Plantar Fasciitis Surgery?

author : AMSSM

comments : 0

What are the results of surgery for PF?

Question from member Dragonfly238:

"I'm interested to talk to people who have had surgery to relieve the symptoms of Plantar Fasciitis. The history: In September 2012, I jumped up to catch a ball and landed on an uneven surface and tore all the ligaments in my left ankle. I did as much damage as I possibly could without needing surgery at the time. I made a full - 90% - recovery and have since done 3 half marathons, three half-iron distance races and at least 12 shorter distance races since that recovery. I have never had full range of motion, but it was adequate.

Now I have been struggling with PF for over 18 months now and haven't been able to run more than about a half-mile for over a year - it has started to affect my body alignment with issues now in my hip and shoulder that I believe are related to compensating for a weak left foot.

I have had - orthotic inserts (2 different podiatrists - second set MUCH better), massage, dry needling, more massage, shock therapy (http://orthopedics.about.com/od/footankle/i/shockwave.htm), cortisone injections (which were swearing sore!) and nothing has provided any sort of real relief. Even an hour's walk tends to need lots of massage, golf balls, etc. to get me to a point where I can walk sort of... (Yes, I have tried golf balls, self-massage, frozen lemons) So after another MRI last week, my GP has referred me to a surgeon and the short answer is surgery. I wanted to know from anyone who has experience with this, will I ever be able to run a half-marathon again after the surgery? What is the recovery time? What about the long term? When I'm in my 70's am I going to regret the surgery?"

Answer by Anna Monroe, M.D. 
Member AMSSM

Your struggles with plantar fasciitis sound extremely frustrating!

It sounds like you have tried multiple appropriate treatments, and certainly consideration of surgical treatment could occur given the length of time you have had symptoms. Typically surgery is the last resort since plantar fasciitis typically resolves with time, but 10% of people experience more long-lasting symptoms. Between 2% and 5% resort to surgery.

The surgical procedure is called a plantar fasciotomy, and there are variations to the technique that is performed. For instance it can be done with an incision (open) or endoscopically, and it can be complete or partial. There are also procedures that can be done with a nearby nerve. Unfortunately none of these methods has been researched with the highest level of scientific certainty, the randomized controlled trial. Therefore, there is still controversy with regards to whether to undergo surgery or what type to consider.

An in depth discussion with your surgeon can help address further questions about the proposed methods, risks and benefits, and the immediate and long-term postoperative periods. Your surgeon may also be able to give you anecdotal information about the experience of other patients.

If you are interested in delaying surgery you could check into some other treatments. Given the association of your foot pain with your ankle injury, you could also consider a detailed physical therapy assessments to identify other biomechanical factors contributing to the chronic plantar fasciitis. There are also some other promising nonsurgical treatments you could investigate such as extracorporeal shockwave therapy or PRP (platelet-rich plasma) injections. However these other methods also suffer from lack of conclusive evidence of benefit as well as lack of coverage under some insurance policies.

With respect to return to running, your surgeon can give you his or her instructions for increasing your activity. One study of endoscopic plantar fasciitis concluded that 2.6 months after surgery was the mean time for return to running. Again, excellent scientific data is lacking for more specific information about returning to running.

However a study of long-term outcomes (up to 15 years) after plantar fasciotomy revealed that 84% of the people were happy with the surgery. There was a trend towards less pain with increased time from surgery, but when statistics were used to analyze the number this fact could not be conclusively stated. However it is reassuring that people experienced less pain as time passed rather than more pain. Another study stated that 90% of people were happy with the surgery, and they would recommend it to another person.

One theoretical long term risk with surgery is alteration in the arch and thus the biomechanics at the foot level. Whether or not there would be eventual changes in the stability of your foot or increased areas of stress from having surgery is not yet known for sure. Again, there is a need for more study of the long term effects.

In summary, I am sorry you have had so much pain. I hope this information allows you to feel more confident as you discuss your options with your surgeon and make a decision about your treatment. I also hope you are soon back to running!

Anna Monroe, M.D.

Reference List: Buchbinder, R. (2014). Plantar fasciitis. Isaac, Z. (Ed.) UpToDate, Waltham, MA. (Accessed July 7, 2016.) Saxena, A. (2004). Uniportal endoscopic plantar fasciotomy: a prospective study on athletic patients. Foot & Ankle International, 25(12), 882–889. Sinnaeve, F., & Vandeputte, G. (2008). Clinical outcome of surgical intervention for recalcitrant infero-medial heel pain. Acta Orthopaedica Belgica, 74(4), 483–488. Wheeler, P., Boyd, K., & Shipton, M. (2014). Surgery for Patients With Recalcitrant Plantar Fasciitis: Good Results at Short-, Medium-, and Long-term Follow-up. Orthopaedic Journal of Sports Medicine, 2(3), 2325967114527901. http://doi.org/10.1177/2325967114527901

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date: July 31, 2016