Retrospective review of endoscopic plantar fasciotomy--1992 through 1994

Treatment of Chronic Plantar Fasciitis With Percutaneous Latticed Plantar Fasciotomy

Plantar fasciitis, the most common cause of pain in the inferior heel, accounts for 11% to 15% of all foot symptoms requiring professional care among adults. The present study reports the results of a minimally invasive surgical treatment of chronic plantar fasciitis. All patients with plantar fasciitis who had undergone percutaneous latticed plantar fasciotomy at 3 clinical sites from March 2008 to March 2009 were included in the present study. The follow-up evaluations for this treatment were conducted using the Mayo clinical scoring system. We investigated 17 patients with recalcitrant chronic plantar fasciitis who had undergone this treatment within a follow-up period of ≥13 months. All procedures were performed in the clinic with the patient under local anesthesia. No wound infections or blood vessel or nerve damage occurred. At a mean follow-up period of 16.0 ± 2.29 (range 13 to 21) months, significant improvement was seen in the preoperative mean Mayo score (from 12.06 ± 2.54 to 89.76 ± 4.28, p < .001) and no patient had developed symptom recurrence. Also, none of the patients had developed complex regional pain syndrome. All patients were able to return to regular shoe wear by 3 weeks postoperatively. The technique of plantar fasciitis with percutaneous latticed plantar fasciotomy could be a promising treatment option for patients with recalcitrant chronic plantar fasciitis.

Evaluating plantar fascia strain in hyperpronating cadaveric feet following an extra-osseous talotarsal stabilization procedure

Abnormal talotarsal joint mechanics leading to hyperpronation is implicated as one of the most common causes of plantar fasciopathy. In patients with hyperpronating feet, the plantar fascia experiences excessive tensile forces during static and dynamic weight-bearing activities because of excessive medial longitudinal arch depression. For the purposes of this study, we hypothesized that plantar fascia strain in hyperpronating cadaveric feet would decrease after intervention with an extra-osseous talotarsal stabilization (EOTTS) device. A miniature differential variable reluctance transducer was used to quantify the plantar fascia strain in 6 fresh-frozen cadaver foot specimens exhibiting flexible instability of the talotarsal joint complex (i.e., hyperpronation). The strain was measured as the foot was moved from its neutral to maximally pronated position, before and after intervention using the HyProCure(®) EOTTS device. The mean plantar fascia elongation was 0.83 ± 0.27 mm (strain 3.62% ± 1.17%) and 0.56 ± 0.2 mm (strain 2.42% ± 0.88%) before and after intervention, respectively (N = 18, variation reported is ± 1 SD). The average plantar fascia strain decreased by 33%, and the difference was statistically significant with p < .001. From this cadaveric experiment, the reduction in plantar fascia strain suggests that an EOTTS device might be effective in stabilizing the pathologic talotarsal joint complex and the medial longitudinal arch and in eliminating hyperpronation. An EOTTS procedure might offer a possible treatment option for plantar fasciopathy in cases in which the underlying etiology is abnormal talotarsal biomechanics.

A 12-year long-term retrospective analysis of the use of radiofrequency nerve ablation for the treatment of neurogenic heel pain

The authors discuss their rationale for the use of radiofrequency nerve ablation (RFNA) in the treatment of chronic neurogenic heel pain. Patients treated for plantar fasciitis who fail to improve after conservative and/ or surgical treatment should be reevaluated for a coexistent nerve entrapment. The results of a retrospective study of 82 patients who have undergone RFNA are presented. The patients were followed at 5, 10, and 12 years after the procedure. An evaluation of medical records was performed as a means of inclusion in this study. A standardized telephone interview was then done, and subjectively scored responses of the patients were recorded and analyzed. Of the patients, 89% reported no recurrence of pain after 5, 10, and 12 years postoperatively. The procedure is relatively easy to perform and involves inserting a 22-gauge cannula with an electrode into the areas of pain. This is done under general anesthesia. It takes approximately 15 to 20 minutes per heel to perform, depending on how many sites of tenderness have been identified. The patient is discharged with a minimal bandage and returns to shoe gear immediately following the procedure. The success rate with RFNA appears to be quite high with fewer associated risks and less post-operative morbidity.

The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010

Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.

Uniportal endoscopic plantar fasciotomy: a prospective study on athletic patients

BACKGROUND

Endoscopic techniques have been described to surgically treat plantar fasciitis in the general patient population. A prospective, single-surgeon study was conducted to evaluate if a uniportal endoscopic plantar fasciotomy technique is effective in allowing athletic patients to return to their desired activities.

METHODS

Sixteen patients with plantar fasciitis who were athletically active were compared to a control group that consisted of 10 patients who did not engage in sports. Most of the athletic patients were runners. Mean age at time of surgery was 39.8 +/- 13.1 years for the athletic group and 51.2 +/- 5.5 years for the control group (p < .01). All patients had conservative treatment for a minimum of 8 months (mean 19.4 months; range 8 to 50). All patients were rated for body mass index (BMI), and the Modified Plantar Fascia Score (MPFS) was obtained before and after endoscopic release. The preoperative MPFS was 42.0 +/- 2.5 for the athletic group and 23.6 +/- 15.7 for the control group (p < .01). All patients had uniportal endoscopic plantar fasciotomy with transection of the medial 50% of the plantar fascia. Postoperatively patients were kept in a low, below-knee, removable cast-boot for a total of 4 weeks, nonweightbearing for the first 2 weeks.

RESULTS

The mean return-to-activity time after surgery was 2.6 +/- 0.7 months. The mean postoperative MPFS was 93.3 +/- 2.4, which was a significant improvement (p = .00001). Using this scoring system score, all results in athletes were excellent or good. The control group had a mean postoperative MPFS of 63.6 +/- 27.1, also significantly improved (p = .0006) but lower than the athletic group (p = .00001). All five poor results in the controls had a BMI of more than 27. Good or excellent results in the control group were obtained only in patients who walked for exercise. The BMI was statistically lower in the athletic group than in the control group (p = .00001). The average BMI in women was significantly higher (p = .02) than in men, and they required a longer time to return to activity (p = .01).

CONCLUSION

Athletic patients undergoing uniportal endoscopic plantar fasciotomy can expect good to excellent results based on the MPFS. Fifty percent of the patients with a BMI of more than 27 had poor results.

Endoscopic plantar fasciotomy: a retrospective analysis of results in 53 patients

This retrospective study analyzes satisfaction of patients who had undergone an isolated endoscopic plantar fasciotomy (EPF) between January 1994 and January 1997. A subjective survey was completed and returned by 53 patients (a total of 69 feet), and a chart review was performed to determine final outcome. Postoperative follow-up averaged 7.2 months (range, 4-42 months). Postoperative pain levels were scored on a 7-point scale at 1 week, 1 month, and 6 months. Forty-three patients (81.1%) were satisfied with the EPF procedure and 10 patients (18.9%) were unsatisfied.