Surgical treatment of resistant chronic painful heel using endoscopic versus open approaches

Abstract

Background Plantar fasciitis has been reported to be the commonest cause of inferior heel pain. Most cases of plantar fasciitis respond to conservative nonsurgical measures. In 5–10% of the cases of plantar fasciitis resistant to conservative treatment, surgery may be required. Plantar fascia release performed by sectioning a part of the fascia via an open or endoscopic procedure has been the mainstay of treatment. This study was conducted to compare the outcome of open versus endoscopic plantar fascia release in cases of chronic resistant heel pain. Patients and methods A total of 50 patients with comparable demographics having chronic persistent heel pain that was diagnosed clinically to be due to plantar fasciitis were randomized to either open or endoscopic plantar fascia release. The patients were randomly divided in two groups; each consisted of 25 patients. The open procedures was done through a 3-cm medial incision, whereas the endoscopic procedure was done by the two-portal technique. The patients were assessed preoperatively and postoperatively using the modified American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. In addition, the patient’s overall satisfaction with the procedure, pain level, time taken to return to full activity, and the complication rate were determined. Results The postoperative score was significantly better in group I (the endoscopic group) than group II (the open surgery group). Regarding the pain, restoration of the function without imitation was significantly better in the endoscopic group. Conclusion Endoscopic plantar fasciotomy is a minimally invasive procedure that entails minimal soft tissue dissection, excellent visualization of the plantar fascia, precision in transecting only the medial one-third of the plantar fascia, and thus minimizing postoperative instability. It also results in minimal postoperative pain, with early return to full weight-bearing status and earlier return to normal activities of daily living.