Endoscopic fasciotomy for plantar fasciitis provides superior results when compared to a controlled non-operative treatment protocol: a randomized controlled trial.

Plantar fasciitis, pain and inflammation in the tissue running along the sole of the foot, often improves with conservative care, but some cases persist for months and surgery has traditionally been reserved as a last resort based on uncontrolled evidence. This trial compared endoscopic surgery, which involves debridement, removal of the heel spur and partial release of the plantar fascia through two small incisions, against a supervised non-operative program of corticosteroid injections and structured strength training, with both groups following the same strengthening protocol afterward. Both groups improved over the two years of follow-up, but the surgical group showed better foot function scores at one year and better pain-during-activity scores at two years, along with more patients returning to running and jumping.

The one-year functional advantage was no longer statistically significant by two years. This is a small randomized trial of only thirty patients, so while the results favor surgery for people who haven't responded to months of conservative treatment, the modest sample size limits how confidently these findings can be generalized.

If you've been dealing with stubborn heel and arch pain from plantar fasciitis for more than three months, you may wonder whether surgery is worth considering compared to continuing non-surgical treatment. This study randomly assigned thirty people with long-standing plantar fasciitis to either a minimally invasive surgery, which removes part of the irritated tissue and any heel spur, or a supervised program of steroid injections plus a structured strengthening routine, both groups later following the same strength training plan. People in both groups felt better over the two years of follow-up.

But those who had surgery reported better foot function at one year and less pain during activity at two years, and more of them were able to get back to running and jumping. The functional difference between groups was no longer statistically meaningful by the two-year mark, showing that some of the early surgical advantage narrowed over time. Because this was a small trial with only thirty participants, these findings offer useful early evidence rather than a definitive answer about which treatment works better for everyone with this condition.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This randomized controlled trial compared endoscopic partial fasciotomy with heel spur removal against a supervised non-operative protocol (corticosteroid injection plus structured strength training) in thirty patients with plantar fasciitis lasting over three months, both groups completing the same strength training program post-intervention. Primary endpoints were Foot Function Index (FFI) at 6 and 12 months and VAS activity pain, followed to 24 months. Both groups improved significantly over time within-group, but the surgical group showed a statistically significant between-group advantage in FFI at 12 months (p=0.033), which attenuated to non-significance by 24 months (p=0.06).

VAS activity pain favored surgery significantly at 24 months (p=0.001), and more surgical patients returned to running and jumping (p=0.04). This pattern suggests an early functional benefit from surgery that may not persist as strongly, while activity-related pain and return-to-sport outcomes showed sustained advantage. The principal limitation is sample size: with only fifteen patients per arm, confidence intervals around these estimates are likely wide, and the loss of significance in FFI by 24 months could reflect either a true narrowing effect or limited power.

No adverse event data were reported in the abstract, so no safety conclusions can be drawn.