Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure)
CPT4 code
Name of the Procedure:
Division of plantar fascia and muscle (e.g., Steindler stripping)
Summary
In layman's terms, this procedure involves cutting through a thick band of tissue on the bottom of the foot, called the plantar fascia, as well as certain foot muscles, to relieve pain and improve mobility.
Purpose
This procedure primarily addresses chronic heel pain that doesn’t respond to other treatments, known as plantar fasciitis. The goal is to reduce pain, enhance foot function, and improve overall quality of life for the patient.
Indications
- Chronic heel pain lasting more than 6-12 months
- Pain that persists despite conservative treatments like physical therapy, orthotics, and medications
- Severe plantar fasciitis
Preparation
- Patients may need to fast for at least eight hours before the procedure.
- Adjustment or temporary halt of certain medications as advised by the physician.
- Diagnostic tests like X-rays or MRI to assess the condition of the plantar fascia.
Procedure Description
- Administer anesthesia (local, regional, or general).
- An incision is made on the inside or back of the heel.
- The plantar fascia is carefully cut, and sometimes portions of muscle are also detached.
- The incision is then closed with sutures.
- Dressing is applied to the surgical site.
Tools: Scalpel, surgical scissors, sutures, and possibly endoscopic equipment if performing minimally invasive surgery.
Duration
Typically takes about 30 minutes to 1 hour.
Setting
Performed in a hospital or outpatient surgical center.
Personnel
- Surgeon (usually an orthopedic surgeon or podiatrist)
- Nurses
- Anesthesiologist
Risks and Complications
Common risks:
- Infection
- Bleeding
- Nerve damage
Rare complications:
- Arch instability
- Continued heel pain
- Chronic swelling
Benefits
- Significant reduction in heel pain
- Improved ability to stand, walk, and perform daily activities
- Immediate results in pain relief for some patients, while others might see gradual improvement over weeks.
Recovery
- Keep the foot elevated and apply ice to reduce swelling.
- Non-weight bearing for the initial days, gradually progressing to weight-bearing activities as advised by the physician.
- Possible use of a walking boot.
- Physical therapy might be recommended.
- Follow-up appointments for wound inspection and suture removal.
Alternatives
- Conservative treatments: physical therapy, orthotic devices, medications
- Alternative surgical options: endoscopic plantar fasciotomy
- Pros: Conservative treatments are non-invasive with fewer risks
- Cons: May not provide relief if the condition is severe
Patient Experience
During the procedure, anesthesia ensures the patient does not feel pain. Post-procedure, there can be mild to moderate pain managed with prescribed pain medications. Expect some swelling and bruising. The initial days might involve restricted movement and adherence to post-operative care instructions to ensure a smooth recovery.