Plantar Fascia Release Research Articles

An evaluation of the long-term effects of total plantar fasciotomy—A preliminary study

Background Plantar fascia release for chronic plantar fasciitis has given excellent pain relief and rapid return to activities with few reported complications. Cadaveric studies have led to the identification of some potential post-operative problems, commonly weakness of the medial longitudinal arch (MLA) and pain in the lateral midfoot. Methods Eight total plantar fasciotomy patients (five bilateral and three unilateral) were evaluated subjectively and objectively with regards to surgical outcome and biomechanical change. The centre of pressure (COP) and loading of the foot were measured using the F Scan mobile system and COM’nalysis software. In addition, five control subjects were evaluated with the F Scan. The reading for one foot of one of the control subjects was discarded due to a biomechanical abnormality. Results The results of this study were that the COP of the foot in post-total plantar fasciotomy subjects was significantly laterally deviated throughout the propulsive phase of gait compared to that of control subjects ( p < 0.05). There was no significant difference in plantar pressure at the rearfoot or the first metatarsophangeal joint (MTPJt) between the post-operative and control groups ( p > 0.05). Six of the eight of the post-operative patients (11 feet) considered the procedure to be successful in resolving their symptoms. Conclusion Total plantar fasciotomy may result in changes to the COP of the foot. It could be extrapolated from this data, in conjunction with subjective visual clinical observations of gait, that supination of the foot could occur post-operatively rather than the pronatory state secondary to a collapsed arch that, collectively, the results of cadaver studies have suggested. The conclusions drawn from this pilot study are to some extent speculative, as the measurements were only made post-operatively and a small number of subjects were studied. Further research is required in this area.

Long-Term Results of Reconstruction for Treatment of a Flexible Cavovarus Foot in Charcot-Marie-Tooth Disease

Cavovarus foot deformity is common in patients with Charcot-Marie-Tooth disease. Multiple surgical reconstructive procedures have been described, but few authors have reported long-term results. The purpose of this study was to evaluate the long-term results of an algorithmic approach to reconstruction for the treatment of a cavovarus foot in these patients. We evaluated twenty-five consecutive patients with Charcot-Marie-Tooth disease and cavovarus foot deformity (forty-one feet) who had undergone, between 1970 and 1994, a reconstruction consisting of dorsiflexion osteotomy of the first metatarsal, transfer of the peroneus longus to the peroneus brevis, plantar fascia release, transfer of the extensor hallucis longus to the neck of the first metatarsal, and in selected cases transfer of the tibialis anterior tendon to the lateral cuneiform. Each patient completed standardized outcome questionnaires (the Short Form-36 [SF-36] and Foot Function Index [FFI]). Radiographs were evaluated to assess alignment and degenerative arthritis, and gait analysis was performed. The mean age at the time of follow-up was 41.5 years, and the mean duration of follow-up was 26.1 years. Correction of the cavus deformity was well maintained, although most patients had some recurrence of hindfoot varus as seen on radiographic examination. The patients had a lower mean SF-36 physical component score than age-matched norms, and the women had a lower mean SF-36 physical component score than the men, although this difference was not significant. Smokers had lower mean SF-36 scores and significantly higher mean FFI pain, disability, and activity limitation subscores (p < 0.0001). Seven patients (eight feet) underwent a total of eleven subsequent foot or ankle operations, but no patient required a triple arthrodesis. Moderate-to-severe osteoarthritis was observed in eleven feet. With the numbers studied, the age at surgery, age at the time of follow-up, and body mass index were not noted to have a significant correlation with the SF-36 or FFI scores. Use of the described soft-tissue procedures and first metatarsal osteotomy to correct cavovarus foot deformity results in lower rates of degenerative changes and reoperations as compared with those reported at the time of long-term follow-up of patients treated with triple arthrodesis.

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.

