Surgical care of plantar fasciitis is performed after conservative measures fail to provide lasting relief. There are several different techniques that are used based on need and surgeon preference. All have generally equal success rates.
The traditional and very successful method of surgery to address plantar fasciitis is called a fasciectomy. In this procedure, an incision is made in the side of the heel, and the fascia is identified. A small section of the fascia is removed, allowing for scar tissue to cross the gap and effectively lengthen the fascia. This removed the strain that the fascia undergoes with weight bearing, and cures the condition. At the same time, any heel spur that is present on the bottom of the heel bone is shaved down, to prevent against any potential irritation it may have on the scar tissue that rill form during recovery. Once the procedure is completed, the foot is protected in a sterile dressing and is supported in a walking boot to prevent undue stress to the incision. Healing of the skin usually takes up to three weeks to complete, and full activity is generally allowed in five or six weeks.
A variation of this procedure is called a fasciotomy, in which the fascia is not cut but is altered or treated to produce a healing response so the tissue can become actively repaired. A current technique to produce this result involves using a wand that creates radiofrequency waves. The fascia is penetrated by the wand tip at various depths in regular intervals and a radiofrequency wave is produced from the wand that generates an inflammatory response and converts chronic inflammation into a significant acute inflammation, this time with proper stimulation of the body’s healing cells. The use of platelet gel, a healing compound produced from spinning and concentrating one’s own blood product, can help improve the tissue healing as well in some cases. The recovery period of this procedure is about the same as a fasciectomy, although more inflammation is created post-operatively that can cause discomfort. This inflammation is vital to the success of the procedure, and is a necessary part of this technique. The procedure’s advantage is in the fact that the length of the fascia is left alone, preserving anatomy.
One final technique that has been introduced relatively recently involves no incision, but merely multiple pokes into the heel tissue with a syringe containing platelet rich plasma (PRP). Prepared similarly to the above mentioned platelet gel, PRP generates an inflammatory response and stimulates the healing process through an injected concentration of cells and chemicals that normally produce healing, but are lacking in fascia tissue stuck in a state of chronic inflammation. PRP is injected into the heel in a grid-like pattern in a sterile procedure room with local and sedation anesthesia. Research on this minimally invasive technique shows promise, and for those whose health or daily life do not allow for a more traditional open procedure it can be considered.