Endoscopic Plantar Fasciotomy

EPF (endoscopic plantar fasciotomy) is one of the surgeries used to treat severe strain of the plantar fascia. If this ligament like band that runs along the bottom of your foot is strained, you're likely to have pain on the inside of your foot, where the arch and heel meet. Walking and even standing may hurt. Your doctor may suggest EPF if medication and devices to control foot movement have not reduced your symptoms.

Your Physical Exam

During the exam, your doctor feels for damaged ligaments, inflamed tendons, and displaced bones. An x-ray may be taken to rule out a stress fracture of the heel bone. If surgery is likely, your doctor will want to know about any medications you take. He or she also needs to know about any allergies or chronic illnesses, such as diabetes or heart disease.

Outpatient Surgery

EPF is an outpatient procedure. It takes about an hour to perform, and may be done at a hospital or a same-day surgical facility. After the procedure, you'll be taken to a recovery area. You will be watched until you can sit up and drink liquids. Although you may feel fine when you are discharged, it is best to have someone drive you home.

Before Your Surgery

Follow your doctor's instructions on when to stop eating and drinking before surgery. If you take daily medication, ask if that should be stopped as well. Once at the facility, you'll be given consent forms to sign. Your temperature and blood pressure will be checked, and you may be trained in how to use crutches. It's normal to feel a little nervous before surgery. If you are very worried, you may be given a sedative to help you relax.

Preparing for the Procedure

Your foot will be scrubbed and draped, and you will be given anesthesia before the procedure. If IV (intravenous) sedation and a local anesthetic are used, you will be awake, but drowsy, during surgery.

During the Procedure

Your doctor makes an incision on each side of your heel. These incisions are less than one-half inch long. Next, a special scope and camera are slipped under the fascia. This allows your doctor to watch the procedure on a nearby monitor. Your doctor then cuts the fascia near the heel bone. If you are awake, you may hear people talking and feel pressure. You should not feel pain.  Tell your doctor if you do.

Risks and Complications

As with any surgery, EPF has certain risks and complications. They include infection, slow healing, an ache on the outside of the foot, nerve entrapment, and a return of symptoms. If necessary, your doctor may change to a more traditional surgery that would require a larger incision.

After Surgery

You may be able to walk right after EPF, but don't overdo it. Your doctor may want you to rest and recover at home for a few days. If a compression dressing is used to control swelling, you may need to wear a special surgical shoe. The dressing is likely to be removed at the first post-op visit.

Recovering at Home

Expect your foot to feel numb right after the surgery. Then, as the local anesthesia wears off, you'll probably feel some pain. To limit pain and swelling, ice the foot for 10-15 minutes several times a day. Also, raise the foot above heart level as often as you can. If you've been given pain medications, take them as directed.

Your First Post-Op Visit

Your doctor may want to see you the first week after surgery. During this post-op visit, your incisions will be checked to make sure they are healing. The compression dressing may be replaced with a smaller surgical dressing. If this occurs, you can probably begin wearing tennis shoes.

For Best Results

As your foot heals, new tissue fills in the gap where the fascia was cut. This lengthens the fascia and reduces strain during foot movement. For best results, see your doctor as directed during the next few weeks or months. Physical therapy or stretching exercises are often prescribed to improve recovery. Wearing shoes with good support also helps.

Physical Therapy

Your doctor may order physical therapy to control swelling. Ultrasound, contrast baths, deep heat treatment, and electronic stimulation are all possible forms of therapy.

Shoes with Good Support

Wearing the right shoes can reduce the amount of strain placed on the plantar fascia. Choose low or flat shoes that lace up. Shoes that also support the heel and arch are your best choice. Your doctor may also prescribe orthoses (custom-mad shoe inserts) to help control your foot movement.

