Plantar Fascia Release Research Articles

Clinical Study of a Four-Step Program for the Treatment of Plantar Fasciitis with Bone Spurs.

The most common causes of plantar and heel pain are plantar fasciitis and calcaneal spurs, and they often co-exist. Surgery is a recognized treatment for refractory plantar fasciitis. However, few studies have proposed treatment options for patients with metatarsophalangeal fasciitis with bone spurs. Accordingly, this study's purpose was to propose a four-step surgical regimen, and to improve the surgical outcome of plantar fasciitis with osteophytes and to establish a procedure for surgical treatment. Retrospective analysis of 45 patients suffering from plantar fasciitis with bone spurs from 2020 to 2023. All patients underwent a four-step procedure, including plantar fascia release, calcaneal spur grinding, inflammatory tissue removal, and calcaneal burr decompression. The imaging parameters and functional scores were recorded before and after the operation. The objective evaluation included the measurement of calcaneal spur length on radiographs. Clinical evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS), the Visual Analog Scale (VAS), and the Foot and Ankle Outcome Scale (FAOS). Measurement data that conformed to normal distribution were expressed as (x2 ± s), and pre-and postoperative AOFAS, FAOS, and VAS scores were compared using repeated-measures ANOVA, and preoperative and postoperative spur lengths were compared using paired t-tests. The 45 patients were followed up for 3 to 30 months, (17.72 ± 8.53) months, at final follow-up, the patient's AOFAS score improved from preoperative (74.93 ± 5.56) to (94.78 ± 3.98), FAOS score increased from preoperative (76.42 ± 3.37) to (96.16 ± 2.74), the VAS score decreased from (3.18 ± 0.54) to (1.07 ± 1.20) (p < 0.05), the length of spur decreased from (0.72 ± 1.81) cm to (0.23 ± 1.19) cm, and there were significant differences before and after operation (p < 0.05). The four-step surgical regimen is an appropriate and effective surgical procedure to treat plantar fasciitis with bone spurs.

Effects of Plantar Fascia Release and the Use of Foot Orthoses Affect Biomechanics of the Medial Longitudinal Arch of the Foot: A Cadaveric Study.

The aim of the study is to evaluate the effect of minimally invasive ultrasound-guided fascial release and a foot orthoses with first metatarsal head cutout on the biomechanics of the medial longitudinal arch of the foot in cadaveric specimens. A cross-sectional study was designed (20 body donors). Anthropometric measurements of the foot, foot posture index, and the windlass test and force were measured in different conditions: unloaded, loaded position, with foot orthoses, after a 25% plantar fascia release and after a 50% release. For the anthropometric measurements of the foot, differences were found in foot length ( P = 0.009), arch height ( P < 0.001), and midfoot width ( P = 0.019) when comparing the unloaded versus foot orthoses condition. When foot orthoses were compared with 25% plantar fascial release, differences were found in foot length ( P = 0.014) and arch height ( P < 0.001). In the comparison with 50% plantar fascial release, differences were found in the arch height ( P < 0.001). A significant interaction between foot orthoses condition and grades was found in the arch height during the windlass test ( P = 0.021). The results indicate that the presence of foot orthoses leads to a significant increase in arch height compared with other conditions. Furthermore, when plantar fascia release is performed, the arch does not exhibit any signs of collapse.

Management of Vatakantaka (Plantar Fasciitis) with Agnikarma-A Case Study

Acharya Sushruta explained that when a person walk on the irregular or uneven surface, vata gets localized and aggravated in khuda pradesha (Ankle joint) and produce pain in heal region known as Vatakantaka. It can be compared to Plantar Fasciitis. Plantar Fasciitis is the one of the painful condition in heel that hampers daily activity. Plantar Fasciitis is caused due to repeated stretch and strain of plantar fascia resulting in injury and inflammation which produces heel pain. Plantar fasciitis is managed with analgesic and anti-inflammatory, intra articular steroid injection and surgically by plantar fascia release as per requirement, but such type of treatment increased hospital stay and high economical expenses. Sushruta mentioned agnikarma in management of Vatakantaka which can be done with less economical expenditure and minimum hospitalization. Agnikarma is used in this case study to assess its efficacy in relieving pain. 46 years old female complaints of right heel pain in first few steps in morning and pain relived after walking, and again pain developed after prolonged period of rest. Patient was treated by Samyak Bindu vat Agnikarma at ankle region in 4 sittings at the interval of 7 days, which given complete relief from pain.

