Endoscopic Plantar Fasciotomy (EPF)

Endoscopic plantar fasciotomy is a minimally invasive surgical procedure used to treat stubborn cases of plantar fasciitis that have failed to respond to standard conservative treatment methods. This procedure essentially releases the proximal medial aspect of the fascia in order to relieve tensions within the musculature of the foot.

Because of the techniques used endoscopic plantar fascitomy is less invasive and has a reduced rate of complications when compared with traditional ‘open’ procedures that require substantial incisions to be made to the tissues of the foot. Due to the minimally invasive nature of this procedure heel spurs are not removed during the fasciotomy; the primary focus of this procedure is the release of fascial tissues.

An EPF typically allows patients to return to their regular routines and activities much more quickly than is generally approved when open surgery is performed, and it also greatly reduces the risk of complications such as infection, nerve entrapment, and a reoccurrence of the initial condition.

It should be noted, however, that a minimally invasive technique still requires more risk and more healing time than non-invasive techniques and that for this reason endoscopic plantar fasciotomy should not be used in place of aggressive conservative treatment programs. EPF should be viewed as a last resort used to treat stubborn cases of plantar fasciitis that have failed to respond to aggressive and consistent conservative treatments.

Unless there are special risks or considerations with the patient EPF is an outpatient procedure that generally takes about an hour to perform, with the patient given sufficient recovery time post-op before being released the same day. The procedure generally entails the use of full anesthia but some patients opt for sedation and a local anesthetic instead. A small incision (less than one-half inch long) is made on each side of the heel and the fascial tissues near the heel bone are then released and the incision closed.

Excessive pressure should not be placed on the foot post-surgery and some use of compression dressing or shoe orthotics may be advised. It is not unusual to experience numbness and tingling after the procedure is performed, and while  a certain amount of discomfort is to be expected as the anesthetic levels in the body drop the pain should not be crippling or excessive. Cold therapy will help to reduce pain and swelling and the foot should be elevated as often as possible.

While an aggressive, conservative treatment program is the preferable way to treat plantar fasciitis some cases will require more invasive intervention, and endoscopic plantar fasciotomy reduces the risks and complications associated with traditional open surgery. EPF has an overall success rate of 87%-90% and because it is less invasive when compared to other non-conservative treatments it is generally thought to be preferable to traditional methods of surgical intervention.

While the success rate and reduced risks associated with this procedure are encouraging it’s important to remember that an endoscopic plantar fasciotomy is not a cure and if proper steps and prevention methods are not taken post-op there is a very good chance that plantar fasciitis will re-occur in the patient.

 

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