Endoscopic partial plantar fasciotomy as a treatment alternative in plantar fasciitis.

OBJECTIVE

One of the most common causes of chronic heel pain is plantar fasciitis (ocalcaneal spur?). This condition most frequently occurs in patients over the age of 40. In most cases pain can be reduced or ceased by conservativ treatment, but in some patients therapy-resistant chronic pain can also develop. In these cases surgery may provide long term solution. The aim of this prospective observational study was to analyse the effectiveness of endoscopic surgery in patients with plantar fasciitis.

METHODS

Between 2001-2006 83 operations were performed on 74 patients (age: 47+/-11 years) by the same surgeon. All patients underwent conservative therapy before the operation, which did not solve their pain. In 41 cases the right and in 42 cases the left foot was affected. In 11 patients both sides had to be operated on.

METHODS

In each case endoscopic partial plantar fasciotomy was performed as described previously, modified by us. Patients were allowed to load full body weight on the operated foot on the first postoperative day. The patients' body mass index (BMI) was also recorded. Pain was assessed by using a visual analog scale (VAS) from 0-10. Patients had been followedup 1, 3, 6 and 12 months after surgery.

RESULTS

Pain was significantly lower at every assessment point as compared to preoperative values (p<0.01). The average period of time during which patients became pain free (i.e.: VAS=0) was 9.6 weeks. Most patients were overweight as indicated by the BMI=32.8+/-5.9 kg/m2. All but 3 operations proved to be successful as indicated by disappearence of pain. Two patients had reoperation of whom the BMI>30 kg/m2.

CONCLUSIONS

Patients with heel spur may benefit from operation if the conservative treatment is unsuccesful. The aim is to relieve the inflammation and irritation of the plantar aponeurosis. One alternative is endoscopic partial plantar fasciotomy. During the operation at least the two-third of the aponeurosis is released without the exstirpation of its calcificated part. As indicated by our results complaints disappeared in most cases within one month after surgery. There were only 3 complications two of which had incresed BMI, suggesting, that obesity may have an important impact on the symptoms and success of surgery. However, further studies are required to come to firm conclusion regarding BMI and plantar fasciitis.

CONCLUSIONS

In this prospective observational study it was found that endoscopic partial fasciotomy successfully releived pain in therapy- resistant cases of plantar fasciitis. Key words: heel pain, heel spur, plantar fasciitis, endoscopic partial plantar fasciotomy, plantar fascia release.