Surgery for recalcitrant plantar fasciitis

Surgery for plantar fasciitis is often a good solution to get rid of this nasty problem. Let’s take a closer look together at the main causes of plantar fasciitis and the various methods used to treat it.

What exactly is plantar fasciitis?

Plantar fasciitis is a common foot pathology that causes severe pain in the heel and arch of the foot. This discomfort is caused by micro-tears in the plantar fascia, a ligament that supports the arch of the foot.

If not treated properly, plantar fasciitis can result in the plantar fascia tearing. When this happens, heel pain becomes unbearable at all times, especially when you wake up from sleeping.

Who is at risk?

Plantar fasciitis affects some people more than others. It is possible to perform surgery on these at-risk patients suffering from this problem.

Those more at risk include:

People with flat feetPeople with hollow feet
Overweight persons (or those who gained weight suddenly)
Pregnant women
Those over the age of 45
Athletes

However, everyone can suffer damage to the plantar fasciitis. It is important to consult if in doubt.

When should a patient elect to seek surgery for plantar fasciitis?

If you can no longer perform your daily activities, work or play sports, you should book a consultation! The same applies if you have tried various conservative treatment methods, without success.

How do we evaluate whether a patient requires surgery for plantar fasciitis?

The professionals at PiedRéseau can offer you several advantages when it comes time to evaluate your condition:

A pre-surgery evaluation can be performed throughout the province of Québec
A detailed report of your medical situation
A clear surgical plan adapted to your specific situation
Initial consultation with the podiatrist
Answers to your questions

PiedRéseau allows you to make an informed choice! And remember that the first step will not necessarily be to refer you for surgery if your condition can be treated by conservative treatment methods.

The patient’s medical history is very important

Using your medical history, we will determine the cause of your recalcitrant plantar fasciitis.

Several factors related to your condition can explain it, including:

Trauma to the foot and heel
Heredity
Activities performed
Foot type
Type of shoes worn

Knowing about this information and sharing it with your podiatrist before your evaluation can help to speed up the process.

Patient expectations

The podiatrist must properly grasp the patient’s expectations regarding the upcoming procedure. They will sometimes have to explain that the foot will not always regain as much autonomy and functionality as before (for example, if irreparable tears have occurred).

However, surgery eases the pain and restores the functional aspect of the foot. These are the most important factors for the podiatrist. Remember that, depending on the seriousness of the case, plantar fasciitis surgery is not always enough to have your feet regain their full autonomy.

Clinical examination

The clinical examination is used to assess whether you are a candidate for surgery. Your surgical history will be studied, as will your medical history, medication and allergies. In addition, a vascular assessment of your feet will be conducted to ensure optimal healing.

Various additional examinations may be requested through your doctor.

Functional limitations

During the evaluation, the podiatrist will determine the functional limitations of your foot. A treatment plan will then be drawn up. This will ensure that you receive the treatment that best suits your needs.

X-ray evaluation of the deformation

The X-ray evaluation is conducted as follows:

There will be an initial X-ray for a bone evaluation of your foot.
Various possible complications are identified, such as the presence of heel spurs.
X-rays make it possible to establish a surgical plan.
A second X-ray can be taken after surgery to ensure everything went well.

Keep in mind that if your operation does not involve any bone structure of your foot, an X-ray is not necessary.

Choosing the right foot professionnal for my surgery

Ask yourself these questions before making a choice:

Is the podiatrist experienced, with a good reputation?

This is an important issue. You can then verify the podiatrist’s background, and see if they have proved themselves. Make sure your foot professional has hospital experience and has been certified by an accredited organization.

Is the care tailored to your specific needs?

You must receive surgical care specifically adapted to your needs. The professional you choose must master a wide range of surgical techniques that respond to a wide range of cases. Since surgery is irreversible, it is important to ensure you make the right choice.

Is care management provided in a humane fashion?

Mutual trust between you and the podiatrist is important. Your podiatrist must be empathetic, listen to you, and closely monitor your progress.

Is the podiatrist available?

Choose a podiatrist who is available and has time for you. If you need special care, they must be able to handle your case quickly.

Initial conservative treatment methods

Before electing to have plantar fasciitis surgery, it is very important to list what you have already tried or what can be tried. For example:

Wearing proper footwear
Exercises and stretching
Plantar fascia massages
Ice compresses
Physical therapy (ultrasounds, lasers, shockwave, etc.)
Wearing foot orthotics
Taking anti-inflammatory medication
Cortisone injections
PRP injections (platelet-rich plasma)
Surgery that did not work or a recurrence after several years

However, sometimes the situation is so advanced that it is impossible to correct it with conservative treatments. Plantar fasciitis surgery then becomes the best option.

Why choose surgery performed by a podiatrist?

