Name of the Procedure:

Endoscopic plantar fasciotomy (EPF)

Summary

Endoscopic plantar fasciotomy is a minimally invasive surgical procedure used to relieve chronic heel pain caused by plantar fasciitis. The procedure involves releasing a portion of the plantar fascia ligament using endoscopic tools, which help reduce inflammation and discomfort.

Purpose

The procedure addresses chronic plantar fasciitis, a condition characterized by severe heel pain due to inflammation of the plantar fascia ligament. The goals are to alleviate pain, improve mobility, and enhance the quality of life for patients who have not responded to conservative treatments.

Indications

• Persistent heel pain lasting longer than six months
• Ineffectiveness of non-surgical treatments such as physical therapy, orthotics, medications, or injections
• Significant limitation in daily activities due to heel pain
• Confirmed diagnosis of plantar fasciitis through imaging studies or clinical evaluation

Preparation

• Fasting for a specified period before the procedure, usually 6-8 hours
• Discontinuation of certain medications as advised by the healthcare provider
• Preoperative assessments, including imaging studies (e.g., MRI or ultrasound) and blood tests
• A detailed discussion with the surgeon about the procedure, risks, benefits, and post-operative care

Procedure Description

1. Patient is given local anesthesia with or without sedation to ensure comfort.
2. A small incision is made on the side of the heel.
3. An endoscope (a thin, flexible tube with a camera) is inserted through the incision to provide visualization of the plantar fascia.
4. Specialized instruments are used to carefully release a portion of the plantar fascia ligament.
5. The instruments and endoscope are removed, and the incision is closed with sutures or surgical tape.
6. A sterile bandage is applied to the site.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Endoscopic plantar fasciotomy is typically performed in an outpatient surgical center or hospital.

Personnel

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

Risks and Complications

• Infection at the incision site
• Nerve damage resulting in numbness or tingling
• Incomplete pain relief or recurrence of plantar fasciitis
• Scarring or delayed healing
• Deep vein thrombosis (rare)

Benefits

• Significant reduction in heel pain
• Improved mobility and ability to perform daily activities
• Lower risk of complications compared to open surgery
• Faster recovery time due to minimally invasive nature

Recovery

• Initial rest and limited weight-bearing on the affected foot
• Use of crutches or a walking boot as recommended by the surgeon
• Gradual return to normal activities over several weeks
• Physical therapy to strengthen the foot and improve flexibility
• Follow-up appointments to monitor healing and progress

Alternatives

• Conservative treatments (e.g., physical therapy, orthotics, corticosteroid injections)
• Extracorporeal shock wave therapy (ESWT)
• Open plantar fasciotomy, which involves a larger incision and longer recovery time
• Pros: Non-invasive alternatives avoid surgical risks.
• Cons: Limited effectiveness for severe or chronic cases.

Patient Experience

During the procedure, the patient may feel slight pressure but should not experience pain due to anesthesia. Post-procedure, there may be mild discomfort, swelling, or bruising at the incision site. Pain management includes prescribed pain relievers and elevation of the foot. Most patients can resume normal activities within a few weeks, with complete recovery taking a few months.