Summary

Endoscopic plantar fascia debridetment and calcaneal spur removal for treatment of Recalcitrant Plantar Fasciitis

Abstract

Background:Plantar fasciitis is a common clinical problem which may be experienced by the general population. Biomechanical stress of the plantar fascia and its insertion into the calcaneus is the most commonly cited reason for plantar fasciitis developing. when conservative therapy fails to relieve the symptoms, surgical intervention is an option.The surgical treatment typically consists of open versus endoscopic plantar fascia release. The former has been the open release of the fascia , with complications such as infection, recurrence ,wound breakdown, and iatrogenic damage to nerves and vessels. The later has the advantage of shorter hospital stay, less wound complication and faster recovery than the open techniques. Satisfactory outcome had been achieved with the endoscopic procedure in literatrue. Objective:To evaluate the clinical outcome of endoscopically-assisted plantar fascia debridetment and calcaneal spur removal for treatment of recalcitrant plantar fasciitis. Methods:From 2011 Apr to 2015 Apr, twenty-four consecutive patients underwent endoscopically-assisted by debriding the plantar fascia at its insertion into the calcaneal and the surrounding inflammatory tissue, excising the calcaneal spur,and maintaining the integrity of band and its attachment for symptomatic plantar fasciopathy unresponsive to nonoperative measures. All patients underwent surgery at an average age of 56 years (range, 29–75 years), after an average period of 13.6 months from the onset of symptoms (range, 10–23 months).The clinical diagnosis was supported by imaging (plain radiographs and magnetic resonance imaging [MRI]).Evaluation of pain was done using VAS and functional evaluation was done using the American Orthopaedic Foot & Ankle Society (AOFAS) score. Also pation’s satisfaction was evaluated by direct questionnaire.Risults:Of the 24 patients, 15(72.1%) were female and 9 were (27.9%) male, with an average reported follow-up of 34.3±7.6 (range 19.1 to 47.6) months.Preoperative American Orthopedics Foot and Ankle Society Ankle Hindfoot Scale( AOFAS) score of 52.2±6.3 points improved to 92.6±5.1 points at 2 years after surgery (P<.0001). The mean duration to full weight bearing after surgery was 14.2±7.4 days. Using the visual analog scale the average post-operative pain was improved from 8.85±1.24(range 2-10) to 1.45±1.25(range 0-6; p=.042)Concerning patient satisfaction, 82.3% of patients were completely satisfied,11.8% of patients were satisfied with reservation and 5.9% of patients were unsatisfied.Conclusion: Endoscopically-assisted procedure by debriding of the plantar fascia surrounding inflammatory tissue, with excision of the calcaneal spur and maintmnance of the integrity of plantar fascia would been provided to be a viable alternative to more invasive procedures for management of recalcitrant plantar fasciopathy. Future randomized controlled trials are needed.