Consequences of Partial and Total Plantar Fascia Release: A Finite Element Study

Plantar fasciotomy, a common operative procedure to relieve chronic heel pain, has been suggested to decrease foot arch stability. A systematic evaluation of the biomechanical consequences of partial or total plantar fascia release is essential to the understanding of the biomechanical rationale behind these operative procedures. A geometrical detailed three-dimensional (3-D) finite element (FE) model of the human foot and ankle, incorporating geometrical and contact nonlinearities, was constructed by 3-D reconstruction of MR images. Partial and complete plantar fascia releases were simulated to evaluate the corresponding biomechanical effects on load distribution of the bony, ligamentous, and encapsulated soft-tissue structures. Partial and total plantar fascia release may decrease arch height but did not necessarily cause total collapse of the foot arch even with additional dissection of the long plantar ligament. Operative release of the plantar fascia was compromised by increased strains of the plantar ligaments and intensified stress in the midfoot and metatarsal bones. Load redistribution among the centralized metatarsal bones and focal stress relief at the calcaneal insertion were predicted with different types of fasciotomy. The FE model suggested that plantar fascia release may provide relief of focal stress and therefore could relieve associated heel pain. However, these operative procedures may pose a risk to arch stability and clinically may produce dorsolateral midfoot pain. The initial strategy for treating plantar fasciitis should be nonoperative. If surgery is necessary, partial release of less than 40% of the fascia is recommended to minimize the effect on arch instability and maintain normal foot biomechanics.

Effect of a sequential plantar fasciotomy on the width of the forefoot

Abstract The effect of a sequential proximal fascial release on the width of the forefoot was studied in 6 cadaveric feet. Six adult below knee cadaver specimens were axially loaded to 900N. The plantar fascia was sectioned sequentially (a third, half, complete release) from medial to lateral. After each sectioning a radiographic dorsoplantar view of the forefoot was obtained and radiologic parameters were determined. No significant change of values was seen in the hallux valgus angle, the proximal articular set angle and the intermetatarsal angle 1/5. However, a progressive increase of the intermetatarsal angle was determined during sequential sectioning of the fascia ( p =0.56). The increase of the IM angle for a static test indicates a stronger stabilizing effect on the plantar plate of the first two rays compared to the lateral forefoot. However, the overall effect of the plantar fascial release on the structure of the forefoot is not significant.

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.

Effects of plantar fascia stiffness on the biomechanical responses of the ankle–foot complex

Background. The plantar fascia is one of the major stabilizing structures of the longitudinal arch of human foot, especially during midstance of the gait cycle. Knowledge of its functional biomechanics is important for establishing the biomechanical rationale behind different rehabilitation, orthotic and surgical treatment of plantar fasciitis. This study aims at quantifying the biomechanical responses of the ankle–foot complex with different plantar fascia stiffness. Methods. A geometrical detailed three-dimensional finite element model of the human foot and ankle, incorporating geometric and contact nonlinearities was constructed by 3D reconstruction of MR images. A sensitivity study was conducted to evaluate the effects of varying elastic modulus (0–700 MPa) of the plantar fascia on the stress/strain distribution of the bony, ligamentous and encapsulated soft tissue structures. Findings. The results showed that decreasing the Young's modulus of plantar fascia would increase the strains of the long and short plantar and spring ligaments significantly. With zero fascia Young's modulus to simulate the plantar fascia release, there was a shift in peak von Mises stresses from the third to the second metatarsal bones and increased stresses at the plantar ligament attachment area of the cuboid bone. Decrease in arch height and midfoot pronation were predicted but did not lead to the total collapse of foot arch. Interpretation. Surgical dissection of the plantar fascia may induce excessive strains or stresses in the ligamentous and bony structures. Surgical release of plantar fascia should be well-planned to minimise the effect on its structural integrity to reduce the risk of developing arch instability and subsequent painful foot syndrome.