Endoscopic Plantar Fasciotomy as an Effective and Reliable Treatment for Plantar Fasciitis: An Overview of the Literature.

Plantar fasciitis is a common cause of heel pain. The aim of this study was to review the current literature and attempt to clarify whether endoscopic plantar fasciotomy (EPF) is an effective and reliable treatment for plantar fasciitis in comparison with other invasive or noninvasive treatments. We performed an electronic search of the medical literature in PubMed database using combinations of the following keywords: plantar fasciitis, endoscopic treatment, and plantar aponeurosis. Overall, we had shown that patients had better scores following EPF/endoscopic plantar fascia release. The clinical scores were improved postoperatively and most of the patients were satisfied. Furthermore, the clinical trials showed that time to return to work or to previous activities was shorter compared with other treatments. These studies suggest that EPF/endoscopic plantar fascia release is probably an effective treatment of chronic plantar fasciitis. EPF is an efficient, safe treatment with good early postoperative results in patients with recalcitrant plantar fasciitis. There is evidence that other methods are equivalently effective for EPF, and some authors support that they should be considered as a second-line treatment because of their minimal invasive character and very low risk of complications; thus, more research is required.

Analysis of the curative effect of triple surgery under endoscope in the treatment of intractable heel pain

To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain. The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed, including 20 males and 30 females;aged from 40 to 68 years old with an average of (50.12±7.35)years old, the medical history ranged from 1 to 4 years. All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression, and were followed up, the duration ranged from 24 to 60 months with an average of(42.00±3.28) months. All patients had obvious heel pain before surgery, and X-ray examinations often showed the presence of calcaneal spurs. In addition to the routine foot examination, the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray, for the evaluation of clinical effect. The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain, voluntary movement, gait and stability. The VAS decreased from (8.75±1.24) before surgery to (5.15±2.35) at 3 months after surgery, (4.07±2.53) at 6 months after surgery, and (3.95±2.44) at the last fllow-up(P<0.05). The AOFAS score increased from (53.46±4.17) before surgery to(92.46±2.53) at 3 months after surgery, (96.33±2.46) at 6 months after surgery, and (97.05±2.37) at the last follow-up(P<0.05). The arch height was (41.54±1.15) mm before operation and (41.49±1.09) mm after the operation, the difference was not statistically significant(P>0.05). The internal arch angle of the foot arch was (121±6)° before operation and (122±7)° after operation. The difference was not statistically significant(P>0.05). Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited great clinical effect for treating intractable heel.

Surgical Treatment of Plantar Fasciitis After failure of Conservative Treatment

Plantar fasciitis is a common problem faced almost daily in our orthopedic clinic, and it is not easy to satisfy patients with a curative treatment in a short period of time; it is characterized by deep pain in the plantar aspect of the heel, particularly on arising from bed, although the pain often subsides after few steps, in some patients the pain will persist for a long period. Aim of the study: To evaluate the result of surgical treatment in cases of plantar fasciitis which are not respond to conservative treatment. Methods: Prospective study was conducted at the Department of Orthopedic Surgery in Al-Kadhemiyah Teaching Hospital from November 2010 to May 2012 to evaluate 50 patients com¬plaining of inferior heel pain. There were 30 females and 20 males; the main presenting symptoms were pain on the inferno-medial aspect of the heel exacerbating by prolongs weight-bearing and in the morning following sleep. The age of the patients is 23-58 years. Bilateral heel pain presented in 10 patients in our series; therefore, the overall number of heels treated in our series was 60 heels. All of the patients were treated first conservatively by rest, anti-inflammatory drugs, and local corticosteroid injection. 13 patients showed no response, so we advised them for surgery; 12 patients out of 13 accepted surgery and were treated by plantar fascial release. Patients with systemic diseases had been excluded from our study. Results: Regarding treatment, 37 patients (74%) respond to conservative treatment, while 13 patients (26%) had no response to conservative treatment. Therefore they were advised to undergo surgery, and 12 of them accepted surgery. Nine patients (75%) undergoing surgery had a good result (pain-free) 17% of patients undergoing surgery in our study showed fair results (pain after heavy exercise), while 8% showed poor results (persistent pain). Per-operative drilling of calcaneum showed to be effective in post-operative heel pain relieve, which may be due to reduced intra-osseous pressure. Regarding complications, 6% showed superficial wound infection, which was treated conservatively by rest and antibiotics for seven days. Post-operative back slab for two weeks is important to decrease post-operative pain and to facilitate soft tissue healing

