What is Open Plantar Fasciotomy

Open plantar fasciotomy is a procedure to cut a band of thick tissue on the bottom of the foot (plantar fascia) to relieve pressure.

The plantar fascia connects the heel bone to the base of the toes. If the fascia swells or becomes irritated (plantar fasciitis), this may cause heel pain.

You may need this surgery if you have heel pain from plantar fasciitis and other treatments have not helped.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Bleeding.
• Infection.
• Foot instability.
• Nerve damage.
• Painful scarring in the arch of the foot.
• A blood clot that forms in the lower leg (deep vein thrombosis). A clot can sometimes break loose and travel to the lung (pulmonary embolism).
• The procedure not working.
• Allergic reaction to medicines.

What happens before the procedure?

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Plan to have someone take you home after the procedure.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• Your surgeon will make a small cut (incision) in the sole of your foot. This incision is usually made on the inside area of the sole, just in front of the heel.
• The surgeon will extend the incision down to the fascia. Then about half of the fascia layers will be cut, mostly on the inside.
• The incision will be closed with stitches (sutures).
• A bandage (dressing) will be taped over the bottom of your foot.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• Your health care provider may send you home with a splint, boot, or shoe to wear while your foot heals. You may also be given crutches to help you walk without using your affected foot to support your body weight (bear weight).
• Do not drive for 24 hours if you received a sedative.

Open Plantar Fasciotomy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Swelling.
• Stiffness.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain and swelling

• If directed, apply ice to the affected foot:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times per day.
• Raise (elevate) your foot above the level of your heart while you are sitting or lying down.

Driving

• Do not drive for 24 hours if you received a sedative.
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have been given a splint, boot, or shoe to wear on a foot that you use for driving.

Activity

• Do not use the affected foot to support (bear) your body weight until your health care provider says that you can. Use crutches as told by your health care provider.
• Do not do any activity that causes foot pain.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers.
• If your health care provider approves bathing and showering, keep your foot out of the bath or cover the splint or bandage with a watertight plastic bag to protect it from water. Do not let the splint or bandage get wet.
• Keep the bandage (dressing) dry until your health care provider says it can be removed.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Wear your splint, boot, or shoe as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have pain or swelling in your foot that is getting worse.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad small coming from your incision.
• Your foot is numb.

Get help right away if:

• You have pain, warmth, and swelling in your calf area.
• You have chest pain.
• You have trouble breathing.