What is Plantar Fascia Release?
Plantar fascia release is a surgical procedure to treat moderate to severe plantar fasciitis, in which your surgeon releases or removes the diseased section of the plantar fascia tissue to relieve pain and inflammation in the foot.
Plantar fasciitis is a condition where the plantar fascia becomes inflamed from overstretching or overuse, causing pain in the heel and bottom of the foot. The plantar fascia is a thick band of tissue present at the bottom of the foot. It runs from the heel bone to the toes and helps support the arch of your foot. Plantar fasciitis is one of the most common causes of heel pain. It is most often seen in middle-age, but may also occur generally in those who are constantly on their feet.
Indications for Plantar Fascia Release
Nonsurgical treatment modalities such as activity modifications, boots, braces, medications, injections, splints, and orthotics are always the first line of treatment for plantar fasciitis. Plantar fascial release is only recommended if:
- You are experiencing severe symptoms for 6 or more months
- Your work and activities of daily living are significantly affected by your symptoms
- Your athletic performance or ability to engage in sports is being affected by your symptoms
- You are a professional athlete who cannot wait for 6 months of conservative treatment
- Conservative treatments have proved to be ineffective
Preparation for Plantar Fascia Release
In general, preoperative preparation for plantar fascia release surgery will involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from supplements or medications such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week before surgery.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be requested from you after the surgical procedure has been explained in detail.
Procedure for Plantar Fascia Release
Plantar fascia release surgery may be performed as an open surgery, where a large incision is made, or as a minimally invasive endoscopic surgery, where small incisions are made to insert an endoscope (a thin, flexible instrument with a camera and light source), and other tiny surgical instruments.
In general, the surgery involves the following steps:
- You will lie on your back with the foot to be treated hanging over the end.
- You will be given regional or general anesthesia.
- For an open surgery, your surgeon will make a large surgical cut on the bottom of the foot or above the heel pad of the foot.
- For an endoscopic surgery, your surgeon will make small surgical cuts on the outer aspect of the foot, close to the ankle.
- The underlying muscles are carefully separated to expose the treatment area, and your surgeon may perform any of the following:
- Make small incisions on either side of the plantar fascia to mitigate tension
- Disconnect the plantar fascia from the heel bone
- Remove a small section of damaged tissue
- Detach a heel spur
- Smoothen or remove the surface of the heel bone to assist with the healing of the plantar fascia with minimal tension
- After confirming adequate plantar fascia release, the overlying soft tissue and skin are closed with sutures and sterile bandages are applied.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after plantar fascia release will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You will be prescribed pain and anti-inflammatory medications as needed.
- Apply ice bags over a towel to the affected area for about 15-20 minutes to reduce postoperative pain and swelling.
- A walking boot or a non-weight-bearing cast will be recommended for 2 to 3 weeks to facilitate tissue healing and support the foot.
- Keep the foot elevated at or above the level of your heart to help minimize swelling and discomfort.
- Start rehabilitation (physical therapy) as recommended by your surgeon to improve range of motion.
- Crutches or a walker may be used to maintain balance or stability while walking. You should begin appropriate exercises to stretch and strengthen the foot muscles.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 3 months. Gradual increase in activities over a period of time is recommended.
- You may return to sports once the foot has regained its normal strength and function, and with your surgeon's approval.
- Most patients will be able to return to their normal activities within 3 to 6 weeks.
Risks and Complications
Plantar fascia release surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection
- Bleeding
- Damage to nerves and vessels
- Thromboembolism or blood clots
- Anesthetic/allergic reactions
- Over-release of the plantar fascia