Clinical Outcomes of Selective Plantar Fascia Release for Hallux Interphalangeal Joint Ulcers

Clinical Outcomes of Selective Plantar Fascia Release for Hallux Interphalangeal Joint Ulcers

Arthroscopic surgery for the treatment of chronic plantar heel pain

The article aimed to investigate the therapeutic effects of arthroscopy-assisted calcaneal spur resection and plantar fascia release on chronic plantar heel pain. This study retrospectively analyzed the clinical data of 32 patients with chronic plantar heel pain who underwent surgery at the Department of Orthopedics, Yubei District People's Hospital of Chongqing, China from January 2019 to August 2021 and had complete follow-up data. All patients had unilateral heel pain and were treated with arthroscopy-assisted calcaneal spur resection and plantar fascia release. The visual analogue scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the pain and function, respectively, of patients before and 1, 2, 3, 6, and 12 months after the surgery. The perioperative complications were also recorded. All 32 patients underwent successful surgery, with follow-up for 12–18 months (mean: 15.6 months). The VAS score was significantly decreased from 6.81 ± 0.90 preoperatively to 4.50 ± 1.14 at 2 months postoperatively. The AOFAS score was significantly increased from 62.53 ± 5.73 preoperatively to 71.16 ± 5.74 at 2 months postoperatively (p < 0.05). Arthroscopy-assisted calcaneal spur resection combined with plantar fascia release achieves rapid relief of postoperative pain and recovery of foot function for the treatment of plantar heel pain. This minimally invasive surgery achieved satisfactory outcomes and is feasible for the treatment of plantar heel pain.

Comparison of Isolated Calcaneal Spur Excision and Plantar Fasciotomy in Addition to Spur Excision in Patients With Plantar Heel Pain Accompanied by Calcaneal Spur.

The aim of this study is to clinically compare isolated calcaneal spur excision and plantar fascia release in addition to spur excision in patients with plantar heel pain accompanied by a calcaneal spur. Patients who did not benefit from conservative treatment and underwent surgical excision of the calcaneal spur and/or plantar fasciotomy were retrospectively evaluated. The patients were divided into two groups according to the surgical procedure performed. The evaluation was done according to the pre- and postoperative foot function index (FFI) using pain and functional evaluation. Pain, disability, and activity restriction were evaluated with FFI. The radiological results and FFI scores of both groups were measured before and after surgery, and the difference between the groups was compared. Of the 46 patients in our study group, 30 (65.2%) were female, and 16 (34.8%) were male. The average age was 41.2 years. There was a significant improvement in postoperative FFI scores in both groups. There was no significant difference in postoperative functional results when the groups were compared. In patients whose plantar heel pain associated with calcaneal spur does not improve despite conservative treatments, both isolated spur excision and plantar fascia release in addition to spur excision may be effective treatment modalities that improve foot functions.

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.

Comprehensive Ayurvedic Management of Calcaneus Spur- A Single Case Study

Agnikarma is an important para-surgical procedures mentioned in Ayurveda. It has emerged as integral part of the Ayurvedic therapeutics. Agnikarma is a thermal and minimally invasive procedure that induces controlled, pointed and therapeutic burns over the regions that are tender or painful. Acharya Sushruta has advised Agnikarma for Snayugata Vata and Asthigata Vata. Painful heel due to prolonged standing is relatively common foot problem in modern era and predominant cause of such pain is calcaneal spur. The calcaneal spur is a condition of pointed bony outgrowth of heel bone. Usually, it affects people day to day routine life and once manifested it becomes difficult to cure. It is caused due to deposition of calcium on underside of heel bone over a prolonged period of time. It is diagnosed by the radio-logical examination (X-RAY). As far as modern medicine is concerned there is no safe and cost-effective treatment available of calcaneus spur. Pharmacological treatment used are NSAID’s, analgesic drugs, steroid injections, and exercises. The surgical treatment is release of plantar fascia and excision of calcaneus spur but complications are incomplete relief of pain and nerve damage. In Ayurveda Agnikarma is one of the competent treatments of calcaneus spur. Agnikarma is carried with special instrument called Pancha Dhatu Shalaka. This Shalaka is made up of five metals (Copper, Iron, Zinc, Silver and Gold). A patient successfully treated with Agnikarma therapy is presented in this case study

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.

