Expert: Ronald Levy, M.D. - 7/10/2010

Question
QUESTION: I am a 16 year old athlete who has been suffering from severe plantar fasciitis for the last year and a half and have exhausted every possible form of non-surgical treatment. My doctor is now talking about several available surgeries including a Plantar Fascia Release, Gastrocnemius Recession or an Instep Plantar Fasciotomy. I have been heavily researching and one of my concerns is the variety of ways the surgery can be done. Why do some doctors prefer to use only an ankle block or a beer block and what are the advantages of that method? As well as completely putting the patient under, is it just because of preference or is there a legitimate reasoning behind it? Also can my doctor perform the block to avoid using an anesthesiologist? Can I also request a simple beer block instead of being completely put under?

ANSWER: The 2 advantages of regional anesthesia over general is that 1) the patient is awake and can report and chest pain etc (they also control their own vital signs). The other reason is you get good post-op analgesia. An ankle block can easily be done by the surgeon (assuming he is experienced doing it) but I would be a little more hesitant to let them do a Bier block. Furthermore, a Bier block requires the use of two tourniquets which can be very painful for the patient if the procedure takes a long time.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: You mentioned post-op analgesia...what options exactly would that include? If I were to have a gastrocnemius recession (where the outer calf muscle is detached and then reattached to lengthen the calf) and a plantar fascia release (a surgical cutting of the plantar fascia) in one operation would that be general anesthesia? And what post-op analgesia would be best? Thanks for your time.

Answer
The post op analgesia is inherent in the regional anesthetic. This operation can be done under regional or general. If regional, the easiest is to do a subarachnoid block (spinal), although you can also have other regional blocks that only block the single leg.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston