Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

INSTEP FASCIOTOMY

Posted by KENT W on 8/18/02 at 08:15 (092823)

I HAVE BEEN SUFFERING PLANTAR'S FASCIITIS FOR ABOUT 5 YEARS. AFTER ALL STANDARD RECOMMENDED NON INVASIVE TREATMENTS, MY DOCTOR HAS FINALLY SUGGESTED AN INSTEP FASCIOTOMY? I AM INTERESTED IN ANY EXPERIENCES OTHERS MIGHT HAVE HAD WITH THIS PROCEDURE. THANK YOU.
(I HAVE NO FINANCIAL CONNECTION WITH ANY HEEL PAIN PRODUCTS OR PROCEDURES.)

Re: INSTEP FASCIOTOMY

BrianJ on 8/18/02 at 11:02 (092831)

Kent --

I had an endoscopic fasciotomy that made my heel pain neither better nor worse. Before any fasciotomy, I would ask (1) What is the surgeon's 'success' rate, and can you speak with some of his/her patients that have already had the procedure, (2) what percentage of the fascia does the surgeon intend to release (the greater the % of PF released, the greater the chance of detrimentally altering the foot's biomechanics), (3) should you consider having the first branch of the lateral plantar nerve decompressed at the same time? (some doctors believe that heel pain is caused by entrapment of this nerve, whether by itself or together with PF).

Hope this helps. Good luck!

Re: INSTEP FASCIOTOMY

Ed Davis, DPM on 8/18/02 at 15:18 (092846)

Kent:
Make sure you have read Scott's Heel Pain Book online here to verify that you have had comprehensive conservative treatment. The latest option is ESWT (there is a whole board just on this subject on this site). Many feel it will supplant most plantar fascial release surgeries within a few years.

The instep procedure is a relatively new approach to plantar fascial release surgery. Most plantar fascial releases are performed at the origin of the plantar fascia at the base of the heel bone. The instep procedure is done further forward in the arch area. I have a friend who practices in Louisiana who has done a number of successful instep procedures. Interestingly, he has performed instep procedures on individuals who have failed EPF (endoscopic plantar fasciotomy). He has found that the instep procedure permits the cutting of fibers that were missed in the EPF. Plantar fascial releases probably fail more because not enough of the fascia was released as opposed to too much -- at variance with Brian's post.

There is absolutely no controversy as to the need for complete release of fibers from the medial aspect of the heel bone and it appears that the insep procedure may do so more completely than the EPF. The area of controversy that does exist is how far lateral (toward the outside of the foot) the fibers should be cut. Again, I have seen far more problems with insufficient release of fibers than too much.

Best of luck.
Ed

Re: INSTEP FASCIOTOMY

Dr. Zuckerman on 8/18/02 at 16:02 (092855)

Hi

I have performed the instep fasciotomy in the past. It works . It took a very long time to heal greater then six months. The patient is completely pain feel post four years. It was done on a failed medial band release

I would place the patient is a walking cast for two weeks.

Re: INSTEP FASCIOTOMY

jimmy r on 11/16/02 at 07:25 (100369)

can this surgery work for scar tissue built around the mediel band it seems i have pain in the arch only from the bottom of the foot if you were to pinch the mediel band from the sides there's no pain whats going on

Re: INSTEP FASCIOTOMY

BrianJ on 8/18/02 at 11:02 (092831)

Kent --

I had an endoscopic fasciotomy that made my heel pain neither better nor worse. Before any fasciotomy, I would ask (1) What is the surgeon's 'success' rate, and can you speak with some of his/her patients that have already had the procedure, (2) what percentage of the fascia does the surgeon intend to release (the greater the % of PF released, the greater the chance of detrimentally altering the foot's biomechanics), (3) should you consider having the first branch of the lateral plantar nerve decompressed at the same time? (some doctors believe that heel pain is caused by entrapment of this nerve, whether by itself or together with PF).

Hope this helps. Good luck!

Re: INSTEP FASCIOTOMY

Ed Davis, DPM on 8/18/02 at 15:18 (092846)

Kent:
Make sure you have read Scott's Heel Pain Book online here to verify that you have had comprehensive conservative treatment. The latest option is ESWT (there is a whole board just on this subject on this site). Many feel it will supplant most plantar fascial release surgeries within a few years.

The instep procedure is a relatively new approach to plantar fascial release surgery. Most plantar fascial releases are performed at the origin of the plantar fascia at the base of the heel bone. The instep procedure is done further forward in the arch area. I have a friend who practices in Louisiana who has done a number of successful instep procedures. Interestingly, he has performed instep procedures on individuals who have failed EPF (endoscopic plantar fasciotomy). He has found that the instep procedure permits the cutting of fibers that were missed in the EPF. Plantar fascial releases probably fail more because not enough of the fascia was released as opposed to too much -- at variance with Brian's post.

There is absolutely no controversy as to the need for complete release of fibers from the medial aspect of the heel bone and it appears that the insep procedure may do so more completely than the EPF. The area of controversy that does exist is how far lateral (toward the outside of the foot) the fibers should be cut. Again, I have seen far more problems with insufficient release of fibers than too much.

Best of luck.
Ed

Re: INSTEP FASCIOTOMY

Dr. Zuckerman on 8/18/02 at 16:02 (092855)

Hi

I have performed the instep fasciotomy in the past. It works . It took a very long time to heal greater then six months. The patient is completely pain feel post four years. It was done on a failed medial band release

I would place the patient is a walking cast for two weeks.

Re: INSTEP FASCIOTOMY

jimmy r on 11/16/02 at 07:25 (100369)

can this surgery work for scar tissue built around the mediel band it seems i have pain in the arch only from the bottom of the foot if you were to pinch the mediel band from the sides there's no pain whats going on