Name of the Procedure:

Fasciectomy, Plantar Fascia; Radical (Separate Procedure)

Common Names: Radical Plantar Fasciectomy, Plantar Fascia Removal Surgery

Summary

A radical plantar fasciectomy is a surgical procedure designed to remove a significant portion or the entirety of the plantar fascia, the thick band of tissue running along the bottom of your foot. This procedure is typically performed to relieve severe or chronic pain resulting from conditions affecting the plantar fascia.

Purpose

This procedure is primarily aimed at treating chronic plantar fasciitis, a condition causing persistent and debilitating heel pain. The goal is to alleviate pain, improve mobility, and enhance the overall quality of life for individuals who have not responded to other more conservative treatments.

Indications

• Chronic heel pain due to plantar fasciitis unresponsive to conservative treatments such as physical therapy, orthotics, or medications.
• Presence of heel spurs or other structural abnormalities causing severe pain.
• Failed prior treatments such as less invasive fasciectomies or injections.

Preparation

• Fasting for a specified period before surgery, typically around 8-12 hours.
• Adjustments to current medications based on surgeon's recommendations, particularly blood thinners.
• Pre-operative diagnostic tests, which may include foot X-rays or MRI to assess the extent of the problem.

Procedure Description

1. Administration of anesthesia, usually general or regional (spinal or epidural).
2. An incision is made on the sole of the foot to access the plantar fascia.
3. The surgeon excises a significant portion or the entirety of the plantar fascia.
4. Any additional structural issues, such as heel spurs, may also be addressed during the procedure.
5. The incision is closed with sutures and the area is bandaged.

Tools: Scalpels, retractors, surgical scissors, sutures Anesthesia: General or regional (spinal or epidural)

Duration

The procedure typically takes about 1 to 1.5 hours to complete.

Setting

A hospital operating room or an outpatient surgical center.

Personnel

• Lead Surgeon
• Surgical Assistants
• Anesthesiologist or Nurse Anesthetist
• Operating Room Nurses

Risks and Complications

• Infection at the incision site
• Excessive bleeding
• Nerve damage leading to numbness or tingling
• Recurrence of pain or failure to relieve symptoms
• Prolonged recovery or complications related to anesthesia

Benefits

• Significant pain relief for those who have not benefited from other treatments
• Improved mobility and ability to perform daily activities
• Enhancement in overall quality of life

Recovery

• Initial recovery involves rest with the foot elevated to minimize swelling.
• Pain management may include medications prescribed by the surgeon.
• Weight-bearing activities may be restricted for several weeks.
• Physical therapy may be recommended to aid recovery and improve mobility.
• Regular follow-up appointments are necessary to monitor healing.

Alternatives

• Conservative treatments like physical therapy, custom orthotics, anti-inflammatory medications, and corticosteroid injections.
• Less invasive surgical options such as partial fasciectomy or endoscopic procedures.
• The decision for radical fasciectomy is typically made when these alternatives fail to provide adequate relief.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, patients may experience discomfort and will be provided with pain management options. Recovery requires a period of rest and gradual return to activities, guided by healthcare providers to ensure effective healing.