Plantar Fascia Release: Everything You Need to Know
Plantar fascia release, or plantar fasciotomy, is a type of outpatient foot surgery in which small incisions are made in the plantar fascia to relieve severe heel pain caused by plantar fasciitis. The plantar fascia ligament runs along the bottom of the foot and connects the heel to the front of the foot.
What Is a Plantar Fascia Release?
This procedure is considered when conservative therapy for plantar fasciitis has not been effective.
Some fibers of the plantar fascia ligament are surgically cut to reduce the pain caused by the thickening, inflammation, and tightness of this structure that are characteristic of this condition.
It requires local anesthesia for pain control and can be done as an open surgery or a minimally invasive endoscopic procedure.
With either surgical approach, you will have a skin incision near your heel pad so your surgeon can access and make small cuts in the ligament to release tension.
An open procedure involves one incision measuring about two to three inches in length.1
An endoscopic (percutaneous) procedure uses a very small incision, measuring about 1/4 of an inch.2 The surgery is performed with a small endoscopic device attached to a camera and small surgical tools.
An open surgery will involve a recovery time of approximately six to ten weeks, although some reports note that recovery can take seven months.1 A laparoscopic procedure typically entails a recovery time of about four to six weeks.
In addition to cuts in your plantar fascia ligament, you might also have a few other steps during your surgery:
Nerves can become entrapped as a result of inflammation and thickening of the ligament, and you might also have a surgical release of nerve impingement when you have your plantar fascia release if you have this issue.
Heel spurs can develop due to severe plantar fasciitis. If you have them, you may have these bone spurs removed during your surgery as well.
If you have a high risk of complications, a plantar fascia release surgery may not be right for you.
Vascular insufficiency: Diminished blood supply can impede proper healing of your foot after surgery and can predispose you to complications.
Peripheral neuropathy: Sensory loss or paresthesias (uncomfortable sensations) due to nerve disease can predispose you to profound foot discomfort after surgical procedures involving your foot.3
An acute foot infection: If you have an infection of your foot, it should be resolved with treatment before you have surgery on that foot.
Additionally, you may need to take it easy on your foot for a few months. You will need to schedule your surgery at a convenient time when you can recover as needed.
This is generally a low-risk procedure, but issues due to the surgery or the local anesthesia can occur.
Complications of plantar fascia release include:4
Over-release of the plantar fascia during surgery may cause a flat foot deformity with loss of the arch of the foot.
Nerve injury can lead to permanent loss of sensation or pain.
An infection can cause pain and fever; in rare cases, infection can spread to other areas of the body.
You and your doctor should discuss the risks and benefits of the surgery in your case before proceeding.
Plantar fasciitis often results from overuse of and/or stress on the foot. It causes sharp heel pain that is at its most severe when you take your first few steps out of bed in the morning. The pain typically improves with activity but then worsens throughout the day or after you stand for a long time.
The release of tension of the plantar fascia ligament has been found to reduce this severe heel pain and restore foot mobility that may have been compromised due to pain-induced limitations.1
You might consider having a plantar fascia release if your plantar fasciitis is causing severe pain, limiting your movement, or persisting despite non-surgical methods of treatment.
Around 90% of people who are diagnosed with plantar fasciitis will experience relief within one year of starting non-surgical therapy, and trying such options before considering surgery is recommended.5 Non-surgical treatments include stretching exercises, shoe inserts, wrapping the foot, anti-inflammatory medications, cortisone injections, platelet-rich plasma injections, and extracorporeal shock wave treatments.
If pain persists despite non-surgical management of confirmed plantar fasciitis, surgery may be the next step. Most people experience decreased pain and can resume high-impact activities after a plantar fascia release.6
While those who move on to have a plantar fascia release may finally get relief, it is still possible for symptoms to persist post-surgery.
Isolated proximal medial gastrocnemius release is another type of surgery used for treating persistent plantar fasciitis. The gastrocnemius is a muscle in the calf, and contraction of that muscle can cause the condition. Your doctor may discuss this option as well, although experts have not yet agreed on criteria to guide which procedure is better for treating plantar fasciitis.
Treatments for Plantar Fasciitis
How to Prepare
Before your surgery, your doctor will thoroughly test your foot sensation and foot movement to determine whether you have nerve impairment. You will likely also have imaging tests of your foot so your surgeon can see any additional anatomical problems that need attention, such as bone spurs.
If such issues are present, your surgical plan will involve addressing them in addition to releasing the plantar fascia. In discussing your surgery, your doctor should also inform you of where your incision will be made and why (there are a few options).
If you have severe and persistent plantar fasciitis in both feet, you might decide to have this procedure done on each of them. Because you can’t bear weight on your foot while you are recovering from a plantar fascia release, it is generally best to wait until you fully recover from your first surgery before having your second one.
