plantar fasciitis surgery

Plantar Fasciitis Surgery: A Comprehensive Guide

In Standard by Bigfoot

If you’re reading this, there’s a good chance you’ve been living with nearly intolerable heel pain for several months (or years, in some cases) and you’ve tried pretty much everything to heal your plantar fasciitis. You’ve exhausted your resources and now you’ve resigned yourself to the fact that plantar fasciitis surgery is the only option you have left. 

95 out of 100 people who have plantar fasciitis are able to relieve their heel pain without surgery

You’ve probably given orthotics a shot. Anti-inflammatory medications have only given you minor relief. You found night splints uncomfortable and they interrupted your beauty sleep and the other things that you have tried haven’t been up to the challenge of treating or curing your pain. Heck, you’ve even taken more extreme measures like cortisone injections and shockwave therapy but nothing has helped.

So what do you do now? For many the answer is surgery. Plantar fasciitis surgery is usually not needed – it’s very rare. In fact, only about 5% of people who suffer from plantar fasciitis are unable to recover without surgery. It’s rare enough that most specialists consider surgery only after 12 months of aggressive non-surgical treatment. If you find yourself in that unlucky 5% minority, then surgery may be right for you. Read on in our comprehensive guide to learn more.

Read the entire article or simply use the links below to jump to the section that interests you the most. Use the “back to top” links after each section to return to the table of contents.

Introduction: Pre-Surgery
Plantar Fasciitis Surgery Cost
Plantar Fasciitis Surgery Success Rate

Plantar Fasciitis Surgery
Plantar Fasciitis Surgery Video
Plantar Fasciitis Surgery Pictures
Plantar Fasciitis Surgery Recovery Time
5 Risks and 5 Rewards of Plantar Fasciitis Surgery

Introduction: Pre-Surgery

As with any surgery, it’s important to be an active member of your care plan and activities. Before you commit to any procedure to fix your foot, be sure to discover as much information as there is available and consider all the possibilities before making a final decision.

Surgery is not risk-free. It is important to learn about the possible risks and rewards involved in any surgical procedure that you plan on having. Although this isn’t brain surgery or an organ transplant, there are valid concerns you should address prior to making a decision about plantar fasciitis surgery. Patients who are informed about their procedure work better with their doctors to make the right decisions about their health than those who don’t.

After you and your doctor have made a decision, it’s very important to get a second opinion. Your specialist or insurance provider can help you find someone who can give you a second opinion. Be sure to check that the visit for a second opinion is covered under your health plan.

Here is a list of questions you should answer before taking the plunge and getting surgery for your plantar fasciitis.


General questions to ask your doctor:


  • What operation are you recommending?
  • Why do I need the operation?
  • Are there alternatives to surgery?
  • What are the benefits of having the operation?
  • What are the risks of having the operation?
  • What will happen if I don’t have this operation?
  • Where can I get a second opinion?
  • What has been your experience in doing the operation?
  • How many have you performed?
  • Where will the operation be done?
  • What kind of anesthesia will I need?
  • How long will it take me to recover?
  • How much will the operation cost?

Specific questions (to plantar fasciitis surgery) to ask yourself:


  • Do you continue to have severe, disabling symptoms despite careful attention to home and other nonsurgical treatment?
  • Have you fully limited activity that would negatively affect your condition?
  • Have you exhausted all treatment options including using orthotics, stretching, exercising, night splints or other recommended “home” remedies?
  • Have you had symptoms for at least 6 to 12 months?
  • Are you an athlete and the symptoms are affecting your performance or ability to take part in a reasonable athletic program?
  • Are you unable to work or is your work limited despite nonsurgical treatment?

If the answer is an honest “yes” to all or most of those questions, then plantar fasciitis surgery may be the best option for you.

Questionnaire

get your free, printable pre-surgery question checklist

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Plantar Fasciitis Surgery Cost

Your first consideration when it comes to the cost of plantar fasciitis surgery is whether or not you have some sort of health care coverage. We’ve broken it out for you in two sections.


I have insurance


For those suffering from plantar fasciitis that have health insurance, the typical out-of-pocket cost for plantar fasciitis surgery will include your deductible or copay (or both depending on your insurance) and a percentage of the cost that is out-of-pocket. That amount depends on your coverage, but usually falls in the 10% – 50% range. Fortunately, plantar fasciitis treatment is typically covered by health insurance. As always, check with your provider before you plan any procedure to calculate the costs and receive any approvals you might need before having surgery.

