Does the minimally invasive complete plantar fasciotomy result in deformity of the Plantar arch? A prospective study

• Published in: Foot and ankle surgery Vol. 26; no. 3; pp. 347 - 353
• Main Authors: De Prado, Mariano, Cuervas-Mons, Manuel, De Prado, Virginia, Golanó, Pau, Vaquero, Javier
• Format: Journal Article
• Language: English
• Published: France Elsevier Ltd 01.04.2020
• Subjects: Adult; Aged; Calcaneus - surgery; Fasciitis, Plantar - surgery; Fasciotomy; Fasciotomy - methods; Female; Humans; Male; Middle Aged; Minimally invasive surgery; Minimally Invasive Surgical Procedures - methods; MIS; Percutaneous; Plantar fasciitis; Prospective Studies; Young Adult; Plantar fasciitis; Minimally invasive surgery; Fasciotomy; Percutaneous; MIS
• ISSN: 1268-7731; 1460-9584
• DOI: 10.1016/j.fas.2019.04.010

•The percutaneous total fascia release is a safe procedure.•The percutaneous total fascia release does not produce an arch instability based on radiological findings in patients.•The percutaneous plantar fasciotomy is an effective approach, and met or exceed the patient expectations.•Lack of success after surgery may be explained by other pathologies simulating plantar fasciitis. Complete plantar fasciotomy has been associated with changes in foot loading, leading to medial longitudinal arch collapse. The purpose of this study is to analyse our clinical experience with percutaneous complete plantar fasciotomy and quantify the possible changes in foot loading measured by the calcaneal pitch angle. A prospective case series study with patients operated between 2005–2012 was conducted, where AOFAS, Maryland Foot Score (MFS), VAS and radiological calcaneal pitch (CP) were recorded. Postoperative data were collected, where the surgeon evaluated the presence of complications, and an independent investigator performed radiological and scale evaluations follow-up: AOFAS, MFS, VAS and Benton-Weil questionnaire. A total of 60 patients, 62 feet, with a mean follow-up of 57 months (range 13–107) were studied. The MFS increased a mean of 21 points (p=.001), the AOFAS score a mean of 25 points (p=.001), and the VAS decreased a mean of 8.89 points (p=.001). