Functional outcome of mid-sole percutaneous plantar fasciotomy versus open plantar fasciotomy in treatment of refractory plantar fasciitis

Background Plantar fasciitis is one of the main causes of heel pain, which is one of the most prevalent complaints in foot and ankle clinics. Surgery may be necessary if conservative therapies have failed. The appropriate surgical technique has been debated, open plantar fasciotomy and percutaneous plantar fasciotomy are the two common surgical techniques.

The aim of the study is to compare the outcomes of open release versus percutaneous midsole release of the plantar fascia in this study to treat recalcitrant heel pain.

Methods A prospective study was conducted on 54 patients who had unresponsive plantar fasciitis following conservative treatment for at least six months. 20 patients in the 54 enrolled cases had open plantar fascia release, whereas the remaining 34 patients had percutaneous mid-sole plantar fascia release. All patients' surgical outcomes were evaluated using the Foot and Ankle Disability Index (FADI) both before and after the procedure and a follow-up period of one year was used to assess the functional results.

Results The percutaneous plantar fasciotomy group's mean foot and ankle disability index score improved statistically significantly from 39 ± 6 preoperatively to 101 ± 3 postoperatively, compared to 38 ± 5 preopera tively and 98 ± 2 postoperatively for the open plantar fasciotomy group at the final follow-up. Two patients in the percutaneous group experienced numbness at the site of surgery, compared to seven in the open group. By the time of the last follow-up, there had been no recurrence of pain.

Discussion We performed a percutaneous release of the mid-sole plantar fascia with a minimum incision and little dissection. We could thus access the plantar fascia effectively while preserving the surrounding tissues and maintaining optimal cosmetic results. Open plantar fascia release is the most conventional technique. However, disadvantages of the surgery include large wound, longer postoperative recovery time, and potential postoperative occurrence of complex regional pain syndrome.

Conclusion Both open and percutaneous plantar fascia releases resulted in a considerable improvement in the patients' limb function and pain symptoms. The long-term curative results of the two surgical treatments were identical. Due to fewer postoperative problems, percutaneous plantar fascia release is a superior procedure.

1. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25(5):303-310. doi: 10.1177/107110070402500505.

2. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234-237. doi: 10.7547/87507315-93-3-234.

3. Hossain M, Alexander P, Burls A, Jobanputra P. Foot orthoses for patellofemoral pain in adults. Cochrane Database Syst Rev. 2011;(1):CD008402. doi: 10.1002/14651858.CD008402.pub2.

4. McNeill W, Silvester M. Plantar heel pain. J Bodyw Mov Ther. 2017;21(1):205-211. doi: 10.1016/j.jbmt.2016.11.001.

5. Dyck DD Jr, Boyajian-O'Neill LA. Plantar fasciitis. Clin J Sport Med. 2004;14(5):305-309. doi: 10.1097/00042752-200409000-00010.

6. Petraglia F, Ramazzina I, Costantino C. Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscles Ligaments Tendons J. 2017;7(1):107-118. doi: 10.11138/mltj/2017.7.1.107.

7. Sinnaeve F, Vandeputte G. Clinical outcome of surgical intervention for recalcitrant infero-medial heel pain. Acta Orthop Belg. 2008;74(4):483-488.

8. Nuhmani S. Plantar fasciitis: a review of current concepts. Indian J Basic Appl Med Res. 2012;2(5):414-418.

9. Beeson P. Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg. 2014;20(3):160-165. doi: 10.1016/j.fas.2014.03.003.

10. Owens BD, Wolf JM, Seelig AD, et al. Risk Factors for Lower Extremity Tendinopathies in Military Personnel. Orthop J Sports Med. 2013;1(1):2325967113492707. doi: 10.1177/2325967113492707.

11. Ballas MT, Tytko J, Cookson D. Common overuse running injuries: diagnosis and management. Am Fam Physician. 1997;55(7):2473-84.

12. Schepsis AA, Leach RE, Gorzyca J. Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature. Clin Orthop Relat Res. 1991;(266):185-196.

13. Banerjee R, Chao JC, Taylor R, Siddiqui A. Management of calcaneal tuberosity fractures. J Am Acad Orthop Surg. 2012;20(4):253-258. doi: 10.5435/JAAOS-20-04-253.

14. Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 Suppl):S1-19. doi: 10.1053/j.jfas.2010.01.001.

15. Cheung JT, An KN, Zhang M. Consequences of partial and total plantar fascia release: a finite element study. Foot Ankle Int. 2006;27(2):125-132. doi: 10.1177/107110070602700210.

16. Davies MS, Weiss GA, Saxby TS. Plantar fasciitis: how successful is surgical intervention? Foot Ankle Int. 1999;20(12):803-807. doi: 10.1177/107110079902001209.

17. League AC. Current concepts review: plantar fasciitis. Foot Ankle Int. 2008;29(3):358-366. doi: 10.3113/FAI.2008.0358.

18. DuVries HL. Heel spur (calcaneal spur). AMA Arch Surg. 1957;74(4):536-542. doi: 10.1001/archsurg.1957.01280100054008.

19. Hassab HK, el-Sherif AS. Drilling of the os-calcis for painful heel with calcanean spur. Acta Orthop Scand. 1974;45(1):152-157. doi: 10.3109/17453677408989133.

20. Zirm RL, Jimenez AL. Results of heel spur surgery. In: DiNapoli DR (ed.). Reconstructive Surgery of the Foot and Leg, Update 1990. Tucker: Podiatry Insttitue Publishing; 1990:199-201.

21. Hale SA, Hertel J. Reliability and Sensitivity of the Foot and Ankle Disability Index in Subjects With Chronic Ankle Instability. J Athl Train. 2005;40(1):35-40.

22. Eechaute C, Vaes P, Van Aerschot L, et al. The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: a systematic review. BMC Musculoskelet Disord. 2007;8:6. doi: 10.1186/1471-2474-8-6.

23. Carcia CR, Martin RL, Drouin JM. Validity of the Foot and Ankle Ability Measure in athletes with chronic ankle instability. J Athl Train. 2008;43(2):179-183. doi: 10.4085/1062-6050-43.2.179.

24. Martin RL, Irrgang JJ. A survey of self-reported outcome instruments for the foot and ankle. J Orthop Sports Phys Ther. 2007;37(2):72-84. doi: 10.2519/jospt.2007.2403.

25. O'Malley MJ, Page A, Cook R. Endoscopic plantar fasciotomy for chronic heel pain. Foot Ankle Int. 2000;21(6):505-510. doi: 10.1177/107110070002100610.

26. Bazaz R, Ferkel RD. Results of endoscopic plantar fascia release. Foot Ankle Int. 2007;28(5):549-556. doi: 10.3113/FAI.2007.0549.

27. Butterworth M. How to address complications of plantar fascia release. Podiatry Today. 2010;23(11):1-5.

28. Barrett SL, Day SV. Endoscopic plantar fasciotomy: two portal endoscopic surgical techniques--clinical results of 65 procedures. J Foot Ankle Surg. 1993;32(3):248-256.

29. Liew SK, Saw A, Chua YP. Foot Arch Changes after Endoscopic Plantar Fascia Release for Recalcitrant Plantar Fasciitis. Malays Orthop J. 2022;16(2):78-86. doi: 10.5704/MOJ.2207.010.

30. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85(5):872-877. doi: 10.2106/00004623-200305000-00015.

31. Luffy L, Grosel J, Thomas R, So E. Plantar fasciitis: A review of treatments. JAAPA. 2018;31(1):20-24. doi: 10.1097/01.JAA.0000527695.76041.99.

32. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. 2005;72(11):2237-2242.

33. Davies MS, Weiss GA, Saxby TS. Plantar fasciitis: how successful is surgical intervention? Foot Ankle Int. 1999;20(12):803-807. doi: 10.1177/107110079902001209.

34. Lane GD, London B. Heel spur syndrome: a retrospective report on the percutaneous plantar transverse incisional approach. J Foot Ankle Surg. 2004;43(6):389-394. doi: 10.1053/j.jfas.2004.09.004.

35. Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur: Fact or fiction? Foot Ankle Surg. 2012;18(1):39-41. doi: 10.1016/j.fas.2011.03.003.