Plantar fascia release
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The vast majority of patients do not require operative treatment for this condition. For those with the severest and most resistant of symptoms however it is indicated and improves symptoms in 80% of patients.
The operations poor reputation is ill founded if the technique and post-operative management are carefully adhered to.
The key factors are to avoid damaging the cutaneous nerves during the approach, adequate release of the fascial layers encountered and careful haemostasis. Appropriate post-operative pain management, splintage, shoewear advice and wound care are also critical.
There are alternatives to the open release through a medial, non-plantar approach, described here. In particular a proximal and medial release of the gastrocsoleus, a direct approach through the sole of the foot and endoscopic release of the plantar fascia.
Readers will also find of use Kartik Hariharans OrthOracle technique Gastrocnemius recession.
Author:Mark Herron FRCS
Institution: The Wellington Hospital, London, UK.