Plantar Fasciitis and Bone Spurs: When to Consider Surgery? - Rehabilitation

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Plantar fasciitis is a common condition that results in heel pain, often exacerbated by activities such as walking or standing. It occurs when the plantar fascia, a thick band of tissue that runs across the bottom of the foot, becomes inflamed. Bone spurs, which are bony protrusions that can develop on the heel bone, are often associated with plantar fasciitis but do not always require surgical intervention.
In your case, you've been experiencing significant pain in your left foot for over two years, with recent exacerbation in your right heel. The pain you describe, particularly the spontaneous sharp pains and the swelling in your heel, suggests that your condition may be more severe than typical plantar fasciitis. The presence of a bone spur, as noted in your orthopedic evaluation, can contribute to the pain, but it is essential to consider the overall clinical picture before deciding on surgery.


When to Consider Surgery for Plantar Fasciitis and Bone Spurs
1. Conservative Treatment Failure: Surgery is generally considered when conservative treatments have failed. These treatments typically include rest, ice application, anti-inflammatory medications, physical therapy, orthotic devices, and corticosteroid injections. If you have tried these methods without relief, it may be time to discuss surgical options with your orthopedic surgeon.

2. Severity of Symptoms: If your pain is severe enough to interfere with daily activities, such as walking or standing, and if it has persisted for an extended period (usually more than six months), surgery may be warranted. The fact that you are experiencing spontaneous pain and significant swelling indicates that your condition is impacting your quality of life.

3. Presence of Bone Spurs: While bone spurs themselves are not always painful, they can contribute to the symptoms of plantar fasciitis. If imaging studies confirm that the spur is directly impinging on the plantar fascia or causing significant discomfort, surgical removal of the spur may be beneficial.

4. Physical Examination Findings: Your orthopedic surgeon will assess the physical examination findings, including tenderness, swelling, and range of motion. If there is significant tenderness over the heel and the plantar fascia, and if other treatments have not provided relief, surgery may be a viable option.

5. Underlying Conditions: You mentioned experiencing a sensation of numbness and a lack of feeling in your foot, which could suggest vascular issues or nerve involvement. If there is a concern about blood flow or nerve compression, it is crucial to evaluate these conditions before proceeding with surgery. Consulting a vascular surgeon may be necessary if there are signs of vascular insufficiency.


Surgical Options
If surgery is deemed appropriate, there are a few options:
- Plantar Fascia Release: This procedure involves cutting a portion of the plantar fascia to relieve tension and pain.

- Bone Spur Removal: If a bone spur is identified as a significant source of pain, it can be surgically removed.

- Endoscopic Surgery: In some cases, minimally invasive techniques can be employed to reduce recovery time and complications.


Conclusion
In summary, considering surgery for plantar fasciitis and bone spurs involves evaluating the failure of conservative treatments, the severity of symptoms, and the impact on your daily life. Given your ongoing pain and the presence of a bone spur, it is advisable to have a thorough discussion with your orthopedic surgeon about the potential benefits and risks of surgery. Additionally, addressing any vascular concerns with a specialist may provide further insight into your symptoms. Always ensure that you are fully informed about your options and the expected outcomes before making a decision.