Dr. Tyson Green, Podiatric Specialist
Heel pain affects nearly 2 million Americans each year and is one of the primary complaints heard by physicians who specialize in foot injury, according to the Plantar Fasciitis Organization. Heel pain, typically caused by faulty foot structure such as flat feet or high arches, can range from mild to debilitating and is often treated through non-surgical procedures, including stretching exercises, shoe modifications, medication, orthotic devices, splints, or injection therapy.
Unfortunately, some discover that conservative care and treatment is ineffective in heel pain relief. The most common surgical procedure used today to correct this issue is endoscopic plantar fasciotomy, or EPF, a relatively new surgical treatment.
EPF is used to treat severe strain of the plantar fascia, which is a ligament-like band that runs along the bottom of the foot. Those who suffer from a strained fascia will usually experience pain on the inside of the foot, where the arch and heel meet. Sometimes the pain becomes so uncomfortable that sufferers find it difficult to stand. Pain is usually worse in the morning or after sitting for long periods of time. Other symptoms of plantar fasciitis include pain that worsens over a period of time, yet decreases with walking. Walking tends to stretch the fascia, which sometimes relieves pain temporarily. More often than not, however, the pain returns.
Although faulty foot structure is typically the culprit for plantar fasciitis, people who have jobs that require a lot of walking on hard surfaces are also commonly affected. Consistently wearing inadequate footwear – those with little or no arch support, for example – can also create problems with the fascia, along with sudden weight gain or overactivity.
When conservative treatment fails to relieve pain associated with plantar fasciitis, EPF is considered as an effective alternative. EPF is minimally invasive and has a very high rate of success.
During the procedure, the physician makes small incisions – less than one-half inch long – on each side of the heel. A special scope and camera are then slipped under the fascia, which allows the physician to observe the procedure on a monitor. The fascia is cut near the heel bone.
Cutting one third to one half of the fascia allows new ease of tension on the insertion, which lengthens the fascia and reduces strain. Most patients walk immediately after surgery with a much quicker return to activity than with previous surgical interventions. Physical therapy is sometimes prescribed during the recovery process as well as continued need for orthotic control within supportive shoes.