Plantar Fascia Release With Proximal and Distal Tarsal Tunnel Release: A Surgical Approach to Chronic, Disabling Plantar Fasciitis With Associated Nerve Pain

Abstract

Chronic symptoms from proximal plantar fasciitis develop in about 10% of patients with plantar heel pain. A subset of these patients will develop chronic disabling plantar heel pain with associated nerve pain. Surgical intervention, which allows for complete resolution of symptoms and return to full activity without limitations, has been difficult to achieve in this group of patients. This paper reviews the typical presentation and appropriate evaluation for patients with chronic proximal plantar fasciitis and distal tarsal tunnel syndrome. The authors present a surgical approach that has yielded promising results with improved rates of total patient satisfaction. The surgical technique employs a complete plantar fascia release combined with a proximal and distal tarsal tunnel release. A detailed postoperative protocol is presented, and it is felt to play a major role in successful surgical outcomes. Data are presented from a study of 33 patients with a minimum 2-year follow-up. In primary surgery patients, high rates of total patient satisfaction (82%) can be expected, with corresponding high rates of resolution of pain and elimination of activity limitations. However, revision surgery results utilizing this technique are much more unpredictable, and further modification of treatment approach is needed.