Endoscopic Plantar Fascia Release Research Articles

Outcomes of Endoscopic Treatment for Plantar Fasciitis: A Systematic Review.

Endoscopic plantar fascia release (EPFR) is an established operative treatment for recalcitrant plantar fasciitis. The purpose of this systematic review is to provide a comprehensive review on the outcomes of EPFR in the treatment of plantar fasciitis at mid-term and long-term follow-up. A systematic review was performed using, MEDLINE, EMBASE, and Cochrane library databases in May 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated regarding level of evidence (LOE) and quality of evidence (QOE) using the modified Coleman methodological score. Clinical outcomes and complications were also evaluated. Twenty-six studies including 978 feet were included in this systematic review with a weighted mean follow-up of 25.6 ± 21.0 months. Eighteen papers used the American Orthopaedic Foot and Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.66 ± 10.3, and the postoperative score was 89.6 ± 5.2 out of 100. The total number of patients who had complications was 88 of 994 (8.9%). The most common complication was recurrence of pain experienced by 41 patients (4.2%). Endoscopic plantar fascia release provides good clinical and functional outcomes in patients with refractory plantar fasciitis. However, this procedure is associated with a moderately high complication rate (8.9%) and should only be considered following failure of conservative management. Future prospective studies comparing the various endoscopic and open techniques with nonoperative treatment are required to elucidate the most effective management for recalcitrant plantar fasciitis. Level I: Systematic review of level IV studies.

Endoscopic Plantar Fascia Release Combined With Calcaneal Spur Resection: A Case Series of 40 Patients.

To review the cases of patients treated using endoscopic plantar fascia release (PFR) with calcaneal spur resection (CSR) and examine why the combined procedures cause complications. The medical records of patients treated with endoscopic PFR with CSR from November 2017 to December 2019 with a follow-up of >2 years were reviewed. A total of 40 feet in 40 patients (22 females, 18 males) were enrolled. The mean age and body mass index were 51.1 years and 24.7 kg/m2, respectively. The mean follow-up duration was 5.7 years. The visual analog scale for pain improved from 80.7 to 8.8 mm, and the Japanese Society for Surgery of the Foot score improved from 44.7 to 95.6 points (Wilcoxon signed rank test, P < .001 for both). Complications occurred in 8 patients (20%): 3 had flatfoot, 3 had an injury to the first branch of the lateral plantar nerve, 1 had scar pain, and 1 had a wound infection. The 40 patients treated with endoscopic PFR with CSR for plantar fasciitis had good outcomes with a high complication rate; the invasiveness of creating the working space for the combined procedures was thought to be responsible. Level IV: Case series.

Foot Arch Changes after Endoscopic Plantar Fascia Release for Recalcitrant Plantar Fasciitis.

Introduction:Endoscopic plantar fascia release (EPFR) is a minimally invasive surgical intervention for recalcitrant plantar fasciitis. Its efficacy has been convincing but the in vivo effect on medial longitudinal foot arch and footprint has not been studied. Our objective is to evaluate the changes of foot posture using radiographs and footprints following endoscopic plantar fascia release in recalcitrant plantar fasciitis.Materials and methods:This prospective cohort involved patients with recalcitrant plantar fasciitis who failed six months of conservative treatment. Two-portal endoscopic release of not more than 50% of plantar fascia width was performed. Footprint and standard weight-bearing anteroposterior and lateral radiographs of the foot were taken pre-operatively and at 12 months post-surgery. Arch index, normalised navicular height truncated, calcaneal inclination angle, calcano-1st metatarsal angle, talonavicular coverage angle and talus-2nd metatarsal angle were measured.Results:Sixteen patients (18 feet) were reported. Patients’ follow-up ranged from 14 to 31 months after surgery (mean±SD: 23.44±5.76). The increase of arch index, calcano-1st metatarsal angle and reduction of calcaneal inclination angle were found statistically significant (p<0.05). Two normal arch patients progressed to asymptomatic flat arch feet. Three complications were noted between three to nine months post-surgery, one with medial column and two with lateral column symptoms.Conclusion:There is evidence of reduction in medial longitudinal arch of the foot after EPFR. Although the reduction remains asymptomatic, post-operative complications related to changes in biomechanics of the foot can occur between three to nine months. Patients should be monitored at least for 12 months and longer for those who are symptomatic.

