Heel spur syndrome: A retrospective report on the percutaneous plantar transverse incisional approach

The purpose of this retrospective study was to investigate patient satisfaction and pain relief of chronic heel spur syndrome via a percutaneous plantar transverse incisional surgical approach. Forty-five patients underwent the procedure between June 1995 and August 1997; 29 responded to a questionnaire. Of the 29 respondents, a 96% success rate was obtained (the procedure met or exceeded patient expectations) at an average of 21 months postoperatively. Based on a 10-point visual analog scale, pain improved from an average of 8.4 +/- 0.3 preoperatively to 1.2 +/- 0.3 at the time of the survey. The surgical technique is also described.     

Trigger point therapy and plantar heel pain: A case report

The cause of plantar heel pain and fasciitis has continued to be a diagnostic challenge even though it is one of the most common musculoskeletal disorders of the foot and ankle. The subject has evoked strong emotions and sparked intense debate regarding the likely causes and effective treatment options. Myofascial trigger point as a treatment option for plantar heel pain and fasciitis has been inconspicuous. The full extent of its significance and potential is largely unexplored in podiatric literature and medicine. Myofascial trigger point may offer an alternative explanation of the etiology of plantar heel pain and fasciitis.     

Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study.

Despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition. The objective of this study was to determine whether extracorporeal shock wave therapy can safely and effectively relieve the pain associated with chronic plantar fasciitis compared to placebo treatment, as demonstrated by pain with walking in the morning. This was set in a multicenter, randomized, placebo-controlled, double-blind, confirmatory clinical study undertaken in four outpatient orthopedic clinics. The patients, 114 adult subjects with chronic plantar fasciitis, recalcitrant to conservative therapies for at least 6 months, were randomized to two groups. Treatment consisted of approximately 3,800 total shock waves (+/-10) reaching an approximated total energy delivery of 1,300 mJ/mm(2) (ED+) in a single session versus placebo treatment. This study demonstrated a statistically significant difference between treatment groups in the change from baseline to 3 months in the primary efficacy outcome of pain during the first few minutes of walking measured by a visual analog scale. There was also a statistically significant difference between treatments in the number of participants whose changes in Visual Analog Scale scores met the study definition of success at both 6 weeks and 3 months posttreatment; and between treatment groups in the change from baseline to 3 months posttreatment in the Roles and Maudsley Score. The results of this study confirm that ESWT administered with the Dornier Epos Ultra is a safe and effective treatment for recalcitrant plantar fasciitis.     

应用跖内侧筋膜皮瓣修复足跟部皮肤软组织缺损

目的：研究修复足跟部皮肤软组织缺损的实用方法。方法：在解剖学研究的基础上，设计足底内侧邻位筋膜皮瓣转位修复足跟部皮肤软组织缺损。结果．临床应用12例，皮瓣全部成活，经8个月-8年随访，患足外观及功能恢复满意。结论：跖内侧邻位筋膜皮瓣转位可有效修复足跟部皮肤软组织缺损，操作简便、安全有效。本皮瓣是修复足跟皮肤软组织缺损的理想选择之一，适合在基层医院推广应用。     

Differentialdiagnose neurogener Fersenschmerz

Lesion of the tibial nerve and its branches in the foot is a common cause for neurogenic plantar heel pain. Diagnosis and management of nerve entrapment as a cause of plantar heel pain is still challenging. The purpose of this article was to provide a summary of possible localisations of nerve entrapment and typical diagnostic clinical findings, in order to differentiate between the individual neurogenic causes of plantar heel pain.     

Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures

Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique, or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique, or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p < 0.05). However contrary to our hypothesis, peak pressures under the second metatarsal were significantly increased by plantar fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p < 0.05). Plantar fasciotomy should not be added to distal metatarsal osteotomy in the treatment of metatarsalgia. If proximal dorsiflexion osteotomy would be preferred, plantar fasciotomy should be approached cautiously not to disturb the forefoot biomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:800–804, 2017.

     

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy,Ultrasound Therapy,and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial

We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm²; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm²); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles–Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes.     

