A recurring stabbing pain in your heel can make it hard to stand, walk, or exercise.
If you have plantar fasciitis and chronic heel pain even after months of treatments, it may be time to talk with a doctor about plantar fasciitis surgery.
Read on to learn what makes an ideal candidate, what happens in surgery, and what recovery is like.
Your plantar fascia is the thick ligament that runs from your toes to your heels and provides support to the arch of your foot.
Plantar fasciitis happens when this ligament is irritated and inflamed. It’s one of the leading causes of heel pain.
Plantar fasciotomy is surgery to detach your fascia from your heel bone in order to relieve tension. During the healing process, the connective tissue experiences new growth, which can encourage lengthening of your fascia.
Plantar fasciotomy or fasciectomy?
Surgery for plantar fasciitis may be referred to as a fasciotomy or a fasciectomy. So what’s the difference between the two? Typically an “-otomy” means that an incision is made without removing any tissue. An “-ectomy” means that an incision is made and parts of the tissue are removed.
So, for a plantar fasciotomy, an incision is made and your fascia (the connective tissue that covers the muscles) is detached from your heel bone. For a plantar fasciectomy, an incision is made and any scarred or inflamed tissue is removed.
Surgery isn’t a first-line treatment. Most people with plantar fasciitis won’t ever need it. But when you’ve tried other remedies and still have chronic heel pain, surgery is an option.
Before choosing surgery, your doctor may recommend less invasive therapies, such as:
- orthotic arch supports
- taping your foot
- physical therapy, including stretching and strengthening exercises
- anti-inflammatory medications
- cortisone, local anesthetic, or platelet-rich plasma injections
- extracorporeal shock wave therapy, which uses high-energy impulses to repair plantar fascia tissue
- radiofrequency ablation, which uses heat to stop the transmission of pain
About 90 percent of people respond to conservative treatment within 12 months, according to a 2018 study.
If you’re living with chronic pain despite these treatments, you might find it difficult to stand, walk, or play sports. Over the long term, plantar fasciitis can change the way you walk and move, leading to other problems with your feet, legs, hips, and back.
The goal of the surgery is to reduce pain and improve foot mobility, so you can get back to your usual activities.
Overall, surgery to release the plantar fascia is successful. In a small 2017 study, for example, it had a 70 to 90 percent success rate.
You may be a good candidate for surgery if:
- You continue to have severe pain, despite trying other measures.
- Your symptoms have lasted 6 months or more.
- You’re unable to participate in physical activities.
- Your heel pain interferes with your ability to work.
- Other potential diagnoses have been ruled out.
The risk of side effects, slow healing, or complications of plantar fasciitis surgery may be higher if you have certain underlying health conditions, such as:
Your doctor will consider your overall health when deciding if you’re a good candidate, as well as which type of plantar fasciitis surgery is right for you.
Plantar fasciotomy can be accomplished two ways:
- Open surgery. This usually takes place in a hospital setting.
- Endoscopic surgery. This procedure can be done in a hospital, surgical center, or doctor’s office.
Either way, you’ll be provided with pre-op instructions. You may be advised to stop eating and drinking 6 to 8 hours before surgery. Follow instructions about whether you should take regular medications that morning.
Your foot will be examined and your vital signs will be checked just prior to surgery. You’ll likely have an intravenous (IV) line inserted into your arm for medications. Your foot will be draped and cleaned with antiseptic.
Here’s what happens in each type of surgery:
- Open surgery. This usually requires general anesthesia or a regional block with sedation. A 1- to 2-inch incision will be made to expose your plantar fascia and detach it from your heel bone. Any trapped nerves or bone spurs can also be removed at this time.
- Endoscopic surgery. This can be performed with a local anesthetic and a mild sedative. Endoscopic surgery involves two small incisions under your ankle bone, each less than half an inch long. The surgeon will insert a small camera, called an endoscope, in one of the openings and a tiny knife in the other to release your plantar fascia.
The incisions will be sutured and bandaged.
Plantar fasciotomy is typically an outpatient procedure. You’ll be released once you’re fully awake and your vital signs are good, usually within a few hours. You won’t be able to drive, though, so be sure to arrange transportation in advance.
You’ll be given post-op instructions specific to your medical needs. You can expect some discomfort or minor pain for several days.
Your doctor may prescribe pain medication. If not, you can take over-the-counter medication as directed.
Recovery from open surgery
Following open surgery, you may need a walking boot, a cast, or a special shoe for several weeks as you heal. You may need to return to the doctor’s office to have the sutures or cast removed.
Your doctor will let you know when you can start wearing normal shoes. You’ll have a small scar where the incision was made.
Full recovery from open surgery could take 6 to 10 weeks.
Recovery from endoscopic surgery
If you have endoscopic surgery, your foot should be able to bear limited weight fairly quickly. You’ll probably be able to wear regular shoes within 1 or 2 days. Scarring will be minimal.
You’ll likely be advised to go easy on your foot for several months. In the meantime, your post-surgery recovery may include flexibility and strengthening exercises, either with a physical therapist or on your own.
Recovery after endoscopic surgery is shorter, typically 3 to 6 weeks. Your doctor can give you some idea what to expect based on your personal circumstances.
Return for follow-up visits as recommended for both open and endoscopic surgery.
The shoes you wear are important
Going forward, always wear that provide ample support, especially during physical activity. If you’re an athlete or have participated in high-impact activities in the past, talk to your doctor before resuming these activities.
While surgery for plantar fasciitis may resolve the issue, some people continue to have problems. Risks of plantar fasciitis surgery may include:
- adverse reaction to general anesthesia
- slow wound healing
- nerve injury or entrapment resulting in loss of sensation (hypoesthesia)
- recurring heel pain
- flattening of your foot’s arch
Endoscopic surgery takes less time to perform and general anesthesia isn’t needed. While some of these same risks exist, there are generally few complications.
Let your doctor know if you have increasing pain or signs of infection.
Plantar fasciitis is a painful condition involving the plantar fascia, a ligament that goes from your heel to your toes. There are several noninvasive treatments that can resolve the problem within a few months to a year, in most cases.
When other methods have failed and heel pain is affecting your quality of life, you may want to consider surgery. The procedure involves releasing the ligament to relieve tension. This can be done via open surgery or endoscopic surgery.
Plantar fasciitis surgery, or fasciotomy, is often an effective remedy for chronic heel pain. Your doctor can help determine if this surgery is a good option for you.