For patients who experience severe heel pain, you might think surgery is a final option that could provide long-awaited relief. In fact it shouldn’t be in consideration at all.
All cheaper and effective options should be exhausted prior to altering your foot mechanics permanently with release surgery.
Here’s a basic hierarchy of non-surgical treatment options:
- Light calf stretches and arch exercises (here’s a link to stretching routines)
- Over the counter insoles (here’s a link to insoles)
- Supportive shoes (without significant heel to toe drop)
- Custom orthotics (if over the counter does not prove effective)
If your injury feels like it’s taking forever to heal you are not alone. Due to limited blood supply, tendons are notoriously slow to heal (think months not weeks – link to tendon recovery times).
Should Plantar Fasciitis Release Surgery Exist?
Plantar fasciitis surgery (plantar fasciotomy) involves creating a small incision on the heel to access the plantar fascia ligament. The surgeon then disconnects all or some of the ligament from the heel and closes up the incision. And that’s it. With some rest and physical therapy, patients can return to daily life, pain free (hopefully).
But wait, did you catch the part about the surgeon partially disconnecting your ligament from your heel and never re-attaching it? Yes your PF pain is gone, but it may soon be replaced by new pain. That’s because biomechanically, the plantar fascia performs an important role in stance and gait.
Altering the mechanics of your foot forever by slicing all or part of your plantar fascia can have serious repercussions on the function of your foot. Longterm implications could include arch instability or painful hammertoe/claw toe deformities.
Let’s look at this from another, albeit blunt lens. If you had ankle pain would you consider a surgical solution that simply amputated your foot? Yes your pain is gone, but so is the ankle. Plantar fascia release surgery is an extreme treatment option with questionable efficacy.
Here’s a link to the debate regarding release surgery on Podiatry Today. That this surgery’s value could even be called into question in a well known publication, should give most patients pause.
Risks and Complications.
Podiatrists may recommend surgery only after you have tried…nearly every other method of relieving pain for a long period, usually six months to a year. If that sounds intense it’s because most patients don’t need surgery.
Podiatry Today reports that cutting the right amount of the plantar fascia is vital for avoiding complications. Research notes that the appropriate incision is less than 40 percent of the ligament.
But let’s take a deeper look at where this number came from. Barrett and Day (the pioneers of the endoscopic plantar fascia release) originally
“…. advocated complete resection of the plantar fascia. However, two years later, they recommended releasing only the medial two-thirds of the plantar fascia. With continued experience and evaluation of postoperative complications, their final recommendation is releasing only the medial one-third of the plantar fascia.”
From this we gather an alarming trend whereby the founders of the surgery, gradually minimized their procedure further and further after noting patient complications.
The reduction in the percentage of recommended sectioning is further explained by the following citation from the same article.
“If the surgeon releases too much of the plantar fascia and employs an active postoperative course with weight-bearing and stretching, one should be cautious of complete rupture.”
“If not enough of the plantar fascia has been released or there is scarring along the plantar fasciotomy site, revisional surgery with possible plantar fasciectomy may be warranted for relief of pain.”
Reading between the lines, we reaffirm our suspicions. While the plantar fascia is indeed a source of pain, its removal/weakening will cause permanent biomechanic instability and further complications.
As unsatisfying as a non-surgical conclusion may be for those seeking a straightforward solution to their chronic plantar fasciitis pain, release surgery is undoubtedly an extreme remedy with questionable value.
The good news however, is that the conservative options (physical therapy, insoles) are affordable, administrable at home, podiatrist recommended and best of all, complication free.