Some insurance companies will require you and your physician to demonstrate that you have tried other forms of treatment; exercises, inserts, stretching or physical therapy. This may not be the case for you, but it is important to note that some patients have been tasked with building and showing a case for surgery prior to receiving authorization.


I don’t have insurance


plantar fasciitis surgery
$0
out of pocket costs

If you don’t have health insurance, expect your savings account to take a pretty sizable hit. Of course, all of this depends on the doctor, facility, exact procedure and other variables, but you can expect to pay anywhere from $5,000 to over $10,000 out of your own pocket if you don’t have any coverage. It’s a lot, but then again, if you’re at the point where your suffering is enough to consider surgery, you might just be willing to pay every last cent for relief.

Contrast those costs to other less expensive types of plantar fasciitis treatments like stretching, exercising, over-the counter anti-inflammatory medication, comfortable shoes and night splints that are likely to cost you in total less than $500, and you can see why exhausting all other forms of treatment is a good idea for you and your bank account. Even more expensive treatments like custom orthotics, cortisone shots and physical therapy will be less expensive than surgery.

Finally, consider what cost surgery will have if you take time away from work, pay for child care, post-surgery physical therapy, prescribed pain management medication and so on.

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Plantar Fasciitis Surgery Success Rate

According to Current Diagnosis and Treatment in Orthopedics, 75% of people report having less pain after plantar fascia release surgery.

Have less pain after plantar fascia release surgery
75%
Continue to have pain related to plantar fasciitis
25%

Some doctors have experienced even higher success rates. One published aggregate demonstrated a success rate of nearly 87% out of a total of 922 procedures. Yet another publication listed an 83% success rate out of a total of 265 procedures.

The odds are in your favor if you ultimately make the decision to go through with surgery for your plantar fasciitis. You’ll want to consult with your specific surgeon about their personal success rate. You may also find additional reviews and information about your doctor from sites like Health Grades, Rate MDs and so on.

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Plantar Fasciitis Surgery

There are actually a number of procedures for treating plantar fasciitis surgically.

Open vs. Endoscopic

Many procedures can be performed in either a traditional “open” surgery that involves cutting an area open or they can be done endoscopically that includes making small incisions and inserting instruments near the affected area.

When plantar fasciitis surgery is indicated, most surgical specialists prefer the endoscopic approach and have noted that it is superior to conventional open surgery because it minimizes surgical trauma that results in a quicker return to regular activities with fewer complications. It is slightly more difficult for your surgeon to perform the procedure endoscopically than with an open incision and there is an elevated risk of nerve damage.

Plantar fascia release

The most popular procedure for treating plantar fasciitis surgically is plantar fascia release. This procedure includes cutting part of the plantar fascia ligament to release tension and relieve inflammation of the ligament. This procedure may also include the removal of bone spurs (if present) and releasing pressure on small nerves in the area. Plantar fascia release can be performed via open surgery or endoscopically.

If your plantar fascia release is performed via open surgery, your surgeon will make an incision on your foot above the heel pad where the thicker skin of the sole meets the thinner skin of the back of the heel. As an alternative, they may make an incision on the bottom of your foot.

If the surgery is done endoscopically, the surgeon will make a small incision on either side of the heel below your anklebone. The endoscope is a small camera that can be inserted under the skin and allows your surgeon to see the structures involved in the surgery. The surgery requires smaller cuts and presumably less damage than open surgery.

Gastrocnemius recession

This procedure is a lengthening of the calf muscles. In some cases, tight calf muscles place increased stress on the plantar fascia and this surgery is indicated for patients who still have difficulty flexing their feet even after several months of calf stretches.

In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. This can also be done with open surgery or endoscopically. Your doctor will have more information if this procedure is indicated for you.

There are few complications with a gastrocnemius but it can cause nerve damage.

Plantar fascia detachment

Your surgeon may choose to detach the plantar fascia from the heel bone or make incisions on either side to release tension.

Bone smoothing

Your surgeon may remove and smooth the bone surface to allow the plantar fascia to heal under less tension. It is also possible for your surgeon to remove a small wedge of damaged tissue.

Nerve damage prevention

Your surgeon may also free the thickest part of a foot muscle to prevent nerves from becoming trapped as a result of the surgery.