Surgery of The Foot & Ankle

Podiatric surgery is surgery performed on the foot, ankle, or lower leg by highly qualified podiatric surgeons who are trained specifically to deal with these problems. The problems may result from birth defects, heredity, trauma, arthritis, physical stress, improper shoes, muscle and joint imbalances, and even the hard surfaces on which you walk. The important fact to remember is that podiatric surgeons are the physicians most thoroughly trained to manage these problems.

Podiatric surgery differs from other surgical procedures because of the special characteristics and functions of the lower extremity. In addition to supporting your weight, the foot is subjected to repeated abuse with each step. Providing immediate treatment and preserving the best function possible are key factors in podiatric surgery.

Research conducted by the American Podiatric Medical Association reveals that more than 70 percent of all people in the United States have painful foot problems at some point in their lives. Even President Lincoln said, "I cannot think clearly when my feet hurt." The situation is no different today. Good foot health can enhance your daily existence and improve your quality of life.

What Conditions Respond Well to Surgery?

Conditions that are often alleviated through surgical procedures include:

• Sprains and fractures
• Arthritis and joint disease
• Benign and malignant tumors
• Birth deformities
• Bunions
• Corns & Calluses
• Flat feet
• Hammertoes
• Heel or toe spurs
• Ingrown toenails
• Neuromas (nerve tumors)
• Warts

If you have questions about any of these conditions, please contact Dr. Eric J. Paul to set up an appointment to review your condition and treatment options.

Why Surgery?

Conservative treatment of many foot and ankle problems often produces temporary relief of pain. If pain persists, surgery is sometimes the more definitive answer to a persistent problem and the best way to prevent more serious conditions.  On the other hand, surgery is not always the best approach for all patients. Please contact Dr. Eric J. Paul to set up an appointment to decide if you are an appropriate surgical candidate.

Does Foot Surgery Require Hospitalization?

Not usually. Surgical procedures may be performed in the office or in an outpatient setting. Dr. Eric J. Paul is well qualified to discuss the needs of your particular case. Surgery may be performed under local anesthesia or with light sedation administered by a trained anesthesia specialist. Dr. Paul will advise you on the best possible postoperative care, so that your recovery will be rapid and as comfortable as possible.

What Is Worn on the Foot Following Surgery?

Each surgical procedure requires a different type of foot immobilization such as a bandage, splint, surgical shoe, cast, or open sandal. Good postoperative results require proper foot support to prevent future problems. Early use of leg and foot muscles hastens recovery. After sufficient healing time, most patients can resume wearing their usual footwear.

Is Special Treatment Needed After Surgery?

Many patients require postoperative care, such as physiotherapy, orthotic devices (foot supports), and special footwear. This care helps ensure that the results of the operation are long lasting.

Are There Risks Involved for Older Patients?

Attention is given to the special needs of older patients. This may include a consultation with your internist or specialist to evaluate your condition and determine the safest procedures.

Is Foot Surgery Advisable for Diabetics?

Diabetics must take special care of their feet. Proper control of the diabetic's blood sugar and thorough evaluation of circulation and healing abilities are necessary before surgery is considered. Foot and ankle surgery on diabetics who are well controlled is usually successful and may serve to prevent severe diabetic complications from occurring.

Futura™ CSI Conical Subtalar Implant for Flexible Flatfoot

Footcare for Babies & Children

The foot's bone structure is pretty well formed by the time your child reaches age 7 or 8. But if a growth plate (the area where bone growth begins) is injured, the damaged plate may cause the bone to grow oddly. With a doctor's care, however, the risk of future bone problems is reduced.

When to Call the Doctor

If an injury is mild, your child probably will not remember it for very long. But if your child keeps complaining of pain, have the injury checked by a doctor. Also, call the doctor anytime an injury causes serious swelling, localized tenderness, limping, or ongoing night pains.

Treating an Injury

If a bone or growth plate is damaged, your child may need to use crutches to take weight off the injury as it heals. In the case of fracture, a cast, splint, or brace may be needed to hold the bone in place during healing.

Your Toddler's Feet