A Review of 105 Consecutive Uniport Endoscopic Plantar Fascial Release Procedures for the Treatment of Chronic Plantar Fasciitis

Abstract

Level of Clinical Evidence: 3 Keywords: calcaneus chronic inflammation endoscopy heel pain plantar fasciitis surgery a b s t r a c t Plantar fasciitis is a common cause of heel pain in the U.S. Army soldier, resulting in a significant loss of man hours. Given the heavy operations tempo of the U.S. military, successful treatment options need to be considered and used as quickly as possible. Plantar fasciitis can be successfully treated in up to 90% of patients using conservative measures. Operative intervention might need to be considered for those in whom conservative measures have failed. The present report is a review of 105 consecutive uniport endoscopic plantar fascial release procedures performed by the principal investigator during a 9-year period. The following data were collected and analyzed: gender, age, weight, height, body mass index, medical treatment facility, procedure laterality, preoperative pain levels, postoperative pain levels at 3 months, first ambulatory day in the controlled ankle motion boot, return to activity as tolerated, and complications. Three major points were of interest: evidence of improvement in chronic plantar fasciitis when treated with uniport endoscopic procedures; the patient attributes associated with self-reported pain levels 90 days postoperatively; and the patient attributes associated with the average time until patients were able to return to activities as tolerated in a controlled ankle motion boot. It was noted that 44.5% of those with a body mass index of 29.80 kg/m 2 or greater reported a postoperative pain level of 0; and 96.3% of those with a body mass index of 25.53 kg/m 2 or less reported postoperative pain levels of 0. The analyzed data were used to characterize the clinical outcomes of the procedure, identify changes in outcome with surgeon experience, and identify whether certain patient subgroups have better outcomes, allowing surgeons to identify which patient might be the best candidates for an endoscopic release procedure.

Ultrasound-Guided Percutaneous Radiofrequency Lesioning When Treating Recalcitrant Plantar Fasciitis: Clinical Results

“…In contrast, patients with lower weights and BMIs had greater postoperative pain relief [14], and those with a BMI > 27 kg/m 2 had less favorable results [29]. Otherwise, older age seems a protective factor for an early postoperative return to work [14,15]. In our patients, the non-obese group showed significantly earlier pain reduction and functional improvement than did the obese group.…”

“…In the endoscopic release of plantar fascia, obesity was reported not to negatively affect the outcome [28]. In contrast, patients with lower weights and BMIs had greater postoperative pain relief [14], and those with a BMI > 27 kg/m 2 had less favorable results [29]. Otherwise, older age seems a protective factor for an early postoperative return to work [14,15].…”

“…It has been used to treat cancer [11], and we have used it to treat recalcitrant lateral epicondylitis [12]. It is well known that obesity, occupations that require prolonged standing, standing on hard surfaces, reduced ankle dorsiflexion, and heel spurs are risk factors for PF [1,13].The possible prognostic factors, including age at the index procedure and body mass index (BMI) [14,15], remain unclear. Anecdotally, in our daily practice, patients with higher BMIs seem to report later pain relief after RTL treatment.…”

Endoscopic Decompression of the First Branch of the Lateral Plantar Nerve and Release of the Plantar Aponeurosis for Chronic Heel Pain

“…[7][8][9][10][11][12][13][14][15][16][17] The technique has been modified to remove the plantar calcaneal spur 18 and plantar calcaneal bursa. 19 However, the deep abductor hallucis fascia cannot be released by the reported techniques of endoscopic plantar fascia release.…”

Treatment of Chronic Plantar Fasciitis With Percutaneous Latticed Plantar Fasciotomy

“…However, surgery can be considered for a small subgroup of carefully selected patients with persistent, severe symptoms despite nonoperative intervention for !6 to 12 months. A previous study showed that patients with a high body mass index could experience greater pain after surgery than leaner patients (27). The surgical procedures used for plantar fasciitis have included variations of open or closed partial or complete plantar fascia release with or without calcaneal spur resection, excision of abnormal tissue, and nerve decompression (28,29).…”