How To Address Complications Of Plantar Fascia Release

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Author(s): 
Michelle Butterworth, DPM, FACFAS

   Some surgeons take a small portion of the plantar fascia and perform a plantar fasciectomy to avoid this possible complication. Some surgeons employ immediate weightbearing postoperatively while others utilize splinting and casting to help keep the fibers of the plantar fascia separated. Stretching of the plantar fascia postoperatively may also be helpful to avoid this complication but take care not to be overaggressive as this can lead to plantar fascia rupture.

   Also, if the surgeon releases too much of the plantar fascia and employs an active postoperative course with weightbearing and stretching, one should be cautious of complete rupture. If not enough of the plantar fascia has been released or there is scarring along the plantar fasciotomy site, revisional surgery with possible plantar fasciectomy may be warranted for relief of pain.

Can ESWT Be An Alternative To Plantar Fasciotomy?

Although plantar fasciotomy can be a successful technique with few complications, extracorporeal shockwave therapy is a non-invasive alternative for the treatment of chronic plantar fasciitis and research has shown good results.30,31

   Surgeons should be aware of this technique and familiarize themselves with the risks and benefits in comparison to a plantar fasciotomy.

In Summary

Plantar fasciotomy can be a successful technique for recalcitrant heel pain. Few complications have been reported and typically resolve with conservative therapies. Most complications are due to temporary instability in the foot from altered biomechanics resulting from the release of the plantar fascia.

   Proper patient selection, accurate diagnosis and good surgical technique can minimize complications, and result in a high rate of patient satisfaction. For persistent pain, revisional surgery may be needed and the patient may need to make lifestyle changes including possible weight loss, change in athletic routines, or even changes in employment.

   Dr. Butterworth is a Fellow and is on the Board of Directors as Treasurer/Secretary of the American College of Foot and Ankle Surgeons. She is in private practice in Kingstree, S.C.




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