Outcomes of Endoscopic Treatment for Plantar Fasciitis: A Systematic Review

Category:OtherIntroduction/Purpose:Endoscopic plantar fascia release (EPFR) is an established operative treatment for recalcitrant plantar fasciitis. The purpose of this systematic review is to provide a comprehensive review on the outcomes of endoscopic plantar fascia release in the treatment of plantar fasciitis at mid- and long-term follow-up.Methods:A systematic review was performed using, MEDLINE, EMBASE, and Cochrane library databases in May 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated with regards to the level of evidence (LOE) and quality of evidence (QoE) using the Coleman methodological score. Clinical outcomes and complications were also evaluated.Results:Twenty-five studies including 729 feet were included in this systematic review with a mean follow-up of 25.1 months. 18 papers used the American Orthopaedic Foot & Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.6 and the postoperative score was 89.6 out of 100. The total number of patients who had complications was 117 of 729 (16.1%). The most common complication was a recurrence of pain experienced by 6.5% of patients (47 of 117).Conclusion:Endoscopic plantar fascia release provides good clinical and functional outcomes in patients with refractory plantar fasciitis. However, this procedure is associated with a moderately high complication rate.

Radiofrequency microtenotomy for plantar fasciitis: A systematic review and meta-analysis

BackgroundCurrently, there is limited evidence on outcomes for plantar fascia radiofrequency microtenotomy. An evidence-based systematic review and meta-analysis for outcomes of radiofrequency microtenotomy for the treatment of plantar fasciitis was conducted. MethodsA comprehensive evidence-based literature review of PubMed and Cochrane Databases was conducted in March 2019, which identified 11 relevant articles assessing the efficacy of plantar fascia radiofrequency microtenotomy. The studies were then assigned to a level of evidence (I–IV). Individual studies were reviewed to provide a grade of recommendation (A–C, I) according to the Wright classification in support of or against endoscopic plantar fascia release. Meta-analysis was performed for 7 of the studies that measured AOFAS scores. ResultsBased on the results of this evidence-based review, there was fair (grade B) evidence to support plantar fascia radiofrequency microtenotomy. There was a statistically significant mean increase of 40.9 in AOFAS scores post procedure. ConclusionThere was fair (grade B) evidence to recommend radiofrequency microtenotomy for plantar fasciitis. There is a need for more high quality level I randomized controlled trials with validated outcome measures to allow for stronger recommendations to be made. Level of evidenceLevel II, systematic review of level II studies.

Plantar Fasciitis: Distal Tarsal Tunnel (Baxter's Nerve) in the Athlete

Plantar medial inferior heel pain is a common complaint in athletes and is frequently caused by plantar fasciitis and/or distal tarsal tunnel syndrome (Baxter's neuropathy). Obtaining an accurate diagnosis is crucial but may be challenging due to a similar site of pain and overlapping symptoms. While both conditions often resolve with nonoperative management, they may present with a prolonged symptomatic course that can last 10-12 months. Consequently, providers treating athletes should understand the various therapies proposed to address these pathologies as no one optimal treatment strategy has emerged. Stretching exercises, orthotic devices, extracorporeal shock wave therapy , plasma-rich protein injections, and endoscopic plantar fascia release have garnered the most attention for the management of plantar fasciitis. Rest, non-steroidal anti-inflammatories , and open distal tarsal tunnel release have been employed for the treatment of Baxter's neuropathy. This review summarizes recent literature on the diagnosis, numerous nonoperative treatment options, and surgical management of plantar fasciitis and distal tarsal tunnel syndrome.

