When Is Plantar Fascia Release Surgery Needed?

Plantar fascia release surgery is considered only after an adequate trial of conservative treatment — typically six months or longer of consistent stretching, custom orthotics, physical therapy, and injection therapy — has failed to provide adequate relief. The vast majority of plantar fasciitis cases resolve without surgery, making patient selection for surgical intervention critically important.

At Balance Foot and Ankle, we ensure every surgical candidate has genuinely exhausted conservative options before proceeding. Patients who have completed dedicated stretching twice daily, worn custom orthotics in all footwear, received at least two corticosteroid injections, and completed a shockwave therapy course without sufficient improvement are appropriate candidates for surgical evaluation.

Endoscopic Plantar Fascia Release (EPFR)

Endoscopic plantar fascia release is our preferred technique for most surgical candidates. Two small incisions of approximately 5 millimeters each are made on the medial and lateral sides of the heel. A camera (endoscope) introduced through one portal provides direct visualization of the plantar fascia while a cutting instrument through the second portal releases the medial one-third to one-half of the fascial origin under direct vision.

The minimally invasive technique produces equivalent pain relief to open surgery at 12 months while offering faster return to activity, less postoperative pain, and smaller scars. Most patients bear weight in a surgical shoe immediately after surgery and transition to regular footwear with custom orthotics within two to four weeks. Return to athletic activity typically occurs at six to twelve weeks.

Open Plantar Fascia Release

Open release uses a larger incision over the medial heel to directly expose and release the plantar fascia under full visualization. This approach provides the best visibility of surrounding structures including the medial calcaneal nerve, which can be simultaneously decompressed if nerve entrapment is contributing to symptoms. Open release is preferred when endoscopic visualization is technically limited by the anatomy or when concurrent nerve decompression is planned.

Recovery from open release takes slightly longer than endoscopic surgery — typically four to six weeks before full weight bearing in regular shoes — due to the larger incision. Published success rates for both techniques range from 75 to 90 percent at one year. Partial fascia release is performed in both approaches — complete release of the entire fascia destabilizes the arch and increases lateral column stress fracture risk.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.