Uniportal Endoscopic Plantar Fasciotomy: A Prospective Study on Athletic Patients

Abstract

Background: Endoscopic techniques have been described to surgically treat plantar fasciitis in the general patient population. A prospective, single-surgeon study was conducted to evaluate if a uniportal endoscopic plantar fasciotomy technique is effective in allowing athletic patients to return to their desired activities. Methods: Sixteen patients with plantar fasciitis who were athletically active were compared to a control group that consisted of 10 patients who did not engage in sports. Most of the athletic patients were runners. Mean age at time of surgery was 39.8 ± 13.1 years for the athletic group and 51.2 ± 5.5 years for the control group (p < .01). All patients had conservative treatment for a minimum of 8 months (mean 19.4 months; range 8 to 50). All patients were rated for body mass index (BMI), and the Modified Plantar Fascia Score (MPFS) was obtained before and after endoscopic release. The preoperative MPFS was 42.0 ± 2.5 for the athletic group and 23.6 ± 15.7 for the control group (p < .01). All patients had uniportal endoscopic plantar fasciotomy with transection of the medial 50% of the plantar fascia. Postoperatively patients were kept in a low, below-knee, removable cast-boot for a total of 4 weeks, nonweightbearing for the first 2 weeks. Results: The mean return-to-activity time after surgery was 2.6 ± 0.7 months. The mean postoperative MPFS was 93.3 ± 2.4, which was a significant improvement (p = .00001). Using this scoring system score, all results in athletes were excellent or good. The control group had a mean postoperative MPFS of 63.6 ± 27.1, also significantly improved (p = .0006) but lower than the athletic group (p = .00001). All five poor results in the controls had a BMI of more than 27. Good or excellent results in the control group were obtained only in patients who walked for exercise. The BMI was statistically lower in the athletic group than in the control group (p = .00001). The average BMI in women was significantly higher (p = .02) than in men, and they required a longer time to return to activity (p = .01). Conclusion: Athletic patients undergoing uniportal endoscopic plantar fasciotomy can expect good to excellent results based on the MPFS. Fifty percent of the patients with a BMI of more than 27 had poor results.

Keywords

Plantar Fasciotomy Endoscopy Athletes Plantar Fasciitis

Get full access to this article

View all access options for this article.

References

1. Barrett

Day

: Endoscopic plantar fasciotomy: preliminary study with cadaveric specimens J. Foot Ankle Surg. 30:568–70, 1991.

2. Barret

Day

Pignetti

Robinson

: Endoscopic plantar fasciotomy: a multi-surgeon prospective analysis of 652 cases J. Foot Ankle Surg. 34:400–406, 1995.

3. Boberg

Dauphinee

: Plantar heel In: A

Banks

Downey

Martin

Miller

, editors. McGlamry's Comprehensive Textbook of Foot and Ankle Surgery., 3rd Edition Philadelphia, PA USA: Lippincott Williams & Wilkins, pp 464–477, 2001.

4. Brekke

Green

: Retrospective analysis of minimal incision, endoscopic, and open procedures for heel spur syndrome J. Am Podiatr. Med. Assoc. 88:64–72, 1998.

5. Brugh

Fallat

Savoy-Moore

: Lateral column symptomatology following plantar fascia release: a prospective study J. Foot Ankle Surg. 41:365–371, 2002.

6. Daly

Kitaoka

Chao

: Plantar Fasciotomy for Intractable Plantar Fasciitis: Clinical Results and Biomechanical Evaluation Foot Ankle Int. 13:188–195, 1992.

7. Gentile

Zizo

Dahukey

Berman

: Traumatic pseudoaneurysm of the Lateral plantar artery after endoscopic plantar fasciotomy Foot Ankle Int. 18:821–822, 1997.

8. Gormley

Kuwada

: Retrospective analysis of calcaneal spur removal and complete fascial release for the treatment of chronic heel pain J. Foot Ankle Surg. 32:166–170, 1993.

9. Hawkins

Langerman

Gibbons

Calhoun

: An anatomic analysis of endoscopic plantar fascia release Foot Ankle Int. 16:552–558, 1995.

10.

10. Hofmeister

Elliot

Juliano

: Endoscopic plantar fascia release: An anatomical study Foot Ankle Int. 16:719–723, 1995.

11.

11. Jeran

McElgun

Mirza

King

: Single portal endoscopic plantar fascial release: operative technique with preliminary results Lower Extrem. 4:103–107, 1997.

12.

12. Kinely

Frascone

Calderone

: Endoscopic plantar fasciotomy versus traditional heel spur surgery. A prospective study J. Foot Ankle Surg. 32:595–603, 1993.

13.

13. Leach

Seavey

Salter

: Results of surgery in athletes with plantar fasciitis Foot Ankle Int. 7:156–161, 1986.

14.

14. Lutter

: Surgical decisions in athletes' subcalcaneal pain Am. J. Sports Med. 14:481–486, 1986.

15.

15. O'Malley

Page

Cook

: Endoscopic plantar fasciotomy for chronic heel pain Foot Ankle Intl 21:505–510, 2000.

16.

16. Rompe

Decking

Schoellner

Nafe

: Shock wave application for chronic plantar fasciitis in running athletes Am. J. Sports Med. 31:268–274, 2003.

17.

17. Sammarco

Idusuyl

: Stress fracture of the third metatarsal after endoscopic plantar fasciotomy: a case report Foot Ankle Int. 19:157–159, 1998.

18.

18. Schepsis

Leach

Gorzyca

: Plantar fasciitis: Etiology, treatment, surgical results and review of the literature Clin. Orthop. 266:185–196, 1991.

19.

19. Snider

Clancy

McBeath

: Plantar fascia release for chronic plantar fasciitis in runners Am. J. Sports Med. 11:215–219, 1983.

20.

20. Stone

Davies

: Retrospective review of endoscopic plantar fasciotomy- 1992 through 1994 J. Am. Podiatr. Med. Assoc. 86:4141–420, 1996.

21.

21. Stone

McClure

: Retrospective analysis of endoscopic plantar fasciotomy. 1994 through 1997 J. Am. Podiatr. Med. Assoc. 90:89–93, 1999.

22.

22. Testa

Maffulli

Capasso

Bifulco

: Percutaneous longitudinal tenotomy in chronic Achilles tendonitis Bull. Hosp. Joint Dis. 54:241–44, 1996.

23.

23. Thordarson

Pradeep

Hedman

Ebramzadeh

: The effect of partial versus complete plantar fasciotomy on the windlass mechanism Foot Ankle Int. 18:16–20, 1997.

24.

24. Tomczak

Haverstock

: A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome J. Foot Ankle Surg. 34:305–311, 1995.

25.

25. Ward

Smith

Cocheba

Patterson

Phillips

: In vivo forces in the stance phase of gait: sequential release of the plantar fascia J. Am Podiatr. Med. Assoc. 93:429–442, 2003.

26.

26. Wolgin

Cook

Graham

Mauldin

: Conservative treatment of plantar heel pain: Long term follow-up Foot Ankle Int. 15:97–102, 1994.

27.

27. Zimmerman

Cardinal

Cragel

Goel

Lane

Schramm

: Comparison of three types of post-operative management for endoscopic plantar fasciotomy. A retrospective study J. Am. Podiatr. Assoc. 90:247–51, 2000.