Endoscopic Plantar Fascia Release by Hooked Soft-Tissue Electrode After Failed Shock Wave Therapy

Abstract

The purpose of this study was to assess the outcome of endoscopic plantar fascia release (EPFR) after failed extracorporeal shock wave therapy (ESWT). Eighteen patients (twenty-one feet) had persistent painful heel after treatment by ESWT for at least 6 months. The treatment protocol included 2,000 pulses of 0.12 mJ/mm(2) given in 1 session weekly for 7 sessions. Preoperative and postoperative assessment of pain and functional evaluation were done blindly by the second author using a visual analog scale (VAS) score and the modified American Orthopaedic Foot & Ankle Society (AOFAS) score for the hindfoot. EPFR was done without the use of a tourniquet under local ankle block. A monopolar hooked soft-tissue electrode (ConMed Linvatec, Largo, FL) was used to sever the plantar fascia and to control bleeding. The mean follow-up period was 25.8 months. Only 17 patients (20 feet) completed 2 years' follow-up. The mean preoperative VAS score was 72.52, and the mean preoperative modified AOFAS score was 24.23. There was a statistically significant improvement in VAS score, modified AOFAS score, and morning pain at 2 years' follow-up (P < .05). Of the patients, 9 (50%) had excellent results, 6 (35%) had good results, 1 (10%) had a fair result, and 1 (5%) had failure of improvement of pain. No major complications were found; 2 patients had hyperkeratosis at the portal site, and 1 patient had paresthesia at the lateral border of the foot. EPFR yielded good to excellent outcomes in 85% of 17 patients with plantar fasciitis resistant to treatment by ESWT after 2 years' follow-up. Level IV, therapeutic case series.