AB062. SOH21AS150. Outcomes of endoscopic treatment for plantar fasciitis: a systematic review

Background: Endoscopic plantar fascia release (EPFR) is an established surgical treatment for recalcitrant plantar fasciitis. Few studies assess the mid to long-term outcomes of this procedure making it difficult for surgeons and patients to establish realistic postoperative expectations. The purpose of this systematic review is to provide a comprehensive review on the outcomes of EPFR in the treatment of plantar fasciitis at mid- and long-term follow up.

Endoscopic Release of Chronic Resistant Plantar Fasciopathy

Plantar fasciopathy is the most common cause of plantar heel pain. No enough evidence in literature strongly supports the effectiveness of any specific treatment for such conditions. To assess the efficacy and safety of a modified surgical technique for endoscopic release of plantar fascia. A total of 40 feet in 40 patients with plantar fasciopathy for at least one year and resistant for at least two modalities of conservative treatment for six months were involved in this prospective study. All patients had been diagnosed clinically.The mean AOFAS preoperative score had improved from 51.36 to 89.44 after six months follow-up. While The VAS score dropped from 9 preoperative to 1. Eighty four (84%) of patients had satisfactory outcomes according to Roles and Madsuley criteria. No major complications were recorded. Endoscopic plantar fascia release could be a viable alternative for management of chronic resistant plantar fasciopathy.

The results and safety of endoscopic plantar fascia release for treatment of chronic plantar fasciitis

BackgroundA prospective study was conducted to evaluate the results of endoscopic plantar fascia release (EPFR) and its safety in treating patients with chronic plantar fasciitis. Patients and methodsThirty patients who had chronic plantar fasciitis for more than 6 months participated in this study from March 2015 to June 2018. Seventeen patients were females, and thirteen were males with an average age of 46 years (ranged between 35 and 52 years). All patients had a failed history of conservative treatment. They were treated with endoscopic plantar fascia release. If a heel spur existed, it was resected by an arthroscopic burr. Pain and functional limitations were evaluated with the American Orthopedic Foot and Ankle Society Scale (AOFAS) and Roles and Maudsley score. ResultsAt the end of follow-up, the mean AOFAS scoring changed significantly from 67 points before surgery to 93 points (P < .0001) which was clinically significant. Sixteen (53.3%) patients had excellent results, 8 (26.6%) patients had good results, 4 (13.33%) patients had acceptable results, and 2 (6.66%) patients had poor results. Three cases complained of postoperative superficial infection at the medial portal. Two cases developed numbness and paraesthesia at the sole of the foot. Three patients had ongoing start-up pain that resolved within two months. The mean duration to full weight bearing after surgery was 40 days. All patients returned to full activities by a mean of 10 weeks. ConclusionEndoscopy offers the optimum solution for the resistant cases, but is not without complications. EPFR should be reserved only for severe cases after a trial period of conservative methods of treatment.

ENDOSCOPIC RELEASE OF RESISTANT PLANTAR FASCIOPATHY

Background: Plantar fasciopathy is the most common cause of plantar heel pain. No enough evidence in literature strongly supports the effectiveness of any specific treatment for such conditions. Objective: To assess the efficacy and safety of a modified surgical technique for endoscopic release of plantar fascia. Patients and methods: A total of 29 feet in 25 patients with plantar fasciopathy for at least one year and resistant for at least two modalities of conservative treatment for six months were involved in this prospective study. All patients had been diagnosed clinically and the study was carried at the Department of Orthopedics, AL-Hussein University Hospital, Faculty of Medicine, Al-Azhar University in the period between December 2019 and September 2020. Results: The mean AOFAS preoperative score had improved from 51.36 to 89.44 after six months follow-up. While The VAS score dropped from 85 preoperative to 12.6. Eighty four (84%) of patients had satisfactory outcomes according to Roles and Madsuley criteria. No major complications were recorded. Conclusion: Endoscopic plantar fascia release could be a viable alternative for management of chronic resistant plantar fasciopathy.