A randomized open label control clinical study to evaluate the efficacy of Kshoudra as Dahanopakarana for the pain management in Snayuvikara with special reference to Achilles Tendinitis

Achilles Tendinitis is otherwise called as Achilles Tendinopathy which causes pain and stiffness, swelling, thickening and weakness of achilles tendon, which worsens with activity, commonly seen in sports person. As per Ayurvedic parameters this condition can be correlated to Snayugata Vikara, which usually presents with Sthambha, Shula, Kriyavasakthi. Treatment include Snehana, Upanaha, Agnikarma, Bandhana and Mardana. In the contemporary science the treatment modalities available are RICE technique, hydrocortisone injection, radiant heat or diathermy, release of plantar fascia from tuberosity of calcaneus through surgery. In Susrutha Samhitha Agnikarma Chikitsa is explained for the par excellence for these conditions considering its Vatakapha Shamaka, Amapachaka property and also this is easy to perform. Agnikarma with the help of Panchadhathu Shalaka was already established with 65% of success rate in the management of Achilles tendinitis. The therapeutic effects of Agnikarma with Kshoudra includes relief of pain and muscle spasm, acceleration of healing, promotion of resolution of inflammation and increase in the range of movement of joint. This study is done by considering Vatakapha Shamaka, Amapachaka, Yogavahi properties of Kshoudra and also this was easy to perform with better cosmetic value. Hence the stagnation of current knowledge demanded an effective method to tackle the painful heel condition.

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.

Case-control study on carpal canal endoscopy and arthroscopy for the treatment of plantar fasciopathy

To explore clinical effects of carpal canal endoscopy in treating patients with plantar fasciopathy who failed by conservative treatment. From August 2018 to August 2019, 50 patients with plantar fascia were divided into two groups and 25 patients in each group. In carpal canal endoscopy group, included 11 males and 14 females, aged from 39 to 67 years old with an average of(57.7±6.4) years old;carpal canal endoscopy was used to plantar fascia release. In arthroscopy group, included 9 males and 16 females, aged from 41 to 73 years old with an average of (58.1±7.2) years old;conventional 4.0 mm arthroscopy Instruments was used to plantar fascia release. Operation time, hospitalization expense and postoperative complications between two groups were observed and compared. Postoperative visual analogue scale(VAS) and American Orthopedic Foot Ankle Society (AOFAS) score were used to evaluate clinical function. All patients were followed up from 12 to 18 months with an average of (14.3±2.1) months. There were significant differentces in operation time and hospitalization expense between two groups (P<0.05). Surgical incision healed well in carpal canal endoscopy group, and 2 patients delayed union in arthroscopy group, and no difference between two groups (P>0.05). There were no statistical differences in VAS, AOFAS and grading between two groups at 12 months after operation(P>0.05). The outcome of carpal canal endoscopy and arthroscopy has similar effects in treating plantar fascia. While carpal canal endoscopy has advantages of need not perfusion during opertaion, protect soft tissue well, less operation time, and lower cost.

Distribution of Patients with Resistant Plantar Fasciitis And Their Response to Percutaneous Partial Plantar Fascia Release under Tibial Nerve Block

Backgrounds and objectives:&nbsp; Plantar fasciitis is considered to be the most popular cause of heel pain. The corticosteroid injection is the second line treatment for these patients whose fail in conservative management of the plantar fasciitis. Surgery is the last line in treatment, that varies into many approaches. This is a clinical trial to assess the benefit of one of these approaches (partial percutaneous plantar fascia release)that would be done under tibial nerve block in various patients with plantar fasciitis that resistant to the previous treatments. Methods: After local medical ethics committee approve a total of 126 patients diagnosed with resistant plantar fasciitis were collected, classified according to different items and treated on by partial percutaneous plantar fascia release under tibial nerve block by ultrasound guidance. The participants were continuously checked up for possible complications during one year. Results:&nbsp; The average age of the patients were participated in this study was 44.97 ± 7.3 years. The majority of the patients were females (almost 78%). The majority of the patients had functional problem at work or home (approximately 80%). This study detected that around 54.0% of the patients had right side plantar fasciitis, about 30% had left side and almost 16% had bilateral. 122 of 126 patients received three times steroid injections for treatment. The patients satisfaction for the percutaneous fasciotomy outcomes were approximately (94%) of the patients. Conclusion: This study showed that partial percutaneous plantar fascia release for plantar fasciitis patients under tibial nerve block is a safe medical surgery with considerable healing ability for them

Fluoroscopic and Endoscopic Calcaneal Spur Resection Without Plantar Fascial Release for Recalcitrant Plantar Fasciitis.