The effectiveness of conservative,non-pharmacological treatment,of plantar heel pain: A systematic review with meta-analysis

Plantar heel pain is one of the most common causes of pain and musculoskeletal pathologies of the foot. The aim of this systematic review was to identify the most effective, conservative and non-pharmacological treatments regarding pain in patients with plantar heel pain.The authors searched 5 databases and included only randomized control trials which investigated the efficacy of a conservative non-pharmacological treatment compared to the placebo, for the outcome of pain.Study selection, data collection and risk of bias assessment were conducted independently by two authors, and consensus was reached with a third author. Results were quantitatively summarized in meta-analyses, by separating homogeneous subgroups of trials by type of intervention.A total of 20 studies that investigated the efficacy of 9 different types of interventions were included, with a total of 4 meta-analyses carried out. The interventions: shock waves, laser therapy, orthoses, pulsed radiofrequency, dry-needling, and calcaneal taping resulted in being effective treatments for the outcome pain in patients with plantar heel pain when compared to the placebo. However, considering that the improvements were very small, and the quality of evidence was mostly low or moderate for many of the interventions, it was not possible to give definitive conclusions for clinical practice.     

Paper Clip Localization: Easy Technique for Verification of Portal Placement for Endoscopic Plantar Fasciotomy Procedures

Surgeons are always searching for useful methods that enhance surgical accuracy. In the case of endoscopic plantar fasciotomy, identifying the optimal location for insertion of the endoscope for precise sectioning of the desired portion of the plantar fascia, without increasing the risk of injury to adjacent anatomic structures and without complicating the surgery in terms of time or costs, would be beneficial to patients and surgeons alike. In the present techniques report, a simple method for accurately determining the optimal location for placement of the endoscope for execution of plantar fasciotomy is described.     

Computer-assisted assessment of lateral column movement following plantar fascial release: a cadaveric study.

In patients who fail conservative treatment, releasing the plantar fascia relieves heel pain but destabilizes the lateral column of the foot. After surgery, pain can present in the area of the sinus tarsi, extensor digitorum brevis muscle, between the fourth and fifth metatarsals, and at the calcaneocuboid joint. The precise mechanism and involved structures for this painful compensation remains unclear. The authors hypothesized that the lateral plantar fascial band, bifurcate and cervical ligaments, lateral talocalcaneal ligament, and interosseous talocalcaneal ligament become excessively strained after this surgery. Using eight cadaver lower extremity limbs amputated 7 cm above the ankle joint, structural changes in the foot in response to staged release of the plantar fascia were measured. All ligament, tendon, and osseous structures were exposed along the plantar, medial, and lateral aspects of the foot and ankle. Using a servohydraulic system, compressive loads in increasing increments (50 lbs) were applied along the tibial axis. Tissue and bony structure displacement in the foot was measured using images electronically captured from two fixed cameras and a digital camera following each load change. All measurements were made in pixels and converted to millimeters in a spreadsheet program. Except for plantar fascial measurements, data were expressed as percentage of initial baseline. As expected, increasing compressive loads changed all measurements [repeated measures ANOVA, p<.04]. When releasing the plantar fascia, the inferior sinus tarsi space widened (intact, 85.4+/-10.8%; 1/4 release, 87.7+/-13.0; 1/2 release, 88.3+/-9.2; 3/4 release, 91.2+/-8.8; p<.04). Lateral length increased and medial height decreased, while medial length and lateral height were unchanged as the fascia was sequentially released. Significant movement of the inferior sinus tarsi strained the bifurcate and cervical ligaments, the lateral talocalcaneal ligament, and interosseous talocaneal ligament, which may account for pain following surgery. The initial 1/4 cut of the plantar fascia exerted the greatest mechanical alteration of the foot, suggesting that a partial release may relieve heel pain while optimizing the patient's chances of maintaining structural integrity with 75% of the plantar fascia intact.     

