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Indiana Podiatry Group
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Do You Need Plantar Fascia Surgery? Indiana Foot Surgeons Explain This Common Procedure

Surgery to correct plantar fasciitis is needed in less than ten percent of all cases of plantar fasciitis, but is the only route to permanent relief for those in whom conservative treatment does not work. There are many procedures used to address this condition, and the surgeons at Indiana Podiatry Group generally use one of two differing techniques.

The fist technique, which is the oldest and more traditional technique, involves creating an incision along the side of the arch by the heel and then removing a small section of the plantar fascia, less than an inch, partially across its width. The created gap eventually fills with scar tissue, and the overall result is that the fascia is lengthened, which reduces the strain to the tissue. Once the strain is gone, the chronic inflammation will resolve after a short while, and the pain will be relieved. During this procedure, it is also customary to remove any bone spur present on the heel bone. Although not contributing to the overall condition, the former traction placed on the spur by the plantar fascia may allow for some remaining inflammation there, and removing the spur may relieve this. The skin is then repaired with sutures, and the patient is placed in a pneumatic walking boot for about a month to keep the heel stable and prevent the incision from gapping open. The heel is generally sore for a few weeks following surgery, but after a month activity can usually slowly be increased to normal. One potential complication, beyond incision gapping and skin infection, can be transfer of arch strain to the non-cut outer band of the plantar fascia. This is uncommon, but can be difficult to treat if it develops.

The second technique is newer, and reaches the same result without removing any fascia tissue. A similar incision is created in the heel and arch, and the fascia tissue is then subjected to numerous punctures by a device that creates radiofrequency waves. This energy, delivered directly in the fascia tissue, changes the chronic inflammatory state in the fascia to that of an acute state, leading to a dramatic increase in the tissue’s ability to heal itself. The healing is further aided by healing factors found in one’s own blood prepared to enrich the platelet component. This preparation from a sample of blood taken in the operating room is applied in gel or plasma form to the fascia tissue following the radiofrequency wave application. The skin is repaired with sutures, and the patient is placed in a pneumatic walking boot for a month while the acute inflammation period passes, and healing finishes. The arch and heel is often more sore after this procedure the first couple weeks compared with the first technique, but this usually and suddenly resolves after that time period. The length of the fascia is maintained, and the likelihood of transferring strain to the outer fascia band is very low. Some patients do not fully improve with this procedure, and do have to have part of the fascia removed later on. However, this is uncommon, as most patients do quite well after this technique.

Either one of these techniques typically result in a pain-free heel, and the choice of which one to perform lies in the clinical indications and the preference of the surgeon. Healing times are similar, and typically lead to full pain resolution about a month following surgery.