Two-Portal Endoscopic Plantar Fascia Release: Step-by-Step Surgical Technique

Plantar fasciitis is a common condition of heel pain with a lifetime incidence up to 10%. For this entity, conservative treatment is considered the gold standard, involving non-steroidal anti-inflammatory drugs, stretching exercises of the plantar fascia, activity modifications, ice, and insoles. When patients do not respond to these treatments, partial or total plantar fascia release has been the mainstay of treatment, with success rates of approximately 70% to 90%. For this purpose, several techniques have been described, including open, percutaneous, and endoscopic release. The objective of this Technical Note is to describe the nonassisted 2-portal endoscopic plantar fascia release in a patient with recalcitrant plantar fasciitis.

Endoscopic Plantar Fascia Release versus Cryosurgery for the Treatment of Chronic Plantar Fasciitis: A Prospective Randomized Study.

In a prospective randomized study, we compared two different surgical techniques used in plantar fasciitis surgery. Forty-eight patients diagnosed as having plantar fasciitis and treated for at least 6 months with no response to conservative modalities were included in this study. The patients were randomly assigned to receive endoscopic plantar fascia release (EPFR) or cryosurgery (CS). Patients were evaluated using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) as a primary outcome measurement at baseline and 3 weeks and 3, 6, and 12 months after surgery. At the final follow-up visit, the Roles-Maudsley score was used to determine patient satisfaction. Five patients did not complete the 1-year follow-up examination (one in the EPFR group and four in the CS group). Thus, the study group included 43 patients. Although both groups showed significant improvement at the final evaluation, the patients in the EPFR group had significantly better AOFAS-AHS scores at 3 months. The success rate (Roles-Maudsley scores of excellent and good) in the EPFR group at 12 months was 87% and in the CS group was 65%. Both EPFR and CS were associated with statistically significant improvements at 1-year follow-up. At 3-month follow-up, EPFR was associated with better results and a higher patient satisfaction rate compared with CS.

Outcomes of Endoscopic Treatment for Plantar Fasciitis: A Systematic Review

Category:Arthroscopy, HindfootIntroduction/Purpose:Open plantar fascia release is an established surgical treatment for plantar fasciitis traditionally. However, it has long recovery period and complications with conflicting late results. Recently, endoscopic plantar fascia release has gained popularity, providing good outcomes with early return to activity. However, there is still a paucity of overall clinical data regarding outcomes and complication rates following endoscopic procedure for the treatment of plantar fasciitis. The purpose of the current study was to systematically review the outcomes of endoscopic plantar fascia release in the treatment of plantar fasciitis.Methods:A systematic review was preformed using, MEDLINE, EMBASE and Cochrane library databases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated with regards to level of evidence (LOE) and quality of evidence (QOE) using the Coleman methodological score. Clinical outcomes and complications were also evaluated.Results:Twenty-one studies including 601 feet were included in this systematic review. The mean patient age was 48.5±5.2 years, and the mean follow-up time was 26.9±22.7 months. Sixteen studies used the AOFAS score for clinical outcome measure. The mean preoperative AOFAS score was 52.3±24.1 and the postoperative score was 88.8±4.1. The VAS score was utilized in 10 studies. The mean preoperative score was 7.8±0.8 and the postoperative score was 1.8±0.7. In total 111 of 601 (18.7%) patients had complications. The most common complication was recurrence of pain with 45 patients (7.5%). Twenty-two patients (3.7%) experienced paraesthesia and numbnesss. Seventeen patients (2.8%) required subsequent operations including gastrocnemius release, hematoma drainage, and baxter nerve release.Conclusion:The current systematic review demonstrates that overall there were good clinical and functional outcomes following endoscopic procedure for the treatment of plantar fasciitis. However, there was a relatively high complication rate (18.7%) associated with the endoscopic procedures. Due to the low level of evidence and poor qualities of evidence, further well designed studies are necessary to determine the clinical outcomes and complications of endoscopic plantar fasciotomy.