Endoscopic Plantar Fasciotomy; Deep Fascial Versus Superficial Fascial Approach: A Prospective Randomized Study

In the present randomized prospective study, 2 different surgical techniques of endoscopic plantar fascia release were compared. Of 547 patients with a diagnosis of plantar fasciitis, 46 with no response to conservative treatment for ≥6 months were included. Of the 46 patients, 5 were lost to follow-up. In group 1 (n = 21), plantar fascia release was performed using a deep fascial approach (DFA), and in group 2 (n = 20), the superficial fascial approach (SFA) with a slotted cannula technique was used. Patients were evaluated using the American Orthopaedic Foot and Ankle Society Ankle Hindfoot scale and visual analog scale at baseline and 3 weeks and 3, 6, and 12 months after the initial surgery. At the final follow-up appointment, the Roles-Maudsley score was used to determine patient satisfaction. At the final follow-up examination, the mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale scores had increased from 53.12 to 83.68, with a decrease in the mean visual analog scale score from 7.95 to 1.65 noted. According to the Roles-Maudsley score, the success rate after 1 year was 90.47% for DFA group, 95% for the SFA group, and 92.68% for all patients. Although no significant difference was found between the final functional scores, better early postoperative scores were found in the SFA group. The mean duration of the procedure was measured as 27.22 ± 9.41 minutes overall, 35 ± 5.62 minutes in the DFA group, and 19.05 ± 4.01 minutes in the SFA group. Two early and two late complications occurred in the DFA group with none reported in the SFA group. In conclusion, the SFA is a faster and safer method of endoscopic plantar fascia release with better early postoperative scores.     

Neurosensory testing of the medial calcaneal and medial plantar nerves in patients with plantar heel pain

Eighty-two patients with a chief complaint of plantar heel pain were evaluated for sensory abnormalities within the cutaneous distribution of both the medial calcaneal nerve and the medial plantar nerve, using quantitative neurosensory testing with a pressure-specified sensory device. The results showed that 22.68% of the patients displayed isolated abnormal sensory function within the distribution of the medial calcaneal nerve, whereas 49.48% of the patients displayed abnormal function within the distribution of both the medial calcaneal and the medial plantar nerves. Thus, 72.17% of the patients displayed abnormal sensory function within the distribution of the medial calcaneal nerve. Statistical analysis of the results, using the Pearson chi-square statistic and odds ratio, indicated that a significant percentage of patients with plantar heel pain, even early in the clinical course of plantar heel pain, display abnormal sensibility within the branches of the posterior tibial nerve, and specifically, within the distribution of the medial calcaneal nerve (P <.0008) and the medial plantar nerve (P <.0001).     

The clinical outcome of endoscopic plantar fascia release: A current concept review

PurposeTo clarify whether endoscopic plantar fascia release is safe and effective in the treatment of chronic plantar fasciitis. Secondary goals were a. to compare the clinical outcome between EPFR and non-operative treatment and b. to describe the various EPFR surgical approaches and their outcomes.Materials and methodsTwo reviewers (MM and EBC) independently conducted the search using the MEDLINE/PubMed database. This database was queried with the terms ‘endoscopic plantar fascia release’ and ‘endoscopic plantar fasciotomy’. To maximize the search, backward chaining of reference lists from retrieved papers was also undertaken.ResultsFrom the initial 63 studies we finally chose and assessed 15 studies which were eligible to our inclusion-exclusion criteria. A total number of 535 patients (576 feet) were reported, with a slightly higher female rate. The vast majority of the studies were case series (66.7% of all), while two papers were randomized controlled trials (13.3%), two were case control studies (13.3%), and one was cohort study (6.7%). The overall quality of the studies included in this review, as it was evaluated according to the GRADE Working Group guidelines, was low, while it ranged from very low to high. All studies showed that the postoperative clinical and functional subjective scores were significantly improved with the use of EPFR. Overall, the postoperative complications’ rate was 11.0%. The most common complications which were recorded were persistent heel pain (5.6%), paresthesias or numbness (4.3%), soft tissue healing problems (1.7%), and superficial infection (0.4%).ConclusionsThere was weak evidence to support that endoscopic plantar fascia release was safe and effective for the treatment of chronic plantar fasciitis.     

