American Family Physician reports most patients have some relief with plantar faciitis surgery, but 27 percent had significant pain afterward. Plantar fasciitis causes inner heel pain that’s worse in the morning or after sitting. Women, people older than 40, and those who are obese and arthritic are most likely to develop plantar fasciitis. Pain can significantly decrease a patient’s activity.
Procedures
Several different surgical procedures are used to treat plantar fasciitis after medication if stretching exercises, orthotics and bracing have failed to cure the pain. The most common procedures are open surgery, and minimally invasive and endoscopic surgery. The difference in the procedures is the size and placement of the incisions. The operation cuts part of the plantar fascia from its insertion on the heel. If there is a bone spur at the planar fascia insertion, it may also be removed.
Injury of Nearby Structures
In the Journal of Foot and Ankle Surgery, Rodney Tomczak lists several complications of the surgery due to damage of nearby structures. Nerves that supply sensation to the bottom of the foot can be cut, producing numbness. The cut nerve ends may form painful neuromas as they try to heal. Incisions, especially on the bottom of the foot, can heal with excess scar tissue or keloids. This produces pain with walking and shoe wearing. After bone spurs are removed, the calcaneus, or heelbone, may become weak and fracture.
Lateral Column Pain
The plantar fascia stabilizes the arch of the foot. Removing part of it can cause the foot to develop painful abnormal motion. Annette Brugh writes in the Journal of Foot and Ankle Surgery that the pain may be worse than the pain before surgery. The pain is usually in the outside or lateral portion of the foot. The tendons in the lateral ankle may become irritated. Some patients have pain in the middle of the foot. The abnormal stress that occurs with walking can result in fractures of the foot bones.
Missed Diagnosis
If the pain before surgery was not due to plantar fasciitis, it probably won’t improve with plantar fascia surgery. Tomczak notes common diagnoses mistaken for plantar fasciiitis are calcaneal stress fracture, heel neuroma, foreign body, soft tissue or bone tumor, and inflammatory arthritis. Nerve pain from a compressed nerve in the foot can also be hard to differentiate from plantar fasciitis.
Surgical Procedures
All surgical procedures have some common risks. Infection and non-healing wounds can occur with plantar fasciitis surgery. Patients may have allergic response to medications given. In addition to the risk of a foot becoming unstable from too much fascia being cut, there is a risk of the surgery needing to be repeated to cut more tissue.