Surgery is considered in a small percentage of patients who are unresponsive to nonsurgical treatment. If heel pain persists after several months of nonsurgical treatment, Dr. Radovic will discuss surgical options and determine the most beneficial approach for each individual case. Surgery is usually not recommended for plantar fasciitis in patients with a flexible flatfoot. ESWT is recommended for those patients.
Traditional open surgical release and removal of heel spurs has been fraught with potential complications and postoperative pain and is rarely used today. A more contemporary procedure,
endoscopic plantar fasciotomy (EPF), developed by a podiatrist, is the surgical treatment of choice for this condition.
It is an outpatient procedure typically performed at a surgery center or hospital under local anesthesia and mild sedation. This minimally invasive procedure is done with the use of an endoscope which is a small instrument that allows the surgeon to see the anatomy inside the foot. When used in joints this is called an arthroscope.
A very small incision of approximately 1/2 inch is made on either side of the heel allowing the introduction of the scope and a small micro blade to release the fascia.
One stitch is used to close each incision. It usually is a 10 minute operation. Postoperative care is walking to tolerance in a protective boot for 3 to 5 days followed by the use of supportive shoes and normal non-athletic activities for 4-6 weeks. Postoperative pain is typically minimal and the prognosis is excellent.
Over 1 million people have had this procedure done since it was developed in 1990. Regardless of the treatment plan followed for planter fasciitis, the underlying causes of this condition may not resolve. Patients need to continue wearing supportive shoes, using custom orthotic inserts and stretching for long-term relief from plantar fasciitis.