Endoscopic Plantar Fascia Release Research Articles

Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique

Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is 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. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes.

Endoscopic plantar fasciotomy versus injection of platelet-rich plasma for resistant plantar fasciopathy

BackgroundResistant plantar fasciopathy is a common orthopedic problem. AimComparing two different methods of treatment. MethodsFifty patients with chronic resistant plantar fasciopathy were divided into two groups. The first included 23 patients treated by endoscopic release of plantar fascia (EPF) and the second included 27 patients treated by injection of platelet-rich plasma (PRP). ResultsIn the EPF group, the average VAS improved from 8.28 to 2.35. The average AOFAS improved from 65 to 94. In the PRP group, average VAS improved from 8.22 to 2.9 and the average AOFAS improved from 66 to 92. ConclusionBoth methods gave comparable results at late follow-up.

Endoscopic approach for plantar fasciopathy: a long-term retrospective study

The purpose of this study was to report the long term effectiveness of endoscopic plantar fascia release for recalcitrant plantar fasciopathy. Twenty-three consecutive patients underwent endoscopically-assisted plantar fascia release for symptomatic plantar fasciopathy unresponsive to nonoperative measures. The clinical diagnosis was supported by imaging (plain radiographs and magnetic resonance imaging [MRI]) and the American Orthopaedic Foot & Ankle Society (AOFAS) score was administered to all patients. All patients underwent endoscopic plantar fascia release. Postoperatively, patients were assessed at clinical examination and the AOFAS score was administered. Twenty-two (26 feet) of the 23 patients included in our original cohort returned to our clinic at an average final follow-up of 9.6 years. The mean preoperative AOFAS score of 51 (range, 41-63) improved to 89 (range, 41-97) at the last follow-up, with no statistically significant difference between patients with or without calcaneal bone spur (p = 0.43). At the last appointment, physically active patients reported significantly higher AOFAS scores than sedentary patients (p = .008). This endoscopic plantar approach could be a viable alternative to more invasive procedures for management of recalcitrant plantar fasciopathy. Future randomised controlled trials are needed.

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

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.

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

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.

Results of Endoscopic Plantar Fascia Release

Conservative treatment for plantar fasciitis usually provides improvement, but some patients progress to surgery. Open release is most commonly performed but is associated with prolonged recovery and complications. Endoscopic plantar fascia release (EPFR) has become popular recently. We present our results. Twenty patients (23 feet) had EPFR. Sixteen patients (19 feet) were available for followup after at least 1 year. Ten were women and 6 were men, with an average age of 44.7 (range 28 to 70) years. The average followup was 47 months. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and Maryland Foot Score were used for evaluation. Gender, obesity, severity, length of preoperative symptoms, and workers compensation (WC) status were studied. The average AOFAS and Maryland scores improved postoperatively (66 to 88, p<0.05; 62 to 83, p<0.05, respectively). Women improved 25 (AOFAS) and 23 points (Maryland) points. Men improved 16 (AOFAS) and 17 points (Maryland) points. Obese patients improved 38 and 28 points, respectively. Normal weight patients improved 16 and 19 points, respectively. Postoperative scores for patients with high preoperative severity improved from 58 to 81 (AOFAS) and from 52 to 73 (Maryland). Patients with moderate preoperative severity achieved scores from 72 to 93 and from 70 to 91. Patients who had symptoms longer than 2 years before EPFR had lower postoperative scores. Non-WC patients improved 25 (AOFAS) and 24 (Maryland) points. WC patients improved 18 and 16 points, respectively. EPFR provides significantly improved patient outcomes. Patients with more severe symptoms before EPFR and those with symptoms for longer than 2 years had worse results. Obesity had no negative effect on outcome. WC patients had inferior results compared to non-WC patients. Women achieved better results than men. This finding may be biased because most WC patients were men.

Endoscopic Plantar Fascia Release

Endoscopic release of the plantar fascia is becoming an increasingly popular alternative to open procedures for the treatment of chronic plantar fasciitis. Although most patients can be successfully treated with Achilles tendon stretching, orthoses, physical therapy and corticosteroid injections, a small percentage of patients will have symptoms that are refractory to such treatments. This is a retrospective review, analyzing the clinical outcome of 22 consecutive patients treated for chronic plantar fasciitis with endoscopic plantar fascia release by a single orthopaedic foot and ankle surgeon. These patients complained of symptoms for an average of 7.43 months before referral to the senior author (MS); 11 patients had chronic symptoms for 12 months or more. The ages at surgery ranged from 30 to 73 years. Followup averaged 8.48 (range 6 to 20) months. Satisfaction rate with this procedure was 97.7% and all patients reported at least a 50% improvement in pain after surgery. Twenty-two patients completed a modified Mayo Foot and Ankle Score: 15 of 22 (68%) were judged to have good or excellent results. Bilateral symptoms and prior ankle trauma or surgery were significantly correlated with less favorable results. Patients who had no previous foot trauma and had unilateral symptoms obtained the best results from this procedure. Even patients who had some residual pain in their foot were satisfied with the procedure and with the level of pain relief that had been achieved. Endoscopic plantar fascia release does appear to benefit selected patients who fail to respond to conservative therapy.

Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (EFRPF)

The purpose of the present study is to present the surgical technique for, and review our indications and results after, endoscopic fascial release in patients with plantar fasciitis. In five thiel-embalmed human specimens, a biportal technique for endoscopic release of the plantar fascia was established. The aim was here to evaluate the relation between the plantar fascia and the heel spur and to perform a release that would not exceed 50-70% of the diameter of the calcaneoplantar fascia. The endoscopic technique was performed within the last 5 years in ten male and seven female patients. All patients with the clinical entity of plantar fasciitis underwent conservative treatment for at least 6 months. The average age at surgery was 35 years (24-56 years). In the first five patients, surgery was performed under c-arm control. In all patients the operation could be finished endoscopically. The endoscopic portals healed without complications. The time for surgery during the learning curve ranged between 21 and 74 min (average 41 min) and was still longer compared to the open technique. The clinical follow-up ranged between 4 and 48 months (average 18.5 months). Out of 17 patients, 13 improved clinically, and they would choose the treatment option again. In the Ogilvie-Harris score, seven patients showed good and six excellent results. In two patients, the initial results were not satisfactory, because of a bony stress reaction of the calcaneus. This complication was treated by 6 weeks of partial weight bearing, without any further problems. Two other patients developed secondary pain in the lateral column. In spite of the minimal invasive approach it seems to be important to be careful in increasing the weight bearing in early rehabilitation. The technique of the endoscopic plantar fascia release (E FRPF) can be performed in a standardised and reproducible procedure. The follow-up examination showed good midterm results, but a loss of stability of the plantar arch has to be strictly avoided.

Endoscopic plantar fascia release: a case series.

Plantar fasciitis is a common disabling condition that can be recalcitrant to treatment. Endoscopic Plantar Fascia Release (EPFR) has received greater attention in recent years as a viable, and possibly superior, alternative to established open procedures for the treatment of plantar fasciitis. In a series of 17 patients (17 feet) with follow-up over an average of 16 months, we report a two portal endoscopic technique of partial release of the plantar fascia, as a successful, safe and reliable procedure for the treatment of plantar fasciitis in the patient group selected. The surgical results of 17 EPFR's performed by the same surgeon were reviewed. All patients had preoperative symptoms of subcalcaneal heel pain for greater than 12 months, all having undergone nonsurgical measures for at least 12 months. Of 17 feet, all reported marked improvement of preoperative symptoms within two months. Patients' subjective assessment of the procedure was strongly supportive, 100% totally satisfied or satisfied with only minor restrictions. Postoperatively, 82.4% reported mild or no pain, and 100% had improvement in walking distance. Complications all resolved within two to six months; there were no re-operations and no infections.

Endoscopic plantar fascia release: a cross-sectional anatomic study

Endoscopic plantar fascia release: a cross-sectional anatomic study

Endoscopic plantar fascia release: a cross-sectional anatomic study.

Endoscopic plantar fascia release is a new procedure proposed to treat heel pain and plantar fasciitis. The purpose of this study was to assess the structures at risk during plantar fascia release using this method. Ten fresh-frozen cadaver feet were divided into two groups. All specimens underwent cannula placement inferior to the plantar fascia. Five-of the specimens had plantar fascia release using the endoscopic technique. Six of the specimens were then frozen and cut in transverse, sagittal, and coronal sections to visualize the relationship between the cannula and plantar fascia and surrounding structures. Gross dissection was performed on the remaining four specimens. The amount of plantar fascia released, the relationship to the nerve to abductor digiti minimi, and the fascia of the abductor hallucis muscle were assessed. The average distance from the cannula margin to the nerve to the abductor digiti minimi was 6 mm at the medial border of the plantar fascia. The average amount of plantar fascia released was 90%. Although a complete release was attempted, the fascia to the abductor hallucis was not released in any of the specimens. The nerve to the abductor digiti minimi was not damaged in any of the specimens. On coronal sections, the nerve was closer to the cannula and plantar fascia release than previously reported.