left foot and are not taking any narcotic pain medications, you can start driving 1 week after surgery. If you had surgery done on your right foot, it’s best to wait 4-6 weeks before driving. You should not wear a post-op shoe when driving, as this can be dangerous.
What Is the Success Rate of a Plantar Fasciotomy Surgery?
The success rate of a plantar fasciotomy surgery is fairly high, with studies showing a success rate of between 70-90%.
Can Plantar Fasciitis Come Back After Surgery?
In some cases, plantar fasciitis symptoms can come back after surgery. This can occur due to fibrosis of the fasciotomy site. The fibers can reattach together over time and cause pain.
It’s important to ensure that enough of the plantar fascia is transected during surgery. Your doctor may also suggest gentle stretching exercises after the surgery to prevent fibrosis.
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