Your podiatrist is the professional of choice because:

They have in-depth knowledge of the foot and its biomechanics.
They have been trained to properly care for your feet.
They can perform specialized foot interventions.
They manage your foot care from A to Z, before, during and after the operation.
They are able to quickly restore your foot’s autonomy.

Your podiatrist takes care of the conservative and post-operative treatment of your foot. They are able to provide you with clinical results and can closely monitor you to ensure the surgery is a success.

Your PiedRéseau clinics provide the following advantages:

Rapid access to a podiatrist
Full monitoring
Answers to your questions.

A PiedRéseau clinic will always be easily accessible!

Procedures to remedy your plantar fasciitis

There are 3 main procedures available to treat your condition:

Topaz procedure, or dry needling:

This needle procedure is designed for chronic cases of plantar fasciitis. It is used to create trauma in your plantar fascia to assist with the healing process and relieve symptoms. Subsequently, you must wear an aircast walking brace for 4 to 8 weeks in order for the plantar fascia to heal properly.

Plantar fascia release procedure:

This is often a last resort solution, but it works in nearly 80% of cases! A small incision is made in the skin near the heel. The podiatrist then accesses the plantar fascia and releases it several millimetres to reduce tension. At the same time, the nerves are decompressed.

Platelet-rich plasma injection (PRP)

Platelet-rich plasma (PRP) is taken from the patient by a blood sample, and is then centrifuged to condense the elements. The professionnal uses the plasma to promote healing of the affected foot area.

Chronological steps of plantar fasciitis surgery

The procedure can be divided into 4 steps:

Pre-surgery assessment

This step allows you to understand all the details of the upcoming procedure so that you can make a clear and informed choice about the desired treatment.

Surgical preparation

This begins a few weeks before surgery:

Sometimes, some patients require a blood test and prescription for antibiotics before surgery.
You must allow for a convalescence and rest period following surgery.
You must be accompanied by someone for the surgery, and they must be available to take you home and stay with you for 24 to 48 hours.
It is important to properly clean your foot before arriving for surgery.

In some more rare cases, fasting is required 12 hours before surgery. Most procedures take place without IV sedation and general anaesthesia.

The day of surgery

Generally speaking, the day of surgery for plantar fasciitis takes place as follows:

If recommended, you must take any medication 2 hours prior to surgery (or as per the instructions of your podiatrist).
You then arrive at the clinic for your surgical preparation.
The surgical team cares for you and prepares you for the procedure. They ensure you are comfortable.

Normally, you will receive a local anaesthesia and sedation through oral anxiolytic tablets.

Back home

Following the operation, you must ensure you heal well. Below are a few tips you must be aware of:

The anaesthesia is long lasting, which means that you will not feel any symptoms for several hours following surgery.
Pain medication will be prescribed. You should start taking it while you are still under anaesthesia.
You will return home the same day as the operation (don’t forget to bring someone with you to assist you!).
It is recommended to keep your leg elevated and apply an ice pack to reduce any swelling.
You must keep your foot dry.

It is especially important not to touch your bandages, unless otherwise directed by your podiatrist.

Follow-up visits and home care

Each procedure requires special care at home. The clinic’s team will give you a personalized home care plan to follow, and a follow-up appointment will then be scheduled with your podiatrist within a week.

Normally, if there are any stitches, they will be removed within 10 to 21 days.

What is the convalescence period for plantar fasciitis surgery?

The convalescence timeframe depends on the type of procedure performed. Some operations require a few weeks; others may take a few months. You will be informed of the length of your convalescence before undergoing the procedure.

When will I be able to recommence my daily activities?

Recommencing daily activities depends on your healing progress and the type of procedure performed.

If you are accustomed to participating in very demanding sports, you will have to wait a little longer than the others. To ensure proper healing of your plantar fascia, it may be suggested that you wear a foot orthosis or a special shoe.

Importance of following your surgical recommendations to the letter

It is very important that you carefully follow the instructions given you before, during and after surgery. Carefully following these medical instructions will have a direct impact on your recovery and the success of the procedure.

The critical healing period will have an impact on the rest of your life. Paying attention to the instructions will allow you to regain your autonomy more quickly and limit any residual pain.

Post-surgical plantar orthotics

Wearing plantar orthotics following surgery is highly recommended:

To avoid a relapse
To have the foot regain its normal shape
To make your foot functional again
To avoid having to return for surgery

The risk of recurrence for this pathology is very high. It is therefore essential to ensure adequate prevention following surgery and to book a consultation quickly if symptoms return.

Possible biomechanical complications and special cases

Your podiatrist’s training enables them to recognize any possible biomechanical complications of surgery.

Given that our feet are subject to so many demands, the slightest imbalance of it can lead to a new pathology (and some complications!) That is why you should consult if you have the slightest doubt about your feet’s health.