Endoscopic Surgery for Plantar Fasciitis: Application of a Deep-Fascial Approach

• Published in: Arthroscopy Vol. 27; no. 8; pp. 1105 - 1109
• Main Authors: Komatsu, Fumito, M.D., Ph.D, Takao, Masato, M.D., Ph.D, Innami, Ken, M.D, Miyamoto, Wataru, M.D, Matsushita, Takashi, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2011; Elsevier
• Subjects: Adolescent; Adult; Aged; Arthroscopy; Arthroscopy - instrumentation; Arthroscopy - methods; Biological and medical sciences; Diseases of the osteoarticular system; Endoscopy; Fasciitis, Plantar - complications; Fasciitis, Plantar - surgery; Female; Heel Spur - complications; Heel Spur - surgery; Humans; Investigative techniques, diagnostic techniques (general aspects); Juxtaarticular diseases. Extraarticular rhumatism; Male; Medical sciences; Middle Aged; Orthopedic surgery; Orthopedics; Recovery of Function; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Young Adult; Juxtaarticular disease; Plantar fasciitis; Endoscopic surgery; Arthroscopy; Orthopedic surgery; Treatment; Diseases of the osteoarticular system; Surgical approach; Endoscopy
• ISSN: 0749-8063; 1526-3231
• DOI: 10.1016/j.arthro.2011.02.037

Purpose The purpose of this study was to determine the clinical results of deep-fascial medial and lateral portals in performing endoscopic surgery for plantar fasciitis. Methods In 10 feet in 8 patients who were treated conservatively for more than 6 months with failure to relieve their symptoms, endoscopic surgery was performed. After the patient was placed in the supine position, a medial portal was made 5 mm deep to the plantar fascia and 10 mm anterior to its origin on the calcaneus under fluoroscopy. The lateral portal was established by placing a blunt trocar deep and perpendicular to the plantar fascia. A 2.7-mm-diameter arthroscope was passed through the deep-lateral portal, and the operative devices were inserted through the deep-medial portal. A motorized shaver was used for making a working space to excise the fat tissue along with a portion of the flexor digitorum brevis muscle. If a heel spur existed, it was resected to establish a clear view of the plantar fascia by use of an arthroscopic burr. After exposure of the plantar fascia, its medial half was removed with electric devices such as an Arthro-Knife (ConMed Linvatec, Largo, FL). Results The mean score on the American Orthopedics Foot and Ankle Society Ankle Hindfoot Scale was 64.2 ± 6.3 points before surgery and 92.6 ± 7.1 points at 2 years after surgery ( P < .0001). The mean duration to full weight bearing after surgery was 13.9 ± 8.4 days. All patients returned to full athletic activities by a mean of 10.7 ± 2.6 weeks. Conclusions Endoscopic surgery for plantar fasciitis through a deep-fascial approach allows a wide field of vision and working space, permitting reliable resection of the plantar fascia and heel spur. Level of Evidence Level IV, therapeutic case series.