Comparative analysis between platelet rich plasma and corticosteroid injection in plantar fasciitis

Introduction: Plantar fasciitis is a disorder resulting in pain in the heel and bottom of the foot. Risk factors include increased exercise, obesity, long periods of standing and heel spur. Non-operative treatment includes rest, contrast bath, sole inserts, stretching exercise, NSAIDS and steroidal medications. Invasive interventions are steroid injections, autologous blood, PRP application and open, endoscopic or percutaneous fascial surgical release of plantar fascia. Aims and Objectives: The aim of this study was to determine the effects on pain and function of PRP obtained manually as a cheap and easy method in the treatment of plantar fasciitis and to compare this data with that of steroid injection which is often used in clinical practice. The hypothesis was that a single dose of manually prepared PRP would reduce pain in plantar fasciitis and this effect is superior to the steroid injection. Materials and Methods: The present study was conduct at our institute during August 2016 to September 2018; 80 consecutive patients with chronic plantar fasciitis were enrolled and randomized in two groups: One group receives the Platelet rich plasma (PRP) therapy and another group receiving corticosteroid injection. The outcomes in both groups were observed and compared by The Foot and Ankle Disability Index (FADI) and Visual Analogue Scale (VAS) at 1st week, 4th week and 12th week post injection. The level of significance was set at p Results: Prospective data was collected of 40 patients. The average follow up duration was about 12 weeks. The score on VAS Scale and FADI improved from the baseline for both the groups but the patients who received PRP therapy had a statistically significant (p Conclusion: The application of PRP appears to be more effective than steroid injection in terms of pain and functional results in the treatment of chronic plantar fasciitis. Keywords: Steroid injection, PRP, Plantar fasciitis, FADI score, VAS scale.

Endoscopic Plantar Fasciotomy Through Two Medial Portals for the Treatment of Recalcitrant Plantar Fasciopathy

Plantar fasciopathy is a common cause of heel pain. Endoscopic plantar fasciotomy has the advantage of less surgical trauma and rapid recovery. The aim of the present prospective study was to delineate the results of endoscopic plantar fascia release through 2 medial portals. The present study included 2 groups. The first group included 27 feet in 25 patients that had undergone endoscopic plantar fascia release followed up for 19.7 (range 12 to 33) months. The second group, the control group, included 20 feet in 16 patients treated conservatively and followed up for 16.4 (range 12 to 24) months. The results of endoscopic plantar fascia release were superior to the conservative methods. The surgically treated group experienced significantly less pain, activity limitations, and gait abnormality. The presence of a calcaneal spur had no effect on the final postoperative score. In conclusion, endoscopic plantar fascia release through 2 medial portals is an effective procedure for treatment of resistant plantar fasciopathy that fails to respond to conservative management options.

The Topaz Micro-Radiofrequency Ablation Achieves Similar Results to Endoscopic Plantar Fascia Release

The Topaz Micro-Radiofrequency Ablation Achieves Similar Results to Endoscopic Plantar Fascia Release

Endoscopic plantar fascia release via a suprafascial approach is effective for intractable plantar fasciitis.

To evaluate the medium-term clinical results of endoscopic plantar fascia release (EPFR) using a suprafascial approach for recalcitrant plantar fasciitis. Twenty-four feet of twenty-three patients who underwent EPFR using a suprafascial approach were followed up for more than 2years using the American Orthopedic Foot and Ankle Society (AOFAS) score. The AOFAS score at final follow-up was compared between patients who participated in athletic activity (group A) and those who were sedentary (group S) and between those with and those without calcaneal spur (group with CS and group without CS, respectively). The ability of patients to return to athletic activity, and if so, the time interval between surgery and return to athletic activity, were investigated in group A. Complications were recorded. The median follow-up duration was 48months. The mean AOFAS score in all patients increased significantly between before surgery and final follow-up (P < 0.001). The mean score in group A at final follow-up was significantly higher than that in group S (P < 0.05). However, there was no significant difference in the mean score at final follow-up between the groups with and without CS. In group A, all patients could return to athletic activity after a median 8weeks. Injury to the first branch of the lateral plantar nerve occurred in three feet. EPFR using a suprafascial approach was effective for recalcitrant plantar fasciitis. However, the prognosis of sedentary patients was inferior to that of patients engaged in athletic activity. IV.

