Surgery for Plantar Fasciitis -

Plantar fasciitis surgery generally describes cutting into the plantar fascia, or the tissue affected by the condition, in order to relieve tension and promote healing.

“The original theory of plantar fascia surgery was to take a piece of plantar fascia out and stimulate a healthy healing response to get a normal plantar fascia,” says Lance M. Silverman, MD, an orthopedic surgeon at Silverman Foot and Ankle in Atlanta. Depending on their training and the patient’s needs, providers may prefer different techniques.

Plantar Fasciotomy (or Plantar Fascia Release) Surgery

One type of surgery for plantar fasciitis is plantar fasciotomy or plantar fascia release surgery. This involves snipping part of the plantar fascia to release tension and reduce inflammation. “It’s important that you don’t release the entire plantar fascia,” says Kevin Schafer, MD, an assistant professor in the department of orthopedic surgery at NYU Grossman School of Medicine. “If you do, the arch sags and collapses and you overload the outside of your foot, and there’s really no solution for that.”

The outpatient procedure can involve numbing the leg and foot below the knee, as well as the choice between general anesthesia and induction into a sort of “twilight” state, Silverman says. While surgeons vary in the specifics of their technique, Silverman typically makes a small incision on the inside of the heel and cuts a centimeter by centimeter section of plantar fascia. Often, he works to release a nerve or nerves trapped by the scar tissue built up in the plantar fascia, too.

Endoscopic Plantar Fascia Release Surgery

Some clinicians prefer to use an endoscope, or a small tube with a camera, to achieve a similar aim in a less-invasive manner than the open surgery described above. This method can involve general or local anesthesia and be performed in a doctor’s office, hospital, or surgical facility. Providers typically make incisions that are less than a half-inch long and use the scope to guide where they snip the fascia, usually near the heel bone.

“The recovery is faster, the risks are lower and the outcomes are probably better,” Dr. Schafer says. Some research suggests the same.

But, the endoscopic technique is more difficult than an open surgery and has a higher risk of nerve damage, the American Academy of Orthopaedic Surgeons says.

Heel Spur Surgery

Sometimes, when surgeons are operating, they’ll find and remove a heel spur, or a bony growth that likely resulted from the strain on the foot’s ligaments. That’s why plantar fasciitis can also be called “heel spur syndrome,” says Ravi Kamble, a doctor of podiatric medicine in private practice in Staten Island, New York. “It’s a myth that the heel spur is actually causing the pain: It’s a result of the [plantar fasciitis] condition, not the cause of the condition.”

Research and professional opinions are mixed when it comes to whether removing a heel spur during plantar fascia surgery is necessary, since operating on the plantar fascia alone can often resolve the pain and improve functioning. Removing a spur also introduces more risk, Silverman says.

Gastrocnemius Recession

Another plantar fasciitis-related surgical technique is called gastrocnemius recession, which is basically a snip of the fascia further up the calf (as opposed to in the plantar fascia itself) to lengthen the muscle, Schafer explains. This strategy can be effective in patients with gastrocnemius contracture, or when their tightened calf muscles limit your ability to pull your toes back toward your knees. It’s typically a minor, outpatient procedure that takes a few hours and requires a boot and physical therapy afterward.

While there’s a strong evidence base for using this method in kids with cerebral palsy, for instance, more long-term data is generally needed on the technique for adults specifically with plantar fasciitis.

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