What if my symptoms of plantar fasciitis do not resolve with time?
As stated above, simple treatment measures will usually work in the treatment of plantar fasciitis. These treatments include anti-inflammatory medication, shoe inserts, and stretching exercises. In cases where a good effort with these treatments fails to provide adequate relief, some more aggressive treatments may be attempted. These include cortisone injections or extracorporeal shock wave treatments.
When does surgery for plantar fasciitis become a treatment option?
Surgery should be reserved for patients who have made every effort to fully participate in conservative treatments, but continue to have pain from plantar fasciitis. Patients should fit the following criteria:
- Symptoms for at least 9 months of treatment
- Participation in daily treatments (exercises, stretches, etc.)
- Understanding of the potential risks and benefits of surgery
What are the risks of surgery for plantar fasciitis?
Unfortunately, surgery for treatment of plantar fasciitis is not as 'predictable' as a surgeon would like. What I mean by this, is surgeons can reliably predict that patients with severe knee arthritis will do well after knee replacement surgery about 95% of the time. Those are very good results. Unfortunately, the same is not true of patients with plantar fasciitis.
Some of the complications of surgery for plantar fasciitis include:
- Over release of the plantar fascia
When your surgeon releases the plantar fascia, it is important to only release about 30-50% of the fascia. Release of more of the plantar fascia during surgery may cause a flat foot deformity due to the loss of the arch of the foot. Flat foot after surgery can lead to chronic problems that may be as bad as the plantar fasciitis.
- Nerve injury to the foot
There are small nerves that travel just adjacent to the plantar fascia. These nerves, even with protection, may be damaged during surgery to release of the plantar fascia. Because of this, a small percentage of patients may have pain or numbness in areas of the foot following plantar fasciitis surgery.
- Persistence of symptoms
As stated earlier in this article, pain around the heel of the foot may not always be due to plantar fasciitis. Symptoms of plantar fasciitis may closely resemble symptoms of other foot problems. Therefore, some patients may not find relief of their symptoms even after surgery.
Unfortunately, infection is a possible complication after any surgery. If a patient sustains an infection following surgery, they will require antibiotics and may require further surgery to remove any infection.
Well, that is a question you need to decide in consultation with your orthopedic surgeon. Surgery for plantar fasciitis can be very successful in the right patients. While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery. This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery.
What about endoscopic plantar fascia release?
New surgical techniques allow surgery to release the plantar fascia to be performed through small incisions using a tiny camera to locate and cut the plantar fascia. This procedure is called an endoscopic plantar fascia release. Some surgeons are concerned that the endoscopic plantar fascia release procedure increases the risk of damage to the small nerves of the foot. While there is no definitive answer that this endoscopic plantar fascia release is better or worse than a traditional plantar fascia release, most surgeons still prefer the traditional approach.
Gill LH. "Plantar Fasciitis: Diagnosis and Conservative Management" J. Am. Acad. Ortho. Surg., Mar 1997; 5: 109 - 117.
Riddle, DL, et al. "Risk Factors for Plantar Fasciitis" J. Bone Joint Surg. Am., May 2003; 85: 872 - 877.