Plantar Fascia surgery is used in around 5% of PF sufferers, whose symptoms do not improve, even after continuous treatment. In most cases, symptoms will improve through conservative treatment and the use of orthotics.
Whilst surgery methods and outcomes are improving considerably, the success rate is still only estimated at around 70-80%.
For this reason, it is advised that a patient has been struggling with symptoms for a minimum of 9 months, has custom orthotics from a Podiatrist, performs daily treatments and exercises and has tried therapies such as Cortisone injections and Extracorporeal Shock Wave Therapy.
In most cases now a procedure called a plantar fascia release is performed. This aims at releasing (cutting) between 30 and 50% of the fascia's fibres. This helps to reduce the pull and stress on the bony attachment, as well as the fascia itself.
Whilst this was previously performed as an open procedure, in more recent years endoscopic plantar fascia releases have become more popular due to the decrease in recovery time. This requires making the release through a series of small incisions, using a camera to locate the fascia.
In making the decision to go ahead with a plantar fascia release, the patient should be fully aware of the possible complications of the surgery.
Nerve damage - there is always a risk of nerve damage with any surgery. This could result in numbness, tingling or weakness in the foot.
Excessive release - occasionally too much of the fascia is released, which results in a fallen arch. This may contribute to further injuries.
Infection - again as with all surgery, there is a small risk of infection. Although if caught early enough a course of antibiotics is effective.
Persistent symptoms - in a few cases, the symptoms may still persist even after surgery. This may be due to not enough of the fibres being released or maybe because the other causes of PF have not been corrected, or even that there is a heel spur which is actually causing the pain. This should always be checked with an X-ray before surgery is undertaken.
After surgery, the foot may be placed in a cast or brace which will allow weight bearing but reduces the force on the heel to allow the tissues to heal. Return to work time is estimated at around 9-12 weeks.