Surgery Overview

Plantar fascia release surgery involves cutting part of the plantar fascia ligament to release tension and relieve inflammation of the ligament (plantar fasciitis). Your doctor can use medication that numbs the area (local anesthetic) for the procedure. Plantar fascia release can be done by cutting the area (open surgery) or by inserting instruments through small incisions (endoscopic surgery).

• The surgeon will make an incision on the foot above the heel pad, where the thicker skin of the sole meets the thinner skin of the back of the heel, or he or she may make an incision on the bottom of the foot. If the surgery is done endoscopically, the surgeon will make a small incision on either side of the heel below the ankle bone.
• The surgeon may detach the plantar fascia from the heel bone or make incisions on either side to release tension.
• The surgeon may remove and smooth the bone surface to allow the plantar fascia to heal under less tension. Sometimes the surgeon removes a small wedge of damaged tissue.
• The surgeon may also free the thickest part of a foot muscle (abductor hallucis) to prevent nerves from becoming trapped as a result of the surgery. If a heel spur is present, it may be removed.

What To Expect After Surgery

If you have traditional open surgery, you may wear a non-weight-bearing cast or brace, such as an equalizer brace or a CAM walker (which resembles a long ski boot), for 2 to 3 weeks after surgery to allow tissues to heal.

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 will begin a gradual strengthening and flexibility program after surgery. Running or jumping is restricted for at least 3 months after surgery.

Why It Is Done

Surgery may be appropriate for only 5% of people with plantar fasciitis.¹ Some foot experts may recommend surgery more often. Generally, your doctor may recommend surgery if:

• You continue to have severe, disabling symptoms despite careful attention to home and other nonsurgical treatment.
• Symptoms have persisted for at least 6 to 12 months.
• You are an athlete and symptoms are affecting your performance or ability to take part in a reasonable athletic program.
• Your ability to work is limited despite nonsurgical treatment.

For more information on making this decision, see:

Plantar fasciitis: Should I have surgery for plantar fasciitis?

How Well It Works

Most people (over 75 out of 100) have less pain after plantar fascia release surgery. Up to 25 out of 100 people who have surgery continue to have pain.²

Recovery may be faster with endoscopic surgery than open surgery, but the risk of nerve damage is higher with endoscopic surgery.²

Risks

Risks of plantar fascia release include:

• Nerve entrapment or tarsal tunnel syndrome.
• Recurring heel pain.
• Neuroma, a benign tumor made of nerve cells and nerve fibers.
• Delayed wound healing.
• Delay in return to normal activity.
• Infection.
• Risks of anesthesia.
• Possibility that symptoms could get worse after surgery (rare).

What To Think About

Endoscopic surgery should be done by a surgeon who is specially trained in the technique and who has experience doing the surgery. Ask how many endoscopic surgeries the surgeon has done and how successful they were.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

Citations

1. Frey C, ed. (2005). Plantar fasciitis chapter of Foot and ankle section. In LY Griffin, ed., Essentials of Musculoskeletal Care, 3rd ed., pp. 667–674. Rosemont, IL: American Academy of Orthopaedic Surgeons.
2. Buchbinder R (2004). Plantar fasciitis. New England Journal of Medicine, 350(21): 2159–2166.