There are numerous techniques used to surgically treat plantar fasciitis when nonsurgical measures fail. These involve different levels of severing or removing tissue within the plantar fascia to release tension and allow for it to heal in a longer position to keep the fascia from continuously becoming inflamed. Unfortunately, this can sometimes result in the transfer of this tension to the outer side of the plantar fascia, a condition that is much harder to treat. A different technique has emerged in the last decade that does not involve any significant tissue removal or cutting, and keeps the plantar fascia intact.
By using a device called Topaz microdebrider, a surgeon can place a small probe into the plantar fascia and release a short burst of radiofrequency energy into the tissue. This process is repeated in a grid-like pattern along the inflamed area of the fascia. The energy released by this device removes small amounts of tissue to break up scarring, and stimulate fresh inflammation needed by the body to complete the healing process. It also increases blood flow across the fascia to further aid in tissue regeneration and recovery. The foot is supported for about 4-5 weeks after the procedure in a walking boot, and pain reduction begins slowly during this time, with full pain relief usually within 2 months of the procedure, if not far sooner. This time frame is similar to more traditional surgery on the plantar fascia, but it results in no tissue loss or general potential for pain transfer. General results are very good.
This surgery can be performed through a small incision (this author’s preferred technique), or through a series of small punctures in the skin. It is performed in an outpatient setting, under sedation and local anesthesia (if appropriate for one’s health status).
While this procedure is appropriate for most cases of plantar fasciitis requiring surgery, there are some instances in which more traditional surgery may be best. These can include cases where the plantar fascia is very tight and bow-strung, or where there is significant calcification or fibrous mass formation (fibroma) in the tissue. One’s surgeon will elect the best technique for their specific case based on these factors and the surgeon’s own procedure preference.