You will have your procedure in a surgical operating room, which will be located at a hospital or an outpatient surgical center.
What to Wear
You can wear anything comfortable when you go in for your procedure. You will go home with a soft or hard cast, so you need to make sure you have a comfortable shoe to wear on your non-surgical foot.
Food and Drink
You can eat and drink whatever you want before your surgery.
If you take blood thinners, your doctor might tell you to stop or reduce the dose for a few days prior to your procedure. Make sure you don’t make any medication changes unless you discuss it with your doctor first.
What to Bring
When you go to your surgery appointment, be sure to bring a form of identification, your health insurance information, and a form of payment if you will be paying for any portion of your surgery.
You might not be able to drive home due to your cast, so you should arrange for someone to take you home after your surgery or bring them along with you.
What to Expect on the Day of Surgery
When you go in for your surgery appointment, you will register and then go to a pre-operative area.
You will have your temperature, pulse, and blood pressure checked. You might have an intravenous (IV, in a vein) line placed and you may be asked to change into a surgical gown.
You meet with your surgeon and an anesthesiologist or nurse anesthetist. Your surgeon will check your foot on the day of your surgery to see if there are any changes since your last pre-operative appointment that might affect the surgical plan. You will then be taken to the operating room.
Before the Surgery
Once you are in the operating room, your foot will be exposed and your leg will be covered with a drape. Your foot will be cleaned with antiseptic.
You will have local anesthesia injected with a needle into several areas of your foot. Your doctor will check your sensation to ensure that you cannot feel your foot prior to starting your surgery.
Your doctor might use a marker to mark the area where you will have your incision.
During the Surgery
Once your foot is numbed with the anesthetic medication, your doctor will begin your surgery by making an incision in your foot.
There are several approaches used for this procedure. Generally, an incision is made on the medial (inner) surface of your heel, on the bottom of the heel, or on the lateral (outer) surface of your heel.4
A small endoscope will be inserted if you are having a minimally invasive procedure. Your surgeon will use the camera to visualize the structures in your foot and will use tiny surgical instruments to cut the ligament in your foot.
An endoscope is not needed with an open procedure as the larger incision means your surgeon can directly visualize the ligament.
Very tiny cuts are made in the middle section of the plantar fascia ligament.5 Overall, your doctor will release about 30% to 50% of the fascia; releasing too much of this ligament can lead to foot instability or deformity.6
Any additional techniques, such as release of nerve impingement or removal of bone spurs will be done as well.
Once the procedure is completed, your incision will be closed with sutures. Your foot will be bandaged and you will have a hard or soft cast or a splint placed on your foot.
After the Surgery
After your operation, you will be taken to a recovery area. Your medical team will check on you to make sure that your pain is well controlled. You will also receive instructions regarding weight-bearing, the specifics of which depend on the type of cast you have and how extensive your surgery was.
If you are recovering as expected, you should be able to go home a few hours after your surgery.
Recovery typically takes two to four months. During this time, you will need to have one or more follow-up appointments with your doctor. Your medical team will remove your cast, remove your sutures, and examine your foot during these visits.
You might have a hard cast removed and a soft cast or splint placed, or you might be able to have a cast removed and directly advance to wearing shoes. Generally, you will be able to put weight on your foot and advance your level of activity sooner if you had a minimally invasive procedure.
You will need to wear supportive shoes as you recover, and your doctor may also advise that you try to wear shoes with good arch support for the long term to avoid placing chronic stress on your foot.
The 9 Best Insoles for Plantar Fasciitis of 2020
In the weeks after your surgery, you should watch for an increase in pain, swelling, warmth, or redness of your foot. Call your doctor if you experience any of these issues. Even if you’re wearing a hard cast and cannot directly see your foot, keep an eye on the skin around your cast.
You will have instructions on caring for your wound and cast, which will include changing bandages as needed and keeping your surgical dressing clean and dry.
If you develop an infection, you might need antibiotics and possibly a procedure to clear the infection. Excessive inflammation with nerve entrapment may require treatment with anti-inflammatory medication and/or surgery.
You can expect to have a small scar from your incision.
Coping With Recovery
As you are recovering, be sure to avoid putting too much strain on your non-operative foot. You might have physical therapy as part of your recovery process to help strengthen your operative foot and to learn techniques for walking and running that won’t cause new podiatric issues.
Possible Future Surgeries
Plantar fascia release is intended to be a one-time procedure.2 You should not need any future follow-up surgeries on the same foot unless you develop a complication that requires surgical intervention, like an abscess.
If it is successful, you should feel substantially better after your surgery. You shouldn’t be limited from participating in normal activities, including running and weight-bearing exercises that don’t cause excessive stress on your foot.
However, if you and your doctor have determined that your plantar fasciitis was caused by overuse or stress on your foot, you may be instructed to avoid offending activities so the condition won’t reemerge once you have recovered.