Endoscopic Plantar Fasciotomy

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1 Endoscopic Plantar Fasciotomy Introduction Plantar fasciitis is a common condition that causes pain centralized around the heel. It may be severe enough to affect regular activities. Health care providers may recommend surgery for people suffering from plantar fasciitis that doesn t improve with other treatments. If your health care provider recommends surgical treatment for your condition, the decision whether or not to have surgery is yours. This reference summary will help you understand the benefits and risks of endoscopic plantar fasciotomy. The Feet Healthy feet are strong and flexible. They allow us to walk and run as they support the weight of the whole body. A ligament connects two bones or holds together a joint. The plantar fascia is a ligament. The plantar fascia is the thick band of tissue that connects your heel bone, also called the calcaneus, to your toes. The plantar fascia fans out as it gets closer to the toes. The arch of your foot is supported by the plantar fascia, absorbing the pressure from the body s weight. With each step, the plantar fascia contracts and loosens. It acts like a rubber band. Also connecting to the heel bone is the Achilles tendon, or heel cord. The Achilles tendon connects the calf muscles to the heel bone. The calf muscles are the muscles on the back of the lower leg. 1

2 Symptoms and Their Causes Plantar fasciitis happens when the plantar fascia is overused. The plantar fascia becomes inflamed, and you feel pain. When the plantar fascia is overused, it causes small tears. The body can usually repair one or a few such tears. But repeated tearing of the ligament can result in inflammation of the plantar fascia, causing pain. Pain associated with plantar fasciitis usually develops slowly over time and is centralized around the heel. The first steps that a person takes after waking up may be the most painful. Pain may lessen throughout the day as the plantar fascia relaxes. The pain can return after long periods of standing or sitting. Usually only one foot is affected. However, plantar fasciitis can happen in both feet at the same time. Heel pain caused by plantar fasciitis may be severe enough to affect regular activities. It can cause a person to avoid walking and exercising. Alternative Treatments Health care providers will try conservative therapies to treat plantar fasciitis. The first recommendation is to rest the foot from the activity causing the pain. This will allow your foot to heal the inflammation in the ligament. Other conservative therapies used to treat plantar fasciitis include physical therapy, shoe inserts and night splints. Your health care provider may also recommend medications to relieve pain and fight inflammation. Many people with plantar fasciitis improve within the first few months of treatment with medication and therapy. However, these conservative treatments may require a long period of time to work, ranging from 3 to 12 months, depending on the patient. 2

3 If conservative treatments fail, your health care provider may recommend a new procedure called extracorporeal shock wave therapy. In this treatment, sound waves are used to stimulate healing through the skin of your foot. This therapy may not work for everyone. Surgery is an option when non-surgical treatments are not working and pain is interfering with regular activities. During surgery, the plantar fascia is detached from the heel bone. Endoscopic Plantar Fasciotomy Plantar fasciotomy is also known as plantar fascia release. Plantar fascia release aims to relieve pain and inflammation of the plantar fascia ligament by cutting it. The operation is done through two small incisions made in the skin on either side of the heel. It usually takes about a half hour. The scope needed to look inside the foot is inserted into one of these incisions. The small cutting tool needed to cut the ligament is inserted into the other incision. When the ligament is released from the heel bone, the tension is relieved. That is why this surgery is called plantar fascia release. The smaller incisions of this type of surgery allow for faster healing than open surgery. They may also cause less pain. However, endoscopic surgery is more difficult than open surgery for plantar fascia release. During the surgery, your surgeon may decide that releasing the plantar fascia cannot be continued using a scope. He or she may then continue without the scope by making a larger incision. Plantar fascia release is an outpatient operation. This means the patient goes home the same day of the operation. Risks and Complications Plantar fascia release is a safe operation. It provides good results for people with severe plantar fasciitis pain. There are, however, some possible risks and complications, which are unlikely but possible. You need to know about risks and complications in case they happen. By being informed, you may be able to help your health care provider detect complications early. 3

4 Some risks and complications include those related to anesthesia and those related to any type of surgery. Anesthesia is safe. But, like any medicine, it can have risks. Complications of general anesthesia may include: Breathing problems. Chipped teeth. Cut lips. Headache. Sore throat. Urinary retention. Rarely, anesthesia may cause serious complications. These include: Lung infections. Stroke. Heart attack. Death. Risks related to anesthesia will be discussed with you in greater detail by your anesthesiologist. Blood clots in the legs can happen due to inactivity after the surgery. These usually show up a few days after surgery. They cause the leg to swell and hurt. Blood clots can become dislodged from the leg and go to the lungs. There, they will cause shortness of breath, chest pain and possibly death. Let your health care provider know right away if you experience symptoms of a blood clot. Sometimes, the shortness of breath can happen without warning. Getting out of bed shortly after surgery may help decrease the risk of this complication. Surgery in general also comes with risks. Complications may include: Bleeding that happens during or after surgery. Bleeding may, in extremely rare cases, require a blood transfusion. Infection, either deep or at the skin level. Skin scars that may be painful or unsightly. Other risks and complications are related specifically to endoscopic plantar fascia release surgery. Again, these are very rare. However, it is important to know about them. 4

5 Nerves in the foot may be injured during plantar fascia release. This may cause pain, weakness or loss of feeling. The risk of nerve damage is higher for an endoscopic surgery than for an open surgery. A neuroma may form as a result of the operation. A neuroma is a tumor that arises from nerve cells. Other possible risks of plantar fascia release are slow healing of the incision and a delay in when you can return to your normal activities. There is also the possibility that the operation may not help symptoms or may even make them worse. After the Surgery Your health care provider will tell you how long it will take before you go back to work. This depends on your age, type of work and the type of surgery you had, as well as other factors. Your activity level will be limited after surgery. You may need to wear a cast or brace, depending on the type of surgery you had. Your health care provider will arrange for a follow-up visit to examine the incision and remove any sutures. Your health care provider will indicate the foot rehabilitation program suitable for you. Summary Plantar fasciitis is a common condition that causes pain centralized around the heel. It may be severe enough to affect regular activities. It happens when the plantar fascia is overused. The plantar fascia becomes inflamed, and you feel pain. Surgery to release the plantar fascia ligament can help relieve severe foot pain caused by plantar fasciitis. Surgery for plantar fasciitis is not common, but may be an option when other non-surgical treatments fail. The operation is done through two small incisions made in the skin on either side of the heel. When the ligament is released from the heel bone, the tension is relieved. That is why this surgery is called plantar fascia release. This operation is very safe with good results. However, as you have learned, complications may happen. Knowing about them will help you detect them early if they happen. 5

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