Surgery for Fasciitis Patients
If conservative treatments are not effective, the plantar fascia can be surgically removed. Plantar fasciotomy can be performed using endoscopic, radiofrequency, or open techniques. Plantar fasciitis patients have a success rate between 70 and 90 percent. The flattening and lengthening of the longitudinal arch and heel hypoesthesia are potential risk factors. We begin by correcting training errors. It is necessary to perform a relative test and use ice after exhausting activities. Also, it is important to assess the patient’s shoes and activities.
We then try to correct biomechanical factors with a strengthening program and stretching. If there is still no improvement, we consider orthotics and night braces. Lastly, other treatment options may be considered. We consider non-steroidal antiinflammatory drugs during the course of the treatment. Therefore, we inform the patient that these medicines are used primarily to control pain and not cure the underlying problems. These are the most important surgical approaches:
Open Plantar Fasciotomy
During an open fasciotomy, many factors are considered, such as incision placement, stabilization post-release, and the release of plantar fascia. Open plantar release can be performed in a variety of ways. In severe cases, the plantar incision provides the best visibility of the plantar ligaments as well as the linking structures such a heel spur. In cases where the plantar ligaments are thick and diseased, the in-step method (a variation of the traditional way) can help to release the fascia selectively and promote faster healing. This approach also has a lower risk of long-term and adverse problems.
In order to allow maximum healing of the incision, it is important to avoid sudden weight bearing after surgery. The open plantar release also known as the Medial Plantar Fasciotomy. The surgeon will surgically acquire plantar fascia on the inner side (proximal middle arch) of toes. The surgeon uses a method that involves ligament release and after-sensation to determine the alignment of the structures. Blind resection is performed on the plantar fascia. This surgical method is therefore less intrusive and offers a faster recovery. However, the chances of complications are slightly increased. A surgeon’s expertise could be crucial to the success of the operation.
Other surgical options for treating plantar fasciitis include
Release of the Medial Proximal Gastrocnemius:
Other surgical methods can be performed depending on the pathophysiology of the patient and other factors. One such method is the proximal-medial gastrocnemius (also called PMGR). Many plantar fasciitis sufferers have isolated tightness of the gastrocnemius muscles that affects biomechanics (both the ankle and knee joints) and results in reduced ankle movement (coupled with a different knee extension). In such patients, this surgical procedure is very helpful to reduce the chances of plantar fasciitis recurring. PMGR scores are high (over 95%), and patients can resume their daily routines within 3 weeks of the surgery.
Endoscopic Plantar Fasciotomy
Endoscopic fasciotomy, also known as endoscopic fascia release, is a relatively new technique that involves a quick surgical dissection with delicate equipment. The tissue is then resected precisely. The surgical resection is done directly under endoscopic cameras. Endoscopic fasciotomy is superior to open fasciotomy for the following reasons:
- Early recovery is possible for patients
- Weight-bearing after surgery is sudden and unexpected
- Recovery and rehabilitation times are shorter in general.
The use of endoscopic fasciotomy is associated with improved post-operative results. Endoscopic fasciotomy is a method that has a success rate of 80-90%. After the initial rehabilitation period, patients who have undergone endoscopic release of plantar fascia report a good improvement in their symptoms. In terms of pain, nerve entrapment and persistent pain, endoscopic plantar facia release is similar to open fasciotomy.
Surgical complications, risks and dangers
There are few complications or side-effects associated with any operative method, regardless of how experienced your surgeon is and what methods he uses. Here are some of the surgical risks and complications associated with plantar fasciitis:
- Full tearing plantar fascia:
Few patients will also experience complete tearing or serving of the plantar fascia after surgery.
- Scarring after surgery of the plantar fascia:
According to studies, scarring is common after surgery (regardless the type of surgery). A precise incision made along the lines of tension of the skin can reduce the risk of painful scarring. In most cases, the painful scarring will resolve on its own. Few patients may need to use a scar removal method.
- Entrapment of the nerve or neuritis.
Nerve pain can also be caused by nerve entrapment, or neuritis due to abnormal scar formation. These patients may need nerve release methods or nerve excision to return to daily activities sooner after surgery.
Reattachment or Fibrosis. The insufficient or inadequate release or plantar fascia can lead to the reattachment or fibrosis that causes persistent pain and discomfort. Pain can also be caused by inflammatory reactions due to metabolic factors or methods for recalcitrant symptoms, such as psoriatic, SLE, Ankylosing Spondylitis (AS), reactive arthritis, inflammatory arthritis, inflammatory intestinal disease, and Rheumatoid Arthritis.
- Stress Fractures:
This instability puts more strain on the surrounding structures. Stress fractures can occur in patients who are under strain or fatigue.
- Instability:
Temporary instabilities are usually the result of temporary changes to biomechanical foot support. In many cases, the structures that support the foot, such as the tendons, ligaments, and muscles, take on a different role.
