Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (EFRPF)

Abstract

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.

The Topaz Micro-Radiofrequency Ablation Achieves Similar Results to Endoscopic Plantar Fascia Release

“…This led to the development of multiple procedures for symptomatic relief, including cryosurgery [10], botulinum toxin injection [14], and extra-corporeal shock wave therapy [9]. Currently a commonly used technique is endoscopic release of the fascia [8], but recently a percutaneous novel radiofrequency based technique has been described [15]. The main advantage of the percutaneous technique might be reduction in the occurrence of neuropraxia after open and endoscopic interventions [16], CRPS [7], lateral column syndrome, as well as iatrogenic pes planus [17].…”

“…Endoscopic plantar fasciotomy allows faster return to regular activities in comparison with open surgical approaches [6]. Risks associated with plantar fascia surgery include complex regional pain syndrome [7], nerve damage and lateral column collapse [7,8].…”

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

“…Furthermore, no consensus has been reached on which of the various endoscopic approaches is best (1). Investigators have described uni-and multiport procedures both with and without insufflations (8)(9)(10). Beginning in 2001, the principal investigator (T.N.M.)…”

Ortopedi ve travmatolojide şok dalga tedavisi

“…Ancak, cerrahi yöntemlerde iyileşmenin uzun sürmesi, operasyon sonrası alçı immobilizasyonu ve rehabilitasyon ihtiyacı, ayak biyomekaniğinin bozulması ve düşük oranda da olsa komplikasyonlar ve rekürrens olguları bildirilmiştir. [99,100] yetersiz kalmaktadır. Bundan dolayı, her ne kadar bu çalışmalar başarılı sonuçlar bildirse de; çalışmaların kanıt gücünün (level of evidence) düşük olması ESWT'nin tedavi etkinliği hakkında net bir fikre varılmasını engellemektedir.…”