Heel spur syndrome or heel pain is usually caused by a mechanical problem involving the alignment of the foot. There is a dense fibrous band of tissue in the bottom of the foot known as the plantar fascia. The plantar fascia inserts into the heel bone and spreads out across the bottom of the foot.

Due to the mechanical mis-alignment of the foot, excessive tension is placed on this band of tissue causing inflammation and pain. The size or presence of a heel spur does not always correlate with the amount of pain. Heel pain is usually worse in the morning, especially the first steps, or after periods of rest. As the pain intensifies, the heel can hurt even while resting.

There is a possibility in some patients, the pain will go away. However, in most cases, the longer a patient waits to seek treatment, the more chronic the condition usually becomes. In most instances, conservative care includes shoe modifications, medications, injections and physical therapy. If pain and discomfort persist after conservative measures have been exhausted, then surgery is recommended.

WHAT IS ENDOSCOPIC PLANTAR FASCIOTOMY?
Endoscopic Plantar Fasciotomy is a recent advancement in foot surgery for the correction of heel spur syndrome and plantar fasciitis. The new procedure allows for a shorter recovery period and a faster return to normal activity. Weight bearing is usually encouraged immediately after the procedure. The surgery is performed on a outpatient basis. The procedure utilizes specially designed instruments that allow the surgeon to directly visualize the foot structures on a video screen while making two small incisions on the foot.

HOW IS THIS PROCEDURE DIFFERENT?
The previous surgical treatment for heel spur surgery involved making a large open incision. The tight ligament was then severed and the bone spur which has attached to the fascia was also removed. The bone spur is the result of chronic inflammation, where the fascia that is attached to the heel bone has been pulling over an extended period of time. The spur is a symptom of the inflammation and not the actual cause of the heel pain. Due to the severity of this procedure, patients were not able to bear weight on their feet after surgery for 2 to 4 weeks.

In performing an Endoscopic Plantar Fasciotomy, it is not necessary to remove the heel spur in order to help alleviate the pain. Two small incisions are made in the fascia to release the tension. Most patients are able to return to work within a week, and resume their normal pace within a month. Factors such as age, weight, and occupation can modify the recovery period.

WHAT ARE THE RISKS AND COMPLICATIONS?
There are fewer complications with the new procedure when compared with the previous surgical treatments offered. As with all surgery, no procedure is risk-free, and there is no guarantee as to the success of the procedure. The postoperative risks include delayed healing, infection, pain in the arch area, and a possibility of a small area of numbness at the incision sites. Fortunately, most surgical complications can be resolved with careful follow-up by the surgeon.

ARE YOU A CANDIDATE FOR THIS SURGICAL PROCEDURE?
If you have failed to obtain relief with conservative treatment, then you may benefit from Endoscopic Plantar Fasciotomy. A complete evaluation and discussion with the physician will help to determine if surgical intervention is an option for you.