Biomechanical mechanisms of overuse injuries of second plantar longitudinal arch in flatfoot

To research biomechanical mechanism of overuse injuries of second metatarsal and plantar aponeurosis of flat foot and normal foot, to contrast injury risk of flat foot with that of normal foot in gait cycle, and to offer quantitative academic base for clinical therapeutic and preventive measures. Biomechanical MTS test, computational medicine means, finite element method and fatigue injury theory were adopted, fatigue behavior of flat foot and normal foot in gait cycle was simulated quantificationally by computer, their models successfully validated by test of stress concentration of foot bones and X-ray measurement of arch deformation. The finite element model of elastic arch of flat foot was established, peak values of fatigue stresses of second metatarsal and plantar aponeurosis in flat foot were individually 28.77 MPa and 12.53 MPa, these stresses of flat foot increased individually 8% approximately 21% and 21% approximately 51% than those of normal foot. Transfer of tension stresses of both flat foot and normal foot took place when plantar aponeurosis got infected or released partially, relative maximum of stress transfer occurred in plantar ligament, absolute maximum of stress transfer occurred in base of second metatarsal, the final stress of flat foot always overrun 0.26 approximately 5.32 MPa than normal foot. Von Mises stresses of both flat foot and normal foot are concentrated on second metatarsal and plantar aponeurosis, but peak values of fatigue stresses of flat foot are higher than normal foot. Tension stress of plantar aponeurosis is maximum in all plantar soft tissues, plantar fasciitis or surgical partial release of plantar fascia leads to transfer of tension stresses, and can aggravate overuse injury of plantar muscles and plantar ligament, also can add risk of fatigue fracture of second metatarsal. Internal rotation of flat foot, arch collapse, and hammer toe of second ray caused by bunions all can increase incidence rate of overuse injury in flat foot.

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.

Plantar Fascia Release With Proximal and Distal Tarsal Tunnel Release: A Surgical Approach to Chronic, Disabling Plantar Fasciitis With Associated Nerve Pain

Chronic symptoms from proximal plantar fasciitis develop in about 10% of patients with plantar heel pain. A subset of these patients will develop chronic disabling plantar heel pain with associated nerve pain. Surgical intervention, which allows for complete resolution of symptoms and return to full activity without limitations, has been difficult to achieve in this group of patients. This paper reviews the typical presentation and appropriate evaluation for patients with chronic proximal plantar fasciitis and distal tarsal tunnel syndrome. The authors present a surgical approach that has yielded promising results with improved rates of total patient satisfaction. The surgical technique employs a complete plantar fascia release combined with a proximal and distal tarsal tunnel release. A detailed postoperative protocol is presented, and it is felt to play a major role in successful surgical outcomes. Data are presented from a study of 33 patients with a minimum 2-year follow-up. In primary surgery patients, high rates of total patient satisfaction (82%) can be expected, with corresponding high rates of resolution of pain and elimination of activity limitations. However, revision surgery results utilizing this technique are much more unpredictable, and further modification of treatment approach is needed.

2003 William J. Stickel Gold Award. In vivo forces in the plantar fascia during the stance phase of gait: sequential release of the plantar fascia.

Plantar fasciotomies have become commonplace in podiatric and orthopedic medicine for the treatment of plantar fasciitis. However, several complications have been associated with plantar fascial release. It has been speculated that the cause of these complications is excessive release of the plantar fascia. The aim of this project was to determine whether the amount of fascia released, from medial to lateral, causes a significant increase in force in the remaining fascia. A dynamic loading system was developed that allowed a cadaveric specimen to replicate the stance phase of gait. The system was capable of applying appropriate muscle forces to the extrinsic tendons on the foot and replicating the in vivo timing of the muscle activity while applying force to the tibia and fibula from heel strike to toe-off. As the plantar fascia was sequentially released from medial to lateral, from intact to 33% released to 66% released, the real-time force and the duration of force in the remaining fascia increased significantly, and the force was shifted later in propulsion. In addition, the subtalar joint was unable to resupinate as the amount of fascia release increased, indicating a direct relationship between the medial band of the plantar fascia and resupination of the subtalar joint during late midstance and propulsion.

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.

Surgical treatment for plantar fasciitis

The results of surgical treatment of 16 patients with plantar fasciitis were reviewed. The indication for surgery was intolerable heel pain despite previous conservative measures. Patients requiring surgical treatment constituted only 7% of overall patients treated for plantar fasciitis. The surgical procedure involved an open medial partial plantar fascia release from the calcaneus and excision of calcaneal spur. A questionnaire about pain relief and function was sent to these patients who were not reviewed clinically. The follow-up ranged from 9 to 42 months. It was concluded that although 81% of patients reported improvement in clinical symptoms, only 44% of patients reported that their pain had completely disappeared. Mild wound complications were encountered in five and significant complications occurred in three patients. The re-operation rate was 6%. Patients need to be warned about surgical complications.