Endoscopic Plantar Fasciotomy; Deep Fascial Versus Superficial Fascial Approach: A Prospective Randomized Study

In the present randomized prospective study, 2 different surgical techniques of endoscopic plantar fascia release were compared. Of 547 patients with a diagnosis of plantar fasciitis, 46 with no response to conservative treatment for ≥6 months were included. Of the 46 patients, 5 were lost to follow-up. In group 1 (n = 21), plantar fascia release was performed using a deep fascial approach (DFA), and in group 2 (n = 20), the superficial fascial approach (SFA) with a slotted cannula technique was used. Patients were evaluated using the American Orthopaedic Foot and Ankle Society Ankle Hindfoot scale and visual analog scale at baseline and 3 weeks and 3, 6, and 12 months after the initial surgery. At the final follow-up appointment, the Roles-Maudsley score was used to determine patient satisfaction. At the final follow-up examination, the mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale scores had increased from 53.12 to 83.68, with a decrease in the mean visual analog scale score from 7.95 to 1.65 noted. According to the Roles-Maudsley score, the success rate after 1 year was 90.47% for DFA group, 95% for the SFA group, and 92.68% for all patients. Although no significant difference was found between the final functional scores, better early postoperative scores were found in the SFA group. The mean duration of the procedure was measured as 27.22 ± 9.41 minutes overall, 35 ± 5.62 minutes in the DFA group, and 19.05 ± 4.01 minutes in the SFA group. Two early and two late complications occurred in the DFA group with none reported in the SFA group. In conclusion, the SFA is a faster and safer method of endoscopic plantar fascia release with better early postoperative scores.

Evaluation of the Results of Endoscopic Release of Plantar Fascia in Cases of Resistant Chronic Heel Pain

AIM: To evaluate the results of endoscopic release of plantar fascia in resistant cases of heel pain.METHODS: An experimental descriptive study involved twenty patients who presented to University hospital with resistant chronic plantar heel pain due to plantar fasciitis, were treated with endoscopic plantar fasciotomy. All patients completed a period of at least six months follow up. Data were collected by the modified American Orthopaedic Foot and Ankle Society (AOFAS) Questionnaire, informed consent was applied, and SPSS was used for data entry and analysis.RESULTS: At the end of follow up the mean modified AOFAS of ankle- hind foot score was improved from 49.10 (ranging from 34 to 56) pre-operatively to 90.25 post operatively (ranging from 67 to 100). Seven patients (35%) had excellent results, ten patients (50%) had good results, two patients had fair results, and one patient (5%) had a poor result. AOFAS score of pain was improved from a mean of 14.0+9.40 points pre-operatively (range 0 – 20) to 31.5 + 6.71 points post-operatively (range 20 – 40). AOFAS score of activity of daily living improved from a mean of 4+0 points pre-operatively to 9.85+0.671post-operatively ranging from 7 to 10 points.CONCLUSION: Endoscopic release of plantar fascia has positive therapeutic effects in cases of resistant chronic heel pain.

Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Technique and Prospective Study of 46 Consecutive Patients

Plantar fasciitis is one the most common pathologies treated by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention might be warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. Comorbidities associated with the release of the plantar fascia have been documented, including lateral column overload and metatarsalgia. We present an innovative technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of the fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia with or without heel spur resection would provide a minimally invasive technique with acceptable patient outcomes.