Plantar Fasciitis Surgery: Recovery Time, Success Rates & How to Avoid It
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Plantar Fasciitis is one of the most common causes of foot pain, especially pain in the arch and heel. It’s a very common repetitive stress injury, affecting one in 10 people at some point in their lives. If you struggle with persistent arch pain or heel pain from this condition for a long time despite treatment, your doctor may recommend Plantar Fasciitis surgery.
If you are like most people, though, getting surgery is probably toward the bottom of your wishlist, and you’ll have questions. How does Plantar Fasciitis surgery work? What’s the success rate? How long is the recovery time? Do you really need one? When is it a reasonable option? Let’s take a look at some of these common questions.
A vast majority of people with Plantar Fasciitis do not need surgery to make full recovery. Almost everyone gets better with conservative treatment. Statistics vary, but at most, only 5% of people with Plantar Fasciitis have surgery, and only after conservative treatments don’t relieve pain. So, even though Plantar Fasciitis usually won’t go away on its own, it’s very, very likely you won’t need surgery!
Plantar Fasciitis is a repetitive stress injury that affects the ligament (the plantar fascia) at the bottom of your foot. Working with muscles and tendons in your lower kinetic chain, your plantar fascia maintains the shock-absorbing spring of the arch of your foot.
Every time you take a step, the plantar fascia gets loaded and stressed. Plantar Fasciitis occurs when this repetitive stress exceeds the tissue’s capacity, leading to microscopic tears and scar tissue in the ligament, causing pain.
To resolve the root cause of your Plantar Fasciitis pain, two things need to happen:
The tissue damage needs to heal, with healthy, resilient tissue replacing the weaker scar tissue
The whole kinetic chain has to get stronger, so that it can provide enough support to the plantar fascia to reduce pain now and prevent recurrences in the future
Some types of surgeries (like the ones that aim to break up scar tissue and promote the growth of healthy tissue) can facilitate the first change, but no surgery can make you stronger, leaving one of the two keys to full Plantar Fasciitis recovery unaddressed.
Conservative but proactive treatment approaches, physical therapy in particular, can create both of these changes. They are also far less invasive, lower-risk, and lower-cost, making surgeries for Plantar Fasciitis the treatment of last resort.
There are several types of surgeries for Plantar Fasciitis with different rationale behind them.
Plantar fascia release: the most common surgery for Plantar Fasciitis, this type of surgery creates small incisions in the plantar fascia to release excessive tension. Plantar fascia release can be done endoscopically (with a camera and a tool inserted through small cuts) or as an open surgery.
Minimally invasive scar tissue removal: there are several Plantar Fasciitis surgery techniques that are less invasive than the open or endoscopic plantar fascia release. All of these techniques break up built-up scar tissue and create new microinjuries that trigger the body’s natural healing process, using radiofrequency waves, ultrasonic waves, or even streams of saline water.
Calf muscle release: some people experience more intense Plantar Fasciitis pain due to extreme tightness in the calf, which can also cause tightness in the plantar fascia. This type of surgery is designed to lengthen the largest calf muscle (gastrocnemius) to relieve the excessive tension and relax the plantar fascia.
Plantar Fasciitis surgeries can relieve pain. However, reported success rates are not stellar, which is one of the reasons surgery is considered a last resort.
In one small study, just 84% of patients who had surgery reported they are satisfied with the result, with only half of the patients going fully pain-free after surgery. Studies generally report a lackluster 70-90% success rate for Plantar Fasciitis surgery, though some methods have higher success and satisfaction rates than others.
In addition to risks associated with surgeries in general (like infections), risks of Plantar Fasciitis surgery includes nerve damage, plantar fascia tear, increased pain (which is rare), and flattening of the arch.
You may find some claims of “one week before you can start walking” after surgery, but that’s likely too optimistic, especially for open surgeries. 3-6 weeks before you can walk normally seems to be the norm. With minimally invasive methods, you could be back on your feet within a week.
Especially if you have an open surgery, you’ll typically wear a walking boot to protect the area for a few weeks as you heal from the surgery. You’ll manage pain with medications, and if you have swelling in the area, your doctor may recommend keeping your foot elevated. Physical therapy is often recommended after surgery to rebuild strength, mobility and flexibility.
Because surgeries have higher risks in general, and not everyone gets full resolution from a Plantar Fasciitis surgery, it’s reserved for people who don’t get pain relief from more conservative treatments.
Most people who consistently follow a good treatment protocol can get significant pain relief quickly, and reach full resolution within 6-8 weeks, without surgery. Your doctor may recommend surgery when both these conditions are met:
You’ve been following a solid treatment plan consistently for over 6-12 months
Your pain is still severe enough to interfere with your daily life
When we say consider surgery only after “following the right treatment protocol consistently for a long enough time,” there are two key phrases: “the right treatment protocol” and “consistently.” Both are essential to maximize your chance of full recovery without surgery, and here’s what we mean:
The three elements necessary for a complete Plantar Fasciitis recovery are load management, soft tissue mobilization, and progressive strengthening. Within this treatment framework, you proactively work on the problematic tissue through massage (soft tissue mobilization), stay active while relieving pain with taping or by wearing a Plantar Fasciitis brace (load management), and build strength and stability throughout your kinetic chain with Plantar Fasciitis exercises.
You’ll notice that the correct Plantar Fasciitis treatment involves proactive movements. Passive treatments like resting, icing, NSAIDs, orthotics, and Plantar Fasciitis night splints can get you the much-needed quick Plantar Fasciitis pain relief temporarily, but by themselves, they are not enough to resolve the root cause of your pain.
Cortisone shots for Plantar Fasciitis fall in the same category - shots can relieve pain in some people, but they don’t resolve the root cause, and come with serious downsides.
So, if your treatment includes only these passive methods, and especially if you aren't seeing results, it's time to change your strategy.
Even when you are following the right treatment protocol, you’ll have to be consistent with your recovery work for it to have a transformative effect.
Chronic pain recovery takes time and effort, and progress isn’t always linear. It’s easy to feel discouraged and stop trying. However, consistency pays. Experiences of Alleviate users illustrate the point:
Users of the Plantar Fasciitis System, for example, experience an average of 70% decrease in pain over 6 weeks when they are consistent with their treatment routine. (That means they are doing the daily Plantar Fasciitis exercises 3-4 times a week, using the Alleviate App.)
In contrast, users who are less consistent with their daily routine see a smaller (though still significant) decrease in pain over the same period, of about 40%.
Make sure that you have a well-designed, proactive Plantar Fasciitis treatment plan that helps the tissue heal, rebuilds strength, and keeps you active. Pro tip: with a quality treatment plan, you should see a noticeable drop in your pain levels quickly; with our Plantar Fasciitis at-home treatment system, users average a 20% drop in pain levels within the first week.
Follow your treatment plan consistently, for at least 6-8 weeks.
Stay active, but listen to your body, and don’t overdo it.
Know that statistics are in your favor: your chances of avoiding surgery is over 95%.
Check out the strategies in this post if your Plantar Fasciitis is not getting better.
Key takeaways:
Most people don't need surgery: conservative but proactive treatments, using physical therapy principles, are very effective in resolving the root cause of Plantar Fasciitis. Over 95% of patients recover without having surgery.
The last resort: higher risk, higher cost, and not-so-stellar success rates push Plantar Fasciitis surgery far down the list of treatments.
Try PT first: done in clinic or at home, consistently following a physical therapy treatment plan for 6-8 weeks should be the first thing you do before considering surgery for Plantar Fasciitis.
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