Lateral column symptomatology following plantar fascial release: A prospective study

Plantar fasciitis or heel spur syndrome usually resolves with conservative management, but for patients with continued pain, surgical intervention is often pursued. In some cases, plantar fasciitis is relieved, but pain in the lateral column area appears postoperatively. This lateral column pain may be debilitating for the patient and often overlooked by the foot and ankle surgeon. The goal of the study was to identify the maximum amount of plantar fascia that can be surgically released to treat recalcitrant heel pain effectively while preventing the development of lateral column symptoms. All patients undergoing plantar fasciotomy after failing conservative treatment were eligible to participate. Patients rated their pain with an 11-point (0-10) visual analog scale (VAS) and described its location prior to and at monthly intervals after their surgery. Surgeons recorded whether 25, 50, or 66% of the plantar fascia was released during surgery. Open procedures were performed 72% of the time, and endoscopically in 28% of the patients. Key outcome variables included degree of fascial release and foot structure. Patients (n = 47) with lateral column pain after surgery (n = 15 feet) had a mean +/- S.E. of 60.6 +/- 3.0% of their plantar fascia released while those without pain (n = 35 feet) had only 48.7 +/- 1.9% of this fascia released during surgery (ANOVA, p = .019). Age, weight, body mass index, gender, smoking status, comorbidities, general health, surgical procedure, postoperative care, calcaneal inclination angle, and talar declination angle did not differ for these groups (p > .146). For this patient population, regardless of surgical technique (endoscopic or open release), lateral column symptoms were more likely to result when more than 50% of the plantar fascia was released. The report proposes that a maximum of 50% of the plantar fascia be released during surgery.

Sectioning the plantar fascia. Effect on first metatarsophalangeal joint motion.

A study on the effect of sectioning the plantar fascia on the range of motion at the first metatarsophalangeal joint is presented. Dorsiflexion and plantarflexion range-of-motion data from 18 patients who had no first metatarsophalangeal joint pathology and had undergone an in-step plantar fasciotomy for recalcitrant plantar fasciitis were analyzed. The average increase in dorsiflexion of the first metatarsophalangeal joint after plantar fascia release was 9.8 degrees, which represented a statistically significant increase using a paired t-test. Thus release of the plantar fascia can be considered a potential adjunct to hallux limitus surgery.

Stress analysis of the standing foot following surgical plantar fascia release

Plantar fascia release is a surgical alternative for patients who suffer chronic heel pain due to plantar fasciitis and are unaffected by conservative treatment. A computational (finite element) model for analysis of the structural behavior of the human foot during standing was utilized to investigate the biomechanical effects of releasing the plantar fascia. The model integrates a system of five planar structures in the directions of the foot rays. It was built according to accurate geometric data of MRI, and includes linear and non-linear elements that represent bony, cartilaginous, ligamentous and fatty tissues. The model was successfully validated by comparing its resultant ground reactions with foot-ground pressure measurements and its predicted displacements with those observed in radiological tests. Simulation of plantar fascia release (partial or total) was accomplished by gradually removing parts of the fascia in the model. The results showed that total fascia release causes extensive arch deformation during standing, which is greater than normal deformation by more than 2.5 mm. Tension stresses carried by the long plantar ligaments increased significantly, and may exceed the normal average stress by more than 200%. Since the contribution of the plantar fascia to the foot's load-bearing ability is of major importance, its release must be very carefully considered, and the present model may be used to help surgeons decide upon the desired degree of release.