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Plantar Fasciitis Surgery Video

Want to see how it all unfolds? Grab some popcorn (well, maybe not), sit back and “enjoy” a preview of what you may be going through in your own plantar fasciitis surgery.


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Plantar Fasciitis Surgery Pictures

For those with a weak stomach, you’ll probably want to avoid this. However, if you want to see pictures of plantar fasciitis surgery, simply click here for a google image search that is sure to make your stomach turn…but also might be educational and help you make a decision about surgery.

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Plantar Fasciitis Surgery Recovery Time

As mentioned above, the majority of patients have good results from plantar fasciitis surgery. However, since there are cases where surgery has resulted in chronic pain and negative outcomes for patients, it is typically only recommended after all non-surgical treatments have been exhausted.

In general, recovery normally takes 6 to 10 weeks before walking is comfortable and it may be several months before a full return to athletic activity. But then, if you’ve experienced enough pain to get the surgery, you’re probably used to it by now.

Open Surgery

If you have traditional open surgery, you will be fitted with a cast, an equalizer brace or a CAM walker (which looks like a long ski boot) after the surgery is complete. This is to protect the surgical area for a period of 2 to 3 weeks after the procedure to allow tissues to heal.

Endoscopic Surgery

If you have endoscopic surgery, you can actually begin putting weight on your foot immediately (but be very cautious) and can begin wearing normal shoes again as soon as it is comfortable. Most people return to their normal activities in 3 to 6 weeks after they are scoped.

You will begin a gradual strengthening and flexibility program after surgery. More strenuous activities such as jumping or running are restricted for at least 3 months after surgery.

Complications

The most commonly encountered complications include lateral column pain and instability, possibly secondary to releasing more than one third to one half of the fascia. Some patients who have had plantar fasciitis surgery developed complications like compensatory tendonitis and medial arch strain. If you experience this and identify it early, then long-term complications can be avoided with proper treatment.

When can I exercise?

This all depends on your personal condition and procedure. It can take anywhere from weeks to several months before full activity can be resumed after surgery. You’ll want to get together with your surgeon to discus the specific surgery you are having, the rest time, recommended physical therapy and timeline for your ultimate return to full activity.

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5 Risks and 5 Rewards of Plantar Fasciitis Surgery

5 Risks:

  • There is a rare possibility that symptoms could actually get worse after surgery. Your recurring heel pain could continue even after surgery and the typical expected recovery time. This can happen if the procedure is done poorly or incorrectly or if your body doesn’t heal properly.
  • As with all surgeries, there is a possibility of infection in the affected area. This can cause all sorts of other problems including delaying the healing process to your surgical wounds.
  • It’s possible that you could develop nerve problems, including nerve entrapment or tarsal tunnel syndrome and numbness.
  • You could develop a different and possibly painful condition known as Neuroma (or sometimes referred to as a “pinched nerve”). Neuroma is a benign tumor made of nerve cells and nerve fibers.
  • Risks associated with anesthesia

5 Rewards:

  • Recovery! You’ve gone this far with all that heel pain, so the typical 6 to 10 weeks it takes before walking is comfortable post-surgery should be a breeze. However, it may be several months before you can return to athletic activity.
  • Most people (more than 75 out of 100) have less pain after plantar fascia release surgery. On the down side, there remain a small percentage of those who have surgery that continue to have pain.
  • Improved strength and flexibility. You will begin a gradual strengthening and flexibility program after surgery that, in most cases, leads to a vast improvement over your pre-surgical condition. However, keep in mind that more vigorous activities like running or jumping are restricted for at least 3 months after surgery.
  • Normal activities and normal shoes! If you have endoscopic surgery, you can begin limited weight-bearing immediately and can begin wearing normal shoes again as soon as it is comfortable. Most people return to their normal activities in 3 to 6 weeks.
  • You’re cured. If you’ve tried everything else and it didn’t work, but surgery does work and cures you of this condition, you’ll certainly be glad you did it.

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Your Turn!

Have you had surgery to treat your plantar fasciitis?

Are you contemplating surgery?

Leave a comment below to share your experience, ask any questions or join our plantar fasciitis surgery forum discussion.

Be sure to use the handy buttons on the left or below to share this with anyone you know who is contemplating plantar fasciitis surgery.

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