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To Dr. Z or Dr. Davis

Posted by dave r on 1/02/03 at 15:35 (104607)

Have either of you ever performed or heard of a plantar fasciotomy that is performed from the bottom of the foot. An incision is made at the bottom of the heel to expoze the medial and central fibers of the fascia. is this a better procedure than the traditional open procedure that is performed from the medial side of the foot?

Re: To Dr. Z or Dr. Davis

Dr. David S. Wander on 1/02/03 at 19:09 (104634)

There are dozens of variations on performing a plantar fascia release. Some surgeons prefer an 'open' approach from the side to allow the tissue to be visualized, some use a small 'stab' incision, some use a C-arm/flouroscope to locate the site, some use an endoscope (EPF) and some prefer an 'instep' fasciotomy. This has recently gained increased popularity since it allows for direct visualization of the plantar fascia, and greatly reduces the chance of nerve injury. It is relatively simple to perform and results are generally very good. The only real drawback is that the incision is at the bottom of the foot, which potentially can cause a painful scar, though good surgical technique can reduce the chances of a bad scar. It is certainly a well accepted and effective approach, especially if your surgeon is comfortable with this procedure. Have you tried all conservative procedures or ESWT?

Re: To Dr. Z or Dr. Davis

Dr. Z on 1/02/03 at 19:19 (104635)

I like the incision from the bottom . Very easy to cut the fascia. It is my opinion that this has the best healing results with the least complication if you are going to have a pf release

Re: To Dr. Z or Dr. Davis

dave r on 1/03/03 at 07:51 (104680)

thanks for your reply. I have done it all in trying to get rid of my pf.
6 pairs of orthotics, months of physical therapy ( which didnt help at all ). I have been wearing nightsplints for four years. I tape my arches every day and ice my feet every day. I have had eswt done twice. the first treatment helped some and the second treatment didnt help at all. I am currently pursueing surgery and the surgeon that i am seeing uses the traditional open approach from the side. I have never heard of the instep fasciotomy until yesterday when a friend of mine said that she had that performed on both of her feet. She is doing well also. No complications. Her doctor doesnt recommend the open approach at all. I am very comfortable with the doctor that i am seeing. But thought i should question both procedures.

Re: To Dr. Z or Dr. Davis

Ed Davis, DPM on 1/03/03 at 15:16 (104725)

Dave:

The 'instep' procedure is yet another 'variation on a theme' in which the plantar fascia is cut at the level of the arch as opposed to the heel. It is a bit newer than other approaches but seems to be a promising method.

A friend who practices in Louisiana had done several instep procedures on patients after EPF failed --- he noted that the EPF had left some medial fibers intact. Those patients went on to success after his procedures.
Ed

Re: To Dr. Z or Dr. Davis

JudyS on 1/08/03 at 19:56 (105133)

Dave - my husband had the PF release surgery, minimally invasive, from the side. He recovered completely and is back to 5-mile jogs.

Re: To Dr. Z or Dr. Davis

Dr. David S. Wander on 1/02/03 at 19:09 (104634)

There are dozens of variations on performing a plantar fascia release. Some surgeons prefer an 'open' approach from the side to allow the tissue to be visualized, some use a small 'stab' incision, some use a C-arm/flouroscope to locate the site, some use an endoscope (EPF) and some prefer an 'instep' fasciotomy. This has recently gained increased popularity since it allows for direct visualization of the plantar fascia, and greatly reduces the chance of nerve injury. It is relatively simple to perform and results are generally very good. The only real drawback is that the incision is at the bottom of the foot, which potentially can cause a painful scar, though good surgical technique can reduce the chances of a bad scar. It is certainly a well accepted and effective approach, especially if your surgeon is comfortable with this procedure. Have you tried all conservative procedures or ESWT?

Re: To Dr. Z or Dr. Davis

Dr. Z on 1/02/03 at 19:19 (104635)

I like the incision from the bottom . Very easy to cut the fascia. It is my opinion that this has the best healing results with the least complication if you are going to have a pf release

Re: To Dr. Z or Dr. Davis

dave r on 1/03/03 at 07:51 (104680)

thanks for your reply. I have done it all in trying to get rid of my pf.
6 pairs of orthotics, months of physical therapy ( which didnt help at all ). I have been wearing nightsplints for four years. I tape my arches every day and ice my feet every day. I have had eswt done twice. the first treatment helped some and the second treatment didnt help at all. I am currently pursueing surgery and the surgeon that i am seeing uses the traditional open approach from the side. I have never heard of the instep fasciotomy until yesterday when a friend of mine said that she had that performed on both of her feet. She is doing well also. No complications. Her doctor doesnt recommend the open approach at all. I am very comfortable with the doctor that i am seeing. But thought i should question both procedures.

Re: To Dr. Z or Dr. Davis

Ed Davis, DPM on 1/03/03 at 15:16 (104725)

Dave:

The 'instep' procedure is yet another 'variation on a theme' in which the plantar fascia is cut at the level of the arch as opposed to the heel. It is a bit newer than other approaches but seems to be a promising method.

A friend who practices in Louisiana had done several instep procedures on patients after EPF failed --- he noted that the EPF had left some medial fibers intact. Those patients went on to success after his procedures.
Ed

Re: To Dr. Z or Dr. Davis

JudyS on 1/08/03 at 19:56 (105133)

Dave - my husband had the PF release surgery, minimally invasive, from the side. He recovered completely and is back to 5-mile jogs.