The role of corticosteroid injections in treating plantar fasciitis: A systematic review and meta-analysis

BackgroundPlantar fasciitis is a recurrent cause of heel pain and is often treated by corticosteroid infections (CSI). The current study reviewed and analysed the role of CSI with platelet rich plasma (PRP), and CSI with extracorporeal shock wave therapy (EWST) for plantar fasciitis treatment.MethodsPubMed, Medline, Web of Science, Embase, Cochrane, and Google Scholar databases were searched for relevant studies. Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA) guidelines were used to search relevant studies published from infinity to April 2021. The risk of bias was performed using Cochrane Collaboration’s tool. GRADE assessment was used for quality of evidence. Data analysis was performed with the use of R software and P < 0.05 was considered statistically significant. CSI was compared with PRP and EWST.ResultsEighteen studies comprising 1180 patients were included in this meta-analysis. When compared to PRP, CSI with lignocaine/lidocaine had significantly higher mean difference on visual analogue scale (VAS) pain scores at 3 months (0.62 [0.13; 1.12], P = 0.01) and 6 months (MD = 1.49 [0.22; 2.76], P = 0.02). At 6 months, VAS scores were higher in the CSI group than the ESWT group (MD = 0.8 [0.38; 1.22], P = 0.1). At 6 months, a significant reduction in the American Orthopaedic Foot and Ankle Score (AOFAS) was observed in the CSI group compared to PRP (MD = − 11.53 [− 16.62; − 6.43], P < 0.0001).ConclusionPatients suffering from plantar fasciitis, PRP achieved better VAS scores compared to CSI at 3 and 6-month follow-up. In addition, ESWT had better VAS score outcomes at 6 months compared to CSI. Regarding AOFAS score, PRP was more efficacious than CSI at 6 months of follow-up. Only through the development of high-quality, large-scale longitudinal studies, will the findings and conclusions of this meta-analysis be strengthened and influence our clinical practice in the treatment of plantar fasciitis.Level of clinical evidenceII.     

Biomechanical consequences of lateral column lengthening of the calcaneus: part I. long plantar ligament strain

Lateral column lengthening of the calcaneus has been a powerful tool used to correct peritalar subluxation in symptomatic flat feet. The mechanical basis and limits for correction with this procedure are not well understood. A flatfoot model was created on 8 fresh-frozen cadaver feet by sectioning the deltoid ligament, talonavicular capsule, and spring ligament. Strain-gauge analysis of the long plantar ligament was performed (on 6 specimens) as the lateral column was sequentially lengthened from 4 to 12 mm in 2-mm increments. Results showed that only the lateral most one-third of the long plantar ligament measured positive strain during this procedure. The medial two-thirds of the long plantar ligament and plantar fascia decreased in tension and became fully lax during lengthening. Maximum tension in the long plantar ligament was measured after placing grafts 6 mm in thickness (P <.05). Larger grafts produced additional strain in the ligament, but were not significant. The authors conclude that grafts >6 mm have no additional corrective capacity without compromising the long plantar ligament. Either larger graft size or loss of the long plantar ligament could compromise the intrinsic stability of the lateral column of the foot. These findings may decrease the incidence of complications with this procedure, specifically lateral column pain, instability, and calcaneocuboid arthrosis.     

Endoscopic Plantar Fasciotomy Through Two Medial Portals for the Treatment of Recalcitrant Plantar Fasciopathy

Plantar fasciopathy is a common cause of heel pain. Endoscopic plantar fasciotomy has the advantage of less surgical trauma and rapid recovery. The aim of the present prospective study was to delineate the results of endoscopic plantar fascia release through 2 medial portals. The present study included 2 groups. The first group included 27 feet in 25 patients that had undergone endoscopic plantar fascia release followed up for 19.7 (range 12 to 33) months. The second group, the control group, included 20 feet in 16 patients treated conservatively and followed up for 16.4 (range 12 to 24) months. The results of endoscopic plantar fascia release were superior to the conservative methods. The surgically treated group experienced significantly less pain, activity limitations, and gait abnormality. The presence of a calcaneal spur had no effect on the final postoperative score. In conclusion, endoscopic plantar fascia release through 2 medial portals is an effective procedure for treatment of resistant plantar fasciopathy that fails to respond to conservative management options.     

American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain

Adult acquired inferior calcaneal heel pain is a common pathology seen in a foot and ankle practice. A literature review and expert panel discussion of the most common findings and treatment options are presented. Various diagnostic and treatment modalities are available to the practitioner. It is prudent to combine appropriate history and physical examination findings with patient-specific treatment modalities for optimum success. We present the most common diagnostic tools and treatment options, followed by a discussion of the appropriateness of each based on the published data and experience of the expert panel.