Edited by Sam Dellenbaugh, MD
Patients with plantar fasciitis that have truly failed all non-operative treatment, over a period of many months, may be candidates for a partial plantar fasciotomy. Fortunately, in most instances plantar fasciitis can be managed successfully without surgery. However, there are occasional patients that, despite strict attention to treatment protocol, still have significant symptoms. These patients with unresolved plantar fasciitis may benefit from a partial plantar fasciectomy.
A partial plantar fasciectomy is performed by making an incision over the inside of the heel. This incision allows the origin of the plantar fascia to be exposed. The plantar fascia is a thick band of tissue that forms on the sole of the foot. The plantar fascia inserts on the undersurface of the heel bone on the inside and extends to the ball of the foot. There can be significant scarring and chronic injury to this tissue leading to the symptoms of plantar fasciitis. The partial plantar fasciectomy procedure involves cutting out this area of scarred and inflamed tissue, without releasing the entire plantar fascia. It is possible to perform a partial plantar fasciectomy endoscopically (through a small scope), which has some advantages and disadvantages over the “open” procedure.
Recovery from the surgery involves relative immobilization in a cast or a walking boot, often for four to six weeks, to allow the soft tissue to settle. After this, patients are gradually rehabilitated, working on strengthening their foot and lower leg muscles. Some scar massage to improve the symptoms may also be beneficial. It often takes a number of months for symptoms to reach the point of maximum improvement.
Specific complications of partial plantar fasciotomy include:
- Plantar fascia rupture If too much of the plantar fascia is released, the entire plantar fascia may rupture. This will cause pain and may cause some loss of arch.
- Injury to the calcaneal branch of the tibial nerve. The surgery is performed near a nerve that may be injured, either by retraction, scarring or direct injury. If this occurs, there can be pain from the nerve or associated numbness in this area.
- Persistence of Symptoms. There may be residual symptoms following this surgery, as scarring and ongoing inflammation in this area may persist.
General complications include the potential for:
Edited November 21, 2015