Endoscopic Plantar Fasciotomy

When conservative treatments such as physical therapy, orthotics, and injections fail to alleviate the pain, surgical intervention may be necessary. Endoscopic plantar fasciotomy is a minimally invasive procedure designed to provide lasting relief from plantar fasciitis. This blog will explore the procedure, potential risks, recovery, and the benefits of wearing custom orthotics post-surgery.

Understanding Plantar Fasciitis

Plantar fasciitis typically presents as sharp, stabbing pain in the heel, especially with the first steps in the morning or after periods of inactivity. Contributing factors include overuse, improper footwear, obesity, and tight calf muscles. Chronic inflammation and micro-tears in the plantar fascia can lead to persistent pain and discomfort.

The Procedure: Endoscopic Plantar Fasciotomy

Endoscopic plantar fasciotomy (EPF) is a minimally invasive surgical technique aimed at relieving tension in the plantar fascia, thereby reducing pain and promoting healing.

Step-by-Step Procedure

1. Preoperative Planning: A thorough clinical evaluation, along with imaging studies if necessary, helps confirm the diagnosis and plan the surgical approach.

2. Anesthesia: The procedure is performed under general anesthesia, depending on patient preference and medical condition.

3. Incisions: Two small incisions, approximately 1 cm each, are made on either side of the heel. These incisions allow for the insertion of an endoscope and specialized surgical instruments.

4. Endoscopic Release: Guided by the endoscope, we carefully release a portion of the plantar fascia. This reduces tension and alleviates pressure on the inflamed tissue.

5. Closure: The incisions are closed with sutures, and a sterile dressing is applied. A surgical shoe or boot is provided to protect the foot during the initial recovery period.

Recovery and Rehabilitation

Recovery from endoscopic plantar fasciotomy is generally quicker and less painful than traditional open surgery.

1. Immediate Post-Operative Period (0-2 Weeks):

   • Patients are allowed immediate weight-bearing in a surgical shoe or boot.
   • Pain and swelling are managed with prescribed medications, ice, and elevation.

2. Transition Period (2+ Weeks):

   • Patients transition to regular shoes as tolerated, with a focus on supportive, comfortable footwear.
   • Gradual return to normal activities is encouraged, with emphasis on avoiding high-impact activities until fully healed.

Risks and Recurrence

While endoscopic plantar fasciotomy is highly effective, there are potential risks and complications, including:

• Recurrence of Plantar Fasciitis: Though rare, the condition can recur if underlying causes are not addressed.
• Cuboid Syndrome: This condition, characterized by pain and instability in the outside of the midfoot, can occasionally occur after plantar fasciotomy due to changes in foot biomechanics.

Preventive Measures: The Role of Custom Orthotics

To minimize the risk of recurrence and other complications, the use of custom orthotics post-surgery is highly beneficial. Custom orthotics provide the following advantages:

• Support and Alignment: Orthotics help maintain proper foot alignment and support the arch, reducing strain on the plantar fascia.
• Shock Absorption: They cushion the foot, absorbing shock and reducing impact during walking and other activities.
• Preventive Care: By addressing biomechanical imbalances, orthotics can help prevent conditions like cuboid syndrome and reduce the likelihood of plantar fasciitis recurrence.

Conclusion

Endoscopic plantar fasciotomy offers a minimally invasive solution for those suffering from chronic plantar fasciitis when conservative treatments have failed. With a structured recovery plan and the use of custom orthotics, patients can achieve lasting relief and return to their active lifestyles more quickly.

If you are experiencing persistent heel pain and have not found relief with non-surgical treatments, consult with a foot and ankle specialist to discuss whether endoscopic plantar fasciotomy is right for you. At Acacia Foot and Ankle Surgeons, we are dedicated to providing the highest standard of care and innovative surgical solutions to help you get back on your feet. Contact us today to schedule a consultation.