Surgery for recalcitrant plantar fasciitis
Last update: 1 November 2019
Surgery for recalcitrant plantar fasciitis
What exactly is plantar fasciitis?
Plantar fasciitis is a common foot pathology that causes severe pain in the heel and arch of the foot. This discomfort is caused by micro-tears in the plantar fascia, a ligament that supports the arch of the foot.
Who is at risk?
Plantar fasciitis affects some people more than others. It is possible to perform surgery on these at-risk patients suffering from this problem.
Those more at risk include:
- People with flat feetPeople with hollow feet
- Overweight persons (or those who gained weight suddenly)
- Pregnant women
- Those over the age of 45
When should a patient elect to seek surgery for plantar fasciitis?
If you can no longer perform your daily activities, work or play sports, you should book a consultation! The same applies if you have tried various conservative treatment methods, without success.
How do we evaluate whether a patient requires surgery for plantar fasciitis?
The professionals at PiedRéseau can offer you several advantages when it comes time to evaluate your condition:
- A pre-surgery evaluation can be performed throughout the province of Québec
- A detailed report of your medical situation
- A clear surgical plan adapted to your specific situation
- Initial consultation with the podiatric surgeon
- Answers to your questions
The patient’s medical history is very important
Using your medical history, we will determine the cause of your recalcitrant plantar fasciitis.
Several factors related to your condition can explain it, including:
- Trauma to the foot and heel
- Activities performed
- Foot type
- Type of shoes worn
The podiatrist must properly grasp the patient’s expectations regarding the upcoming procedure. They will sometimes have to explain that the foot will not always regain as much autonomy and functionality as before (for example, if irreparable tears have occurred).
The clinical examination is used to assess whether you are a candidate for surgery. Your surgical history will be studied, as will your medical history, medication and allergies. In addition, a vascular assessment of your feet will be conducted to ensure optimal healing.
X-ray evaluation of the deformation
The X-ray evaluation is conducted as follows:
- There will be an initial X-ray for a bone evaluation of your foot.
- Various possible complications are identified, such as the presence of heel spurs.
- X-rays make it possible to establish a surgical plan.
- A second X-ray can be taken after surgery to ensure everything went well.
Choosing the right foot surgeon
Is the surgeon experienced, with a good reputation?
Is the care tailored to your specific needs?
Is care management provided in a humane fashion?
Is the surgeon available?
Initial conservative treatment methods
Before electing to have plantar fasciitis surgery, it is very important to list what you have already tried or what can be tried. For example:
- Wearing proper footwear
- Exercises and stretching
- Plantar fascia massages
- Ice compresses
- Physical therapy (ultrasounds, lasers, shockwave, etc.)
- Wearing foot orthotics
- Taking anti-inflammatory medication
- Cortisone injections
- PRP injections (platelet-rich plasma)
- Surgery that did not work or a recurrence after several years
However, sometimes the situation is so advanced that it is impossible to correct it with conservative treatments. Plantar fasciitis surgery then becomes the best option.
Why choose surgery performed by a podiatrist?
Your podiatrist is the professional of choice because:
- They have in-depth knowledge of the foot and its biomechanics.
- They have been trained to properly care for your feet.
- They can perform specialized foot interventions.
- They manage your foot care from A to Z, before, during and after the operation.
- They are able to quickly restore your foot’s autonomy.
Your PiedRéseau clinics provide the following advantages:
- Rapid access to a podiatrist
- Full monitoring
- Answers to your questions.
A PiedRéseau clinic will always be easily accessible!
Procedures to remedy your plantar fasciitis
Topaz procedure, or dry needling:
Plantar fascia release procedure:
Platelet-rich plasma injection (PRP)
Chronological steps of plantar fasciitis surgery
This begins a few weeks before surgery:
- You must obtain medical clearance from your doctor for outpatient surgery.
- Sometimes, some patients require a blood test and prescription for antibiotics before surgery.
- You must allow for a convalescence and rest period following surgery.
- You must be accompanied by someone for the surgery, and they must be available to take you home and stay with you for 24 to 48 hours.
- It is important to properly clean your foot before arriving for surgery.
The day of surgery
Generally speaking, the day of surgery for plantar fasciitis takes place as follows:
- If recommended, you must take any medication 2 hours prior to surgery (or as per the instructions of your podiatric surgeon).
- You then arrive at the clinic for your surgical preparation.
- The surgical team cares for you and prepares you for the procedure. They ensure you are comfortable.
Following the operation, you must ensure you heal well. Below are a few tips you must be aware of:
- The anaesthesia is long lasting, which means that you will not feel any symptoms for several hours following surgery.
- Pain medication will be prescribed. You should start taking it while you are still under anaesthesia.
- You will return home the same day as the operation (don’t forget to bring someone with you to assist you!).
- It is recommended to keep your leg elevated and apply an ice pack to reduce any swelling.
- You must keep your foot dry.
Follow-up visits and home care
Each procedure requires special care at home. The clinic’s team will give you a personalized home care plan to follow, and a follow-up appointment will then be scheduled with your surgeon within a week.
Normally, if there are any stitches, they will be removed within 10 to 21 days.
What is the convalescence period for plantar fasciitis surgery?
When will I be able to recommence my daily activities?
Recommencing daily activities depends on your healing progress and the type of procedure performed.
Importance of following your surgical recommendations to the letter
It is very important that you carefully follow the instructions given you before, during and after surgery. Carefully following these medical instructions will have a direct impact on your recovery and the success of the procedure.
Post-surgical plantar orthotics
Wearing plantar orthotics following surgery is highly recommended:
- To avoid a relapse
- To have the foot regain its normal shape
- To make your foot functional again
- To avoid having to return for surgery
The risk of recurrence for this pathology is very high. It is therefore essential to ensure adequate prevention following surgery and to book a consultation quickly if symptoms return.
Possible biomechanical complications and special cases
Your podiatrist’s training enables them to recognize any possible biomechanical complications of surgery.
Given that our feet are subject to so many demands, the slightest imbalance of it can lead to a new pathology (and some complications!) That is why you should consult if you have the slightest doubt about your feet’s health.