Long-Term Outcome of Open Plantar Fascia Release

Abstract

Background: Plantar fasciitis is thought to be a self-limiting condition best treated by conservative measures, but despite this many patients have a prolonged duration of symptoms and surgery may be indicated. Partial plantar fascial release is reported to have a short-term success rate of up to 80%, but anecdotally this was not thought to represent our local experience. Methods: An audit of long-term patient-reported outcomes following open partial plantar fascia release was performed. A total of 30 patients (33 feet) were identified over a 10-year period and case notes were reviewed. Patients were contacted by letter and invited to complete 2 validated patient-reported outcome score questionnaires (Visual Analog Scale-Foot and Ankle [VAS-FA] and Manchester Oxford Foot Questionnaire [MOXFQ]). Responses were received from 24 patients (26 feet). The average ages were 42.4 (range 24-61) for male and 46.2 (range 33-60) for female patients, with a female/male ratio of 2.7:1. The average duration of treatment prior to operative intervention was 3.1 years (range 1-5). Preoperatively, our cohort underwent a range of conservative measures. All patients were reviewed postoperatively, and average time from surgery to completion of questionnaires was 80 months (range 14-130). Results: The outcomes were worse in patients who had received preoperative steroid injections and this was found to be statistically significant. The mean MOXFQ score was 33.6 ± 3.9 (0-64). Mean VAS-FA score was 57.8 ± 4.9 (24-100). Conclusion: This study found a negative correlation between duration of follow-up and outcome, in both MOXFQ and VAS-FA, showing that patients continued to improve many years postoperatively. The authors also found worse outcomes with preoperative steroid injections, better outcomes in older patients, and a weak gender bias, suggesting results in men were better than those in women. A prolonged recovery period and generally poor outcomes leads the authors to suggest that open plantar fascia release is of questionable clinical value and that patients may improve in the natural course of the disease, in spite of surgery. Level of Evidence: Level III, comparative study.

Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand

“…Although presurgical scores were not documented for the patients in the current study, it appears that improvements from this procedure were comparable to or better than outcomes cited in recent studies that reviewed results from both open and endoscopic release. 12,16,21…”

Partial Plantar Fasciotomy Using Endoscope with Inner Two-Channel Portals Produced Better Functional Outcomes Than Mini-Open Procedures for The Treatment of Refractory Plantar Fasciitis

“…After 12 months of follow-up, the AOFAS score increased from 46.00 to 91.67, and the postoperative functional satisfaction reached 89%. In MacInnes's study, [27] [28][29][30] After the treatment in this study, the patients in the arthroscopy group can walk normally and return to normal life on the second day after surgery, while the traditional incision surgery group needs a transition period (about 2 weeks for walking). Partial resection of the calcaneus fascia under two-channel arthroscope in plantar fasciitis patients is a new and innovative technique that has been reported and clinically applied in recent years.…”

Proximal Medial Gastrocnemius Release Versus Open Plantar Fasciotomy for the Surgical Treatment in Recalcitrant Plantar Fasciitis

“…A wide and variable range of results in terms of satisfaction have been published, between 48% and 90%. 8,13,22,36 Some concerns have been raised about this technique, which include iatrogenic flat foot or lateral column overload due to a shift in the center of pressure of the foot, as well as the loss of the windlass effect. 16,24,34 Due to these adverse effects, which are probably associated with the amount of fascia released, 5 other surgical treatments have been used.…”

“…1,10,25 The published results are very inconsistent in most cases retrospective short series. 1,22,25,36 As far as we know, the literature covering level I evidence studies on RPF surgery is sparse. Therefore, there is an important knowledge gap in our decision-making process when a surgical procedure is needed to treat this frequent problem.…”