Computer-assisted assessment of lateral column movement following plantar fascial release: A cadaveric study

In patients who fail conservative treatment, releasing the plantar fascia relieves heel pain but destabilizes the lateral column of the foot. After surgery, pain can present in the area of the sinus tarsi, extensor digitorum brevis muscle, between the fourth and fifth metatarsals, and at the calcaneocuboid joint. The precise mechanism and involved structures for this painful compensation remains unclear. The authors hypothesized that the lateral plantar fascial band, bifurcate and cervical ligaments, lateral talocalcaneal ligament, and interosseous talocalcaneal ligament become excessively strained after this surgery. Using eight cadaver lower extremity limbs amputated 7 cm above the ankle joint, structural changes in the foot in response to staged release of the plantar fascia were measured. All ligament, tendon, and osseous structures were exposed along the plantar, medial, and lateral aspects of the foot and ankle. Using a servohydraulic system, compressive loads in increasing increments (50 lbs) were applied along the tibial axis. Tissue and bony structure displacement in the foot was measured using images electronically captured from two fixed cameras and a digital camera following each load change. All measurements were made in pixels and converted to millimeters in a spreadsheet program. Except for plantar fascial measurements, data were expressed as percentage of initial baseline. As expected, increasing compressive loads changed all measurements [repeated measures ANOVA, p<.04]. When releasing the plantar fascia, the inferior sinus tarsi space widened (intact, 85.4+/-10.8%; 1/4 release, 87.7+/-13.0; 1/2 release, 88.3+/-9.2; 3/4 release, 91.2+/-8.8; p<.04). Lateral length increased and medial height decreased, while medial length and lateral height were unchanged as the fascia was sequentially released. Significant movement of the inferior sinus tarsi strained the bifurcate and cervical ligaments, the lateral talocalcaneal ligament, and interosseous talocaneal ligament, which may account for pain following surgery. The initial 1/4 cut of the plantar fascia exerted the greatest mechanical alteration of the foot, suggesting that a partial release may relieve heel pain while optimizing the patient's chances of maintaining structural integrity with 75% of the plantar fascia intact.

Endoscopic Plantar Fascial Release

Summary: Plantar fasciitis continues to be one of the most common and frustrating causes of chronic heel pain. Non-operative methods continue to be the mainstay of treatment for this entity. However, both patients and physicians have struggled with the often-lengthy non-operative recovery period. As a result, operative methods have been developed to help treat those that fail a non-operative course. Open procedures for decompression have been around for nearly a century. However, it was not until 1991 that an effective endoscopic procedure was developed to attempt a more minimally invasive approach. Since its introduction, surgeons have evaluated the results and made modifications to the original procedure. Additionally, the indications for its use have narrowed. Endoscopic plantar fascial release can be an effective procedure to treat primarily plantar fasciitis with its associated chronic micro-tears of the fascia. This procedure has proven to be much less effective in treating neurogenic causes of heel pain. This article is an update of the current concepts on endoscopic plantar fascial release.

Five-year follow-up results of instep plantar fasciotomy for chronic heel pain

The results of a 5-year follow-up of patients who underwent surgical partial release of plantar fascia with plantar skin incision for treatment of chronic heel pain are presented. Evaluation included survey results from both a modified Mayo Scoring System and a list of specific questions developed by the authors. Thirty-three feet of 30 patients are evaluated. Thirty of the 33 feet studied achieved good or excellent results, scoring 80 or better on a 100-point scale. Ninety percent pain relief was achieved in 27 of the 33 feet studied (81.8%). A satisfaction rate of 90% or better was found with 30 of the 33 feet studied (90.9%). Long-lasting complications were described by five patients, including opposite foot pain, dorsal foot pain after extended activity, scar tissue discomfort, callus at scar area, and continued heel pain.

Endoscopic plantar fasciotomy for chronic heel pain.

The purpose of our study was to determine whether endoscopic plantar fasciotomy is a safe and effective operation in this patient population. We reviewed our surgical results following endoscopic plantar fasciotomy in sixteen patients (twenty feet) with an average preoperative duration of symptoms of four years. Of the 20 feet, 9 had complete relief of pain while symptoms were improved in nine feet. One patient with bilateral symptoms had no relief in either foot. The average AOFAS hindfoot score improved from 62 to 80, a statistically significant difference. Unilateral patients did better than bilateral with no bilateral patients reporting complete resolution of symptoms. There were no iatrogenic nerve injuries. On the basis of our review, we recommend endoscopic plantar fasciotomy as an alternative to open plantar fascial release for those patients with recalcitrant heel pain.