Name of the Procedure:

Fasciectomy, plantar fascia; partial (separate procedure)

Summary

A partial plantar fascia fasciectomy is a surgical procedure that involves removing a portion of the plantar fascia, a thick band of tissue that runs along the bottom of the foot. This procedure is typically performed to relieve pain and improve function in patients suffering from chronic plantar fasciitis that has not responded to conservative treatments.

Purpose

The primary purpose of this procedure is to alleviate chronic pain associated with plantar fasciitis, a condition where the plantar fascia becomes inflamed and painful. The goals are to reduce pain, enhance mobility, and improve the overall quality of life for the patient.

Indications

• Chronic plantar fasciitis not responsive to conservative treatments like physical therapy, orthotics, or medications
• Severe and persistent pain in the heel or along the arch of the foot
• Significant impairment in foot function affecting daily activities

Preparation

• Pre-operative fasting as instructed by the healthcare provider
• Adjustments to medications, especially blood thinners, as directed
• Diagnostic tests such as X-rays or MRI to assess the condition of the plantar fascia and rule out other issues

Procedure Description

• The patient is given regional anesthesia or sedation to ensure comfort during the procedure
• A small incision is made in the sole of the foot to access the plantar fascia
• The surgeon removes a portion of the plantar fascia to relieve tension and reduce inflammation
• The incision is then closed with sutures, and the foot is bandaged

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed on an outpatient basis in a surgical center or hospital.

Personnel

• Orthopedic surgeon or podiatric surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection at the incision site
• Nerve damage leading to numbness or tingling
• Prolonged pain or discomfort
• Scarring
• Potential for the condition to recur

Benefits

• Significant reduction or elimination of pain
• Improved foot function and mobility
• Enhanced quality of life due to reduced discomfort

Recovery

• Post-procedure care involves keeping the foot elevated and applying ice to reduce swelling
• Pain management with prescribed medications
• Gradual return to weight-bearing activities as advised by the surgeon
• Physical therapy may be recommended to aid in recovery
• Full recovery usually takes several weeks, with follow-up appointments to monitor healing

Alternatives

• Continued conservative treatments such as physical therapy, orthotics, and anti-inflammatory medications
• Corticosteroid injections to reduce inflammation
• Extracorporeal shock wave therapy (ESWT) to promote healing Pros and cons of alternatives: Conservative treatments have fewer risks but may not be effective in severe cases; ESWT is non-invasive but can be costly and require multiple sessions.

Patient Experience

During the procedure, the patient will be sedated or under regional anesthesia, so they should not feel pain. Post-operatively, there may be discomfort and swelling, managed with pain medications and by following care instructions. Gradual improvement in symptoms is expected within weeks, with a noticeable reduction in pain and improved function as the foot heals.