Endoscopic Partial Plantar Fasciotomy via 2 Medial Portals vs Mini-Open Procedure for Refractory Plantar Fasciitis

Abstract

Background: The treatment of plantar fasciitis may require surgical intervention in patients with ineffective response to conservative treatment. There is a lack of evidence regarding the differences in clinical outcomes between the endoscopic and the mini-open procedures. The purpose of this study was to compare the clinical outcomes of the endoscopic partial plantar fasciotomy via 2 medial portals with mini-open partial plantar fasciotomy for treating refractory plantar fasciitis. Methods: A retrospective analysis was carried out on 62 patients with refractory plantar fasciitis from January 2015 to July 2017. Thirty-three patients received endoscopic partial plantar fasciotomy, while the other 29 received mini-open procedure by patient preference. Two medial portals were used in the endoscopic group while single mini-medial method was used in the open group. All patients were followed up for 24 months. The pain visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, the calcaneodynia score (CS), and the 36-item Short Form Health Survey questionnaire (SF-36) were employed to evaluate the clinical outcomes of the 2 groups. Results: There was increase in the functional scores (eg, VAS, AOFAS, CS, and SF-36) in both groups recorded at 3 months, 6 months, 1 year, and 2 years after surgery. The patients in the endoscopic group had better VAS, AOFAS, CS, and SF-36 scores at 3 months after the surgery compared with those of the open group. During the 6-month follow-up, although the 2 groups showed similar VAS and AOFAS, the CS and SF-36 scores of the endoscopic group were significantly higher than those of the open group. During the 1-year and 2-year follow-ups, the endoscopic group gained equivalent VAS, AOFAS, CS, and SF-36 scores compared with those of the open group. The recurrence rate was similar in both groups. Moreover, the patients in the endoscopic group achieved earlier recovery in comparison to those in the open group. Conclusion: For refractory plantar fasciitis, endoscopic partial plantar fasciotomy via 2 medial portals produced better short-term and equivalent long-term subjective outcomes than the mini-open surgery. Level of Evidence: Level II, comparative study.

Fluoroscopic and Endoscopic Calcaneal Spur Resection Without Plantar Fascial Release for Recalcitrant Plantar Fasciitis

“… 24 Considering this, the partial release of the plantar fascia attached to the calcaneal spur may be associated with pain alleviation. The pain resolution using endoscopic PFR without CSR 2 , 3 , 6 , 12 , 13 , 16 , 29 , 34 - 36 can be explained by a similar mechanism described above. Because of the PFR, the plantar fascia was released from the tensile loads, and the calcaneal spur avoided stresses from the plantar fascia.…”

“… 17 Endoscopic procedures for plantar fasciitis include PFR without calcaneal spur resection (CSR) and PFR with CSR. 2 , 3 , 5 , 6 , 8 , 11 - 13 , 16 , 17 , 20 , 29 , 34 - 37 Both procedures are reported to have good outcomes, suggesting that CSR might not be necessary for plantar fasciitis treatment.…”

Clinical Study of a Four‐Step Program for the Treatment of Plantar Fasciitis with Bone Spurs

“…A variety of surgical procedures are available, all of which are designed to restore the normal anatomy and function of the foot and to eliminate pain. Several studies have shown that endoscopic surgery is more effective in the treatment of recalcitrant plantar fasciitis than open surgery, 7,13,24,25 therefore, the four‐step program of therapeutic surgeries carried out in this study was performed endoscopically to ensure its therapeutic efficacy. Several studies have found that endoscopic plantar fascia release is often satisfactory in the treatment of recalcitrant plantar fasciitis 10,26,27 .…”

“…Recent studies have found that endoscopic surgery is a safer and more effective treatment for Plantar fasciitis than open surgery, improving patient satisfaction earlier and returning to work more quickly. 13 But there is no “gold standard” to treat plantar fasciitis with a bone spur. In a meta‐analysis, due to the unstandardized nature of the surgical protocol, the available evidence does not demonstrate that endoscopic plantar fascia release is safe and effective for the treatment of plantar fasciitis.…”

“…Recent studies have found that endoscopic surgery is a safer and more effective treatment for Plantar fasciitis than open surgery, improving patient satisfaction earlier and returning to work more quickly 13 . But there is no “gold standard” to treat plantar fasciitis with a bone spur.…”