Plantar Heel Incision Techniques

Heel spurs and severe plantar fasciitis can be painful and debilitating. But surgeries to correct these conditions are routine and highly successful. Podiatrists and surgeons even have their choice of which techniques to use. Some of the latest procedures leave only minimal scarring.

Traditional Incision

• Plantar fascia is the tissue on the bottom of the foot. To enter the fascia to begin surgery, surgeons used to make an incision 2 to 3 centimeters long. Now many doctors see this incision as larger than necessary and feel it has a greater risk of infection and post-surgical complication.

Endoscopic Surgery

• Using endoscopic technology, a doctor can use an incision as small as 0.5 centimeters. The doctor uses small, arthroscopic tools to make the tiny incision and then inserts the tools deeper into the foot--operating the computer guided tool from a device control outside the fascia. Ultrasound allows the doctor to see inside the foot.

  There is some debate in the podiatry community as to whether this is the most effective technique, but a 2009 study published by the Journal of the American Podiatric Medical Association
  showed that 46 surgeries performed with this technique had successful outcomes when examined four weeks after surgery with no infections or complications.

Multiple Stab Incision

• Some podiatrists advocate another relatively newer technique which they claim has few complications. The multiple stab incision is much like it sounds: the surgeon or podiatrist makes multiple holes in the fascia using an 18-gauge needle to stimulate neovascularization. These incisions themselves can be used to relive tension of the central medial band, thereby treating plantar faciitis.

  The doctor uses ten small stab incisions in a 3-4-3 pattern around the plantar medial tubercle. Then he or she will distal with a 64 blade on a beaver handle. After making the incision, the doctor should use a hemostat for blunt dissection of the subcutaneous tissue, after which the blade should be inserted. This is repeated for each spot on the 3-4-3 grid pattern.