#882 Did I tear my fascia after plantar fascia surgery? - DOC

#882 Did I tear my fascia after plantar fascia surgery?

Did I tear my fascia after plantar fasciitis surgery? Well, that is what we’re talking about today on the Doc On The Run Podcast.



I got a comment from a runner who posted this question as a comment on one of the YouTube videos on the Doc On The Run YouTube channel and what he said was that he had had plantar fascia surgery on February 6, 2024. So, when I am recording this, this is May and he said that following everything he was supposed to do, he did it to a tee and it had been three months, and he was feeling great until he started developing a small pain at the back of the arch right where the heel starts.

Presumably, this is where he had the surgical incision is where my guess was because that is usually the area where the surgery is done. He said it was tolerable, so it sounds like pain was not that bad, but he went for a walk on a flat trail, and his whole arch started to hurt tremendously. He was hobbling back to the car and then he said, “My whole arch is in pain. Do you think I could have a torn plantar fascia? It was tolerable but in hindsight this has not been ignored.”

Okay, that was his whole story. Now, I have a bunch of questions here. Our first question is what surgery exactly was done for the plantar fascia. I suspect that what he had was a plantar fascia release surgery of some variety. What a release is just a fancy word for cut. Right? So, the plantar fascia ligament is a huge ligament on the bottom of the foot, attaches to the heel right where his pain was that he was describing. But most of the time when we do it, depends on who the surgeon is how they were trained, I would do it through a scope.

I would put a scope in there, look at it, cut a very specific amount of the fascia, turn the camera upside down, make sure that I can look at it on top and bottom. Make sure it is cut all the ways that have no little fibers still hanging on under tremendous tension and make sure that it has released the amount of fascia that I want in that area and that is it. So, I suspect he had that done. Sometimes it is done is an open procedure where you make an incision, you look at it, you cut it with some scissors or a scalpel or whatever. And it is done not through scope, but we open the skin and look at it and cut it. I do not know what surgery was done.

The other thing is did the surgeon recommend that you start walking and started this new pain starting and I suspect the answer that would be no. I would also suspect that this person did not actually ask the doctor but I do not know. So, I do not know the whole story here. I also would want to know that when you made that transition from recovering and three months after surgery is really not that long, particularly if you think about a gap in the fascia that has to fill in with collagen. It has not been that long and if you are walking and you are having pain, I wonder if the doctor looked at it with ultrasound and saw that you have a whole bunch of college and bridging that area. And then it looks like it is strong enough to actually withstand that activity at that time or not.

The main point here is there is a couple things you should take away from this. Number one, surgery should always be your last option. Lots of things can go sideways when you have surgery. So, surgery should be the last option but because it is your last option, if you opt for surgery, you really want to make sure you do not mess this up. You need to pay super close attention.

The fascia is weaker than it was before when you released it so you do not cut it and make it stronger. You cut it and make it weaker and that means there is more stress and strain on the rest of the fascia and one of the main complications that we worry about is that it will rip more. So, could this grip more, maybe I have no idea. I do not know the whole story. I do not know what the foot looked like. I do not know if it was bruised, if it was swelling, if there was an ultrasound that looked at it, if he has had an MRI, I have no idea. I do not know how much of the pain was even.

Sometimes the amount of pain, swelling and bruising you have can give you a huge amount of information and tell you whether or not it is unlikely that you actually tore the fascia, but you have got to pay real close attention. The whole goal with all runners that I talk to, all the stuff I teach in the masterclasses for all the different conditions including runner’s heel pain, it is all about making sure that you as an athlete who understand your body and is able to pay attention really pays attention so that you do not just get a timeline of “Oh, you had surgery. We are going to wait for a year before you run.”

You do not have to wait for a year. You just have to wait until it is strong enough to actually increase your level of activity to match the activity that it can tolerate given the strength in the tissue at that time. But you have to be able to track and monitor your pain and symptoms. If you ignore them, that never works. You can just destroy it, particularly if you are an athlete. All athletes have a higher pain threshold than normal individuals, which is why you are an athlete. You know how to suffer and if you suffer to the point of actually doing damage after surgery, it is not going to make you better. It is going to make you worse, and it might actually change your outcome long term.

So, if you are a runner, make sure that you explain exactly what you want to do with your doctor, exactly what you are going to do to ramp up back to running and the timeline that you expect to follow to do that, so that they know how to look and see if you are actually ready for that next move or not.

If you liked this episode, please like it, please subscribe. If you haven’t checked out the runner’s heel pain masterclass and you think you have one of these problems like plantar fasciitis or a partial tear of the plantar fascia, come check it out. So, sign up it is free, and I’ll see you in the training.