New York Health - Should I have surgery for plantar fasciitis? Key points in...

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Deciding whether to have surgery for plantar fasciitis will involve several issues, including the severity of your condition, the success of past treatment, and whether your condition is preventing you from working or participating in an athletic or exercise program. Consider the following when making your decision:

You may not need surgery. Only about 5% of people with plantar fasciitis do.¹ Experts recommend that you try at least 6 months of nonsurgical treatment before you consider surgery.
Surgery may be right for you if you continue to have severe heel pain despite 6 to 12 months of home treatment or if heel pain is affecting your ability to work or participate in a reasonable athletic program.
If you do need surgery, it will most likely reduce your heel pain. Of the few people who require surgery, about 75 out of 100 have less pain than they did before surgery.²
Having surgery is not a guarantee that your heel pain will go away. About 25 out of 100 people who have surgery continue to have heel pain.²

Medical Information

What is plantar fasciitis?

Plantar fasciitis causes heel pain, which often becomes long-lasting (chronic). It occurs when the long, flat ligament on the bottom of the foot (plantar fascia ) stretches irregularly and develops small tears that may cause the ligament to become inflamed.

The most common symptom of plantar fasciitis is heel pain when you take your first steps after getting out of bed or after sitting for a long time.

What causes plantar fasciitis?

Plantar fasciitis is often caused by problems that affect the way you walk, such as walking with an inward twist or roll of the foot (pronation ) or having high arches, flat feet, or tight Achilles tendons. Repetitive activities, being overweight, or wearing bad shoes can aggravate or contribute to plantar fasciitis. These factors lead to small tears, which may result in inflammation of the ligament and pain in the heel.

What are the risks of having plantar fasciitis?

Ongoing heel pain will make walking and standing painful. You may change the way you walk to relieve the pain. This eventually may lead to more discomfort and pain as well as other foot, leg, hip, or back problems. Chronic plantar fasciitis may limit your ability to work and enjoy athletic or exercise activities.

How is plantar fasciitis treated?

Treatment for plantar fasciitis is easy to follow and is usually successful if you start soon after symptoms appear. Nonsurgical treatment includes rest, ice, anti-inflammatory drugs, stretching exercises, shoe inserts (orthotics), and night splints. Corticosteroid injections may be used in some cases to reduce inflammation. These treatments may take 6 months to a year to relieve heel pain.

Surgery is usually not necessary for plantar fasciitis. Most people (95%) who have plantar fasciitis are able to relieve heel pain with nonsurgical treatment.¹ You and your doctor may consider surgery when nonsurgical treatment for at least 6 months has not helped and when heel pain is limiting your daily activities. Surgery involves cutting (releasing) part of the plantar fascia ligament to release the tension and relieve inflammation.

What are the risks of surgery?

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).

For more information, see:

Your Information

Your treatment choices are:

Use nonsurgical treatments to see whether your heel pain improves.
Have surgery to release the tension and relieve inflammation of the plantar fascia ligament.

The decision about whether to have surgery for plantar fasciitis takes into account your personal feelings and the medical facts.

**Deciding about surgery for plantar fasciitis**
Reasons to have surgery	Reasons not to have surgery
You have been using nonsurgical treatments for at least 6 months, and they are not controlling your heel pain. Heel pain is interfering with your ability to work or engage in a reasonable athletic or exercise program. You are not willing or able to do 6 to 12 months of nonsurgical treatment. Your job or hobby requires standing for prolonged periods. Are there other reasons you might want to have surgery for plantar fasciitis?	Nonsurgical treatments are improving your heel pain. You have been using nonsurgical treatments for less than 6 months. You are willing and able to do 6 to 12 months of nonsurgical treatment to see if your heel pain improves. Your job or hobbies are not affected by your heel pain. Your health status makes the risks of surgery and anesthesia unacceptable. Are there other reasons you might not want to have surgery for plantar fasciitis?

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about surgery for plantar fasciitis. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My symptoms have improved with the use of medicines, orthotics, or other nonsurgical treatments.	Yes	No	Unsure
Before considering surgery, I am willing to try nonsurgical treatments for at least 6 months to see if my symptoms improve.	Yes	No	Unsure
I have used orthotics, medicines, or other nonsurgical treatments for at least 6 months, and my symptoms are still the same.	Yes	No	Unsure
My heel pain is interfering with my ability to work.	Yes	No	Unsure
My heel pain is interfering with my athletic or exercise program.	Yes	No	Unsure
I would prefer to avoid surgery if at all possible.	Yes	No	Unsure
My heel pain is forcing me to adjust the way I walk, stand, or run.	Yes	No	Unsure
I have heel pain, but neither my work nor my personal life is affected by it.	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery

Leaning toward NOT having surgery

Return to the topic Plantar Fasciitis.

References

Citations
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.
Buchbinder R (2004). Plantar fasciitis. New England Journal of Medicine, 350(21): 2159-2166.