Foot Pain After a Plantar Fasciotomy: An MR Analysis to Determine Potential Causes

Abstract

The cause of foot pain in patients who had a plantar fasciotomy appeared to be multifactorial. Three likely causes of pain were identified: persistent or recurrent acute plantar fasciitis, pathology related to arch instability, and structural failure from overload.

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

“…The current prediction complies with the commonly observed postoperative lateral foot pain syndrome after fasciotomy. 4,22 The postoperative complications, such as acute plantar fasciitis, midfoot syndrome, and metatarsal stress fractures may be more painful than the initial heel pain. 4,22 Nonoperative treatment such as the use of stretching programs and orthoses should thus be done first to preserve the normal biomechanics of the ankle-foot complex.…”

“…4,22 The FE model predicted that operative release of 40% of the plantar fascia may result in a pronounced increase in load-bearing of the centralized metatarsal bones, plantar ligaments, and associated cuboidal joint capsules.…”

“…4,9,20 However, plantar fascia release decreases the stiffness of the foot and creates a more deformable foot arch or a pes planus foot. 9,14,22 These biomechanical consequences raise concerns about the adverse effects of decreased arch stability and biomechanical compensation of adjacent ligamentous structures, such as the plantar ligaments. Fewer than 50% of patients reported were satisfied with operative treatment.…”

Conservative Chiropractic Management of Recalcitrant Foot Pain After Fasciotomy: A Retrospective Case Review

“…In fact, there are reports in the literature of these changes being substantial enough to resul t in cuboid stress fract ure after operat ion. 12 Joint manipulation continues to grow in acceptance in the health care community. Numerous reports have shown its effectiveness in the management of spinal pain syndrom es, [13][14][15] an d emerging eviden ce suppor t the use of manipulation and mobilization in mechanical extremity probl ems as well.…”

Considerations in Metatarsalgia and Midfoot Pain: An MR Imaging Perspective

“…8 Additional predisposing factors that can contribute to the development of stress fractures of the metatarsal bones include altered weight bearing, recent foot surgery, and decreased height of the longitudinal arch of the foot. 9,10 When a fracture develops in the metatarsal bone, it tends to involve the midshaft or neck of the second, third, and fourth metatarsal bones, although in ballet dancers there is a higher propensity for the bases to be affected. Subchondral stress fractures can have a similar appearance to those that occur in the setting of neuropathic arthropathy.…”