Endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal for management of painful heel syndrome

Abstract

Background The pathogenesis of painful heel syndrome is multifactorial including plantar fasciitis, increased intra-osseous pressure of the os calcis, calcaneal periostitis and presence of calcaneal spur. The currently used endoscopic treatment of painful heel syndromes involves endoscopic plantar fascia release alone without addressing other pathological changes. Objectives To evaluate the clinical outcome of endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal. Methods The study was conducted on 22 cases/24 feet with idiopathic painful heel syndrome resistant to conservative treatment. All cases were treated by plantar fasciotomy; calcaneal drilling and calcaneal spur removal using a modified cannula trocar system. Evaluation of pain was done using VAS and functional evaluation was done using the Modified Mayo Scoring System for Plantar Fasciotomy. Also patient's satisfaction was evaluated by direct questionnaire. Results There was statistically significant improvement in the mean VAS from 82.81 (±7.8 std) preoperative to 6.63 (±2.75 std) and the Mayo score form 7.05 (±3.67 std) preoperative to 87.5 (±4.81 std) at 2 years follow up ( P < 0.05). The satisfaction rate was 85% with no major complications. Conclusion Endoscopic plantar fascia release with calcaneal drilling and calcaneal spur removal has high success rate and patient's satisfaction rate when compared to published reports on isolated endoscopic plantar release.