Background:Studies on endoscopic calcaneal spur resection (CSR) without plantar fascial release (PFR) are limited. This study aimed to review the data of patients who underwent fluoroscopic and endoscopic CSR without PFR for plantar fasciitis with a calcaneal spur to assess the effectiveness of CSR.Methods:Medical records of consecutive patients with plantar fasciitis with ≥2 mm calcaneal spur who underwent endoscopic CSR without PFR from November 2017 to December 2019 were reviewed. Patients with ≥2 years of follow-up were included, whereas those who underwent another surgery on the operated foot were excluded. Age, body mass index (BMI), follow-up duration, calcaneal spur length, duration to full weightbearing postoperatively, Japanese Society for Surgery of the Foot (JSSF) score, visual analog scale (VAS) score for pain, and complications were assessed.Results:The mean follow-up duration was 2.7 years. A total of 47 patients (31 female, 16 male; mean age, 56.4 years; mean BMI, 25.5) were included. The mean calcaneal spur length was 5.7 mm. The VAS score improved from 79.6 ± 12.9 mm preoperatively to 5.3 ± 7.3 mm postoperatively. The JSSF score improved from 54.0 ± 19.1 points preoperatively to 97.5 ± 5.7 points postoperatively (Wilcoxon signed-rank test, P < .001, respectively). The mean duration to full weightbearing postoperatively was 4.4 ± 4.2 days. Two patients presented with tenderness, and one presented with hypesthesia at the portal site.Conclusion:Endoscopic CSR without PFR resulted in good outcomes, early return to full weightbearing, and few complications in patients with plantar fasciitis with ≥2 mm calcaneal spur. The results suggested that CSR was sufficient to relieve symtoms and improve function. PFR may not be necessary for treating plantar fasciitis with calcaneal spur.Level of Evidence:Level IV, retrospective case series.

Increased Complication Rate Associated with Podiatric Surgery

Category:Other; Ankle; Bunion; Diabetes; Hindfoot; Midfoot/ForefootIntroduction/Purpose:Nationally, there has been an increase in the scope of practice between orthopaedic surgeons and podiatrists. However, there is a paucity of studies in the literature comparing outcomes between orthopaedic and podiatric surgeons in different areas of foot and ankle surgery.Methods:A retrospective analysis was conducted using 2016-2017 5% US national sample of the Medicare limited dataset (LDS). This included a total of 527 patients undergoing one of 14 CPT foot and ankle specific codes. Basic demographics, medical comorbidities, and 1-year post-surgical complications were reviewed. One-hundred and eighteen patients were operated on by a podiatrist versus 409 who were operated on by a physician. Mean age was 69. Common procedures included gastrocnemius recession (n=168), ankle fracture open reduction internal fixation (168), and Achilles tendon repair (72). Continuous variables were compared using Wilcoxon-Mann Whitney test and categorical variables with chi-squared test. In addition, a multivariable regression was performed, evaluating the impact of various factors on odds of complication.Results:Between cohorts, there were no statistically significant differences in demographics, Charlson Score, COPD, hypothyroidism, hypertension, or obesity. There was a higher rate of peripheral vascular disease in patients treated by a podiatrist versus a physician (8.5% vs. 2.4%; P=.0025). Univariate analysis showed complication rates were higher among podiatrist compared to physicians (29.7% vs. 18.8%; P=.0113). Specifically, there were high rates of complications for bunion correction (4.2% vs. 1.0%; P=.0160), diabetic wound infection (11.0% vs. 1.5%; P<0.0001), and plantar fascia release (7.6% vs. 0.1%; P=.0001). Multivariable logistic regression showed patients operated on by a podiatrist had 84.1% greater odds of suffering a complication than those operated on by a physician (OR: 1.84, 95% CI: 1.15-2.96).Conclusion:Surgical treatment of multiple types of foot and ankle conditions by orthopaedic surgeons was associated with lower complication rates when compared with podiatrists. The reasons for these differences are likely multifactorial, but warrants further investigation. Our findings have important implications for policymakers, as well as for large healthcare systems and patients when selecting a treating provider for surgical problems.

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.