Plantar Fasciitis: Plantar Fascia Release

Plantar Fasciitis: Plantar Fascia Release

This is a cadaveric surgical demonstration of a minimally invasive approach to the release or cutting of the plantar fascia to treat plantar fasciitis. Here we have a right foot. The surgeon has drawn out a number of anatomical landmarks for reference during the procedure with a purple skin marker. For the purpose of this video, we will not be detailing each one.

Currently, the surgeon is pointing to a spot near the heel bone on the inside of the foot where they will make the first small incision called the portal. A blunt instrument is then introduced into the bottom of the foot through this portal. The surgeon will use the instrument to feel the plantar fascia above and verify the correct location for the surgical release.

The surgeon will then push the instrument over to the outside of the foot to help them find the location for one more portal. Once the incision is made, the surgeon will push the blunt instrument through the incision. Next, a purple tube called a cannula is placed over it and passed through both portals as well. The blunt instrument is then removed.

This cannula has a slot that will be positioned so it opens up towards the planter fascia. This will help with the release of the tissue later in the case. Next, the camera is introduced through the cannula on the outside of the foot, allowing the surgeon to visualize the planter fascia and identify the appropriate anatomy. Sometimes there is fatty tissue overlying the planter fascia, which will require removal with a scraping tool.

Once the surgeon has good visualization of the planter fascia, the toes and the foot are pulled back towards the patient's face to put tension on the planter fascia and a small hook knife blade is introduced through the opposite end of the cannula. The surgeon will use this knife to release the tight planter fascia. Upon release of the tissue, the surgeon will look with the camera to confirm the release was complete.

Here we can see the muscle underlying the fascia which confirms a complete release. The instruments are then removed. The surgeon feels the bottom of the foot for another confirmation that the planter fascia is released and the incisions are closed.