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What Is Surgery for Plantar Fasciitis?
Several different surgical procedures can be used to treat plantar fasciitis. The condition is caused by inflammation or degeneration of the ligament that connects the heel to the toes, and can cause minimal to severe foot pain. The main goal of surgery is to relieve pain and improve function if noninvasive solutions don’t work.
Clinicians almost always try treating plantar fasciitis with more conservative treatments before recommending surgery, because more than 90 percent of patients with plantar fasciitis recover within a few months to a year without it. And, while usually effective, surgery comes with risk, including the small chance of irreversible damage to the bottom of the foot.
But for some patients, surgery can be the right choice.
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.
The vast majority of plantar fascia problems, including plantar fasciitis, resolve within a year with nonsurgical treatments — including no treatment at all. So, for many clinicians, surgery is a last resort. “So many will get better without surgery,” Dr. Kamble says. “If you can get someone better with stretching and a little bit of time, it's worth it.”
In addition to plantar fascia stretching exercises, like pulling your toes back with a towel or stretching your calf while standing, they might suggest identifying and reversing the cause (like a change of footwear or activity level), orthotics for arch support, a nonsteroidal anti-inflammatory medication like ibuprofen, icing the heel area, or massage or physical therapy. Taping the arch of your foot can be effective, too.
Other treatments for plantar fasciitis that are still less invasive than surgery include shockwave therapy and corticosteroid injections for foot and heel pain. Additionally, complementary and integrative therapies like acupuncture and platelet-rich plasma injections also has supportive evidence.
If these methods don’t work — or if someone is unable or unwilling to adhere to more conservative protocols — surgical interventions may enter the conversation. “My strong recommendation is that patients at least give [nonsurgical treatments] a try, ideally for up to three months,” Schafer says.
If surgery is recommended, you’ll get specific instructions from your surgeon or their office on how best to prepare for your procedure. Most protocols are specific to that clinician or facility, Schafer says.
Broadly, though, you’ll first undergo a preoperative medical evaluation to make sure you’re a candidate for surgery and anesthesia, including whether you have any allergies to medications or latex, Silverman says. Prior to the procedure, you’ll also need to fast for at least eight hours and avoid even water for two hours to prevent aspiration, or when food or liquid enters the airway, during surgery, he adds. It’s helpful to get good rest and eat a healthy diet leading up to the procedure, too, to support your immune system, which will help your recovery, Silverman says.
The most straightforward plantar fasciotomy can be as short as 15 minutes of surgical work, Schafer and Silverman say. In general, it involves an anesthesiologist delivering anesthesia and a clinician making a small incision or two on the bottom of the foot (in open surgery) or on the side of the foot near the heel (for endoscopic surgery). More extensive operations may also include bone spur or damaged tissue removal, too. Finally, the doctor will stitch up the cuts and put the patient in a boot or cast.
Most surgeries for plantar fasciitis are outpatient. You’ll likely go home that day.
Risks and complications from plantar fasciitis surgeries are uncommon. They tend to arise when the wrong amount of plantar fascia is (unintentionally) removed.
Risks and complications include:
- Infections Like after any surgical procedure, plantar fasciotomy patients can develop an infection if, for instance, they don’t properly clean and care for the incision as it heals.
- Nerve Damage It’s also possible to develop temporary or permanent nerve damage if the clinician accidentally cuts a nerve in the process, Schafer says. Nerve entrapment (a pinched nerve) can happen, too.
- Recurring Heel Pain The procedure may not work to fully resolve pain if, for instance, the core issue isn’t only plantar fasciitis but also a condition called tarsal tunnel syndrome, or compression of the ankle’s tibial nerve, Schafer says. That’s why it’s important your provider fully understands your foot’s issues before operating.
- Permanent Foot Damage Ten percent of people with a partial release surgery will end up with a complete tear — even after the surgery itself appears to be successful at first, Schafer says. That’s irreversible. “Even if you release part of the plantar fascia, the remainder of the plantar fascia can then tear and complete itself,” he says. That’s why finding a skilled surgeon and following recovery protocols is key.
Schafer says most patients walk out of the operating room in a boot, which they’ll stay in for a few weeks.
Silverman instructs his patients to not put any weight on the foot for four weeks (maybe by using a rolling knee cart) to allow the tissue to fully heal. Patients should also continue the strengthening exercises like “toe yoga” that they are supposed to learn pre-surgery. Strengthening the foot muscles is key to making the whole problem go away and never come back, Silverman explains.
Doctors might prescribe pain relievers for the first few days post-surgery, too. Then, patients can transition to over-the-counter meds like ibuprofen. Seven to 10 days after your procedure, patients typically return to the doctor to have their sutures removed and are referred to physical therapy to aid recovery, according to NYU's website.
Most patients will resume normal activity within three to six weeks, with those who underwent an endoscopic procedure usually recovering closer to the three-week mark.
The Takeaway
- Given that plantar fasciitis almost always heals with nonsurgical interventions, most experts consider surgery for the condition a last resort.
- If conservative tactics don’t work, surgery that partially releases the plantar fascia is usually effective, though there are risks.
- A plantar fasciotomy can be as short as 15 minutes, and involves local anesthesia. Patients can typically resume normal activity in a few months.
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