Plantar fasciitis is an overuse injury to the Plantar Fascia (the tough band of tissue connecting the heel to the toes). Degenerative tearing of the tissue on the bottom of the heel makes it very painful to bear weight. When the tissue tries to heel it thickens and can cause compression of the Baxter’s nerves on the inside of the heel. Pain increases during the day and persists with rest. Common non-operative treatments include:
- Stretching with physical therapy
- A night splint
- Non-steroidal anti-inflammatory medication
- Cortisone injections
- And sometimes cast bracing
It is important to put a solid effort into non-surgical treatment as more than 90% of patients will recover without surgical intervention. However, surgery should be considered if symptoms persist after 6 months of starting treatment. This surgery is performed on an outpatient basis.
The surgical center will inform you when to arrive and how to prepare for surgery. The day of surgery you will receive regional anesthesia known as a Popliteal nerve block. This is a procedure performed by the anesthesiologist prior to surgery. You will be given medication to induce “twilight sleep,” placed on your stomach, and a small needle will be used to inject Novocain-like medication around the nerve in the back of your leg. This gives complete pain relief that lasts for 12 to 36 hours after surgery. Patients report extraordinary satisfaction with this type of anesthesia.
Operative Care – Plantar Fasciitis Surgery
During the surgery you will be put into a relaxed state by the medication delivered through the I.V. A tourniquet will be placed around your calf. You will not feel the pressure because of the nerve block. An incision is made on the inside of the heel. The degenerative plantar fascia tissue is excised and the entrapped nerves are released. Occasionally, longer incisions on the ankle are made to complete the nerve release. The wounds are closed with stitches. A short-leg cast is set.
Immediate Post-Operative Care
Once your anesthesiologist is satisfied that have recovered you will be permitted to leave the surgical center. During this recovery time, a family member may take your prescription to the nearest pharmacy. You will be given crutches. Take your narcotic pain control medications before falling asleep or as you feel the “numbing” effect wearing off. Remember post operative pain is much easier to control with prevention. Call our office to schedule for the first follow-up appointment when you feel able.
To schedule surgery, please contact our office at firstname.lastname@example.org or 952-224-8500 at least four weeks in advance to best ensure your desired surgery date. If you have questions after surgery, please contact my office.
Post-Operative Course – Partial Plantar Fasciectomy
This timeline is a general guideline. Your post-operative course may vary.
|Elevation||23 hours / day for 3 days; then keep elevated as needed. Swelling may last over 4 months.|
|Motion||Move your toes and knee when the block resolves. This will decrease pain and swelling, and improve healing. Begin ankle motion at 2 weeks.|
|Walking||No weight bearing until 4 weeks, then begin weight bearing in a cast brace.|
|Bathing||Bathing Keep cast dry by using a DryPro cast protector. There are no restrictions after 2 weeks.|
|Pain Control||Expect to use strong narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Motrin.|
|Work||Return depends on specific demands. It is safe to return to sedentary work at 10 days post-op. Return to heavy labor will take over 2 months.|
|Driving||Patients with left foot surgery may drive an automatic transmission. Patients with right foot surgery may drive with their left foot if they practice in advance of surgery.|
Routine Clinic Visits
|2 weeks||Remove cast and apply fracture brace. Obtain a physical therapy prescription to start at 4 weeks post-op. No weight bearing until 4 weeks post operative.|
|3 months||Return for a recheck.|
|6 months||Return if symptoms persist.|
|**********||If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, contact our office.|
The nerve pain usually resolves quickly but plantar fascial heel pain may take as long as 8-12 MONTHS to reach maximum improvement after surgery.
Visit our video center to watch rehab exercise videos that will help you recover after your surgery.