Introduction
Plantar fasciitis is a crippling pain on the medial side of the heel. It is due to degeneration of the attachment of the plantar fascia to the calcaneus (heel bone). It has traditionally been rather chronic and intractable and literally dozens of treatments have been proposed for it. As is often the case where there are many treatments many of them are ineffective. The Steindler release is an operation I have developed from years of experience treating plantar fasciitis.
Indications
If you have had many of these treatments and your pain has progressively worsened, then our operation can help you.
Preoperative Instructions
There is no major preparation required for this operation other than to protect the skin on your foot to keep it clean and healthy to reduce the possibility of infection.
Procedure
Operations for plantar fasciitis have always had a bad reputation and with good reason. Most procedures described cut the plantar fascia. Any operation that cuts the plantar fascia disturbs the mechanics of the foot. This can result in the later development of troublesome lateral foot pain. Our operation is specifically designed to preserve normal foot mechanics and is directed at dealing with the degeneration of the plantar fascia. It is performed through a small incision on the medial side of the heel and is a dissection of the tissues in the heel when the pain arises. If there is a spur it is removed but often no spur is present. The plantar fascia is split in the line of its fibres but is not divided and this preserves the mechanics of the foot. Because this makes the heel quite sore for a day or so, a long acting local anaesthetic is used to relieve the pain after the operation enabling you to go home the next day after a complete dressing change.
Postoperative Instructions
It is best to remain in hospital overnight for both pain control and to limit bleeding and possible haematoma formation which can retard wound healing. You will be able to walk on your tip toes but it is advisable not to weight-bear on your heel until the wound has healed and the sutures have been removed. Full weight-bearing commences after suture removal. A small patch of altered sensation usually occurs due to the position of the incision but this resolves in time. At two weeks after the surgery, the sutures are removed and immediate full weight-bearing is permitted.
Risks
All operation can have complications and this is no exception. The most common complication is post-operative pain which is lessened by the local anaesthetic injection into the heel and bleeding from the wound. The next most common problems are minor wound problems and DVT. This is a very safe operation.
Outcomes
Even long-standing heel pain can be reliably relieved by this surgery. There is no duration of symptoms which renders the operation ineffective. Most patients are comfortable enough to walk normally by six weeks but most patients also note that their long-standing plantar fasciitis pain resolves immediately even if it is temporarily replaced by the bruising type pain of an operation. This is only short lived. Importantly, foot mechanics are maintained and the pain relief is permanent.
Treatment Alternatives
By the time surgery is being discussed, it is likely you will have had many other unsuccessful modalities. Surgery is recommended when the pain is severe, has been present for a prolonged period of time, seriously impeded recreation or occupational activity or you accept that the problem is simply progressively worsening despite non-operative treatment.
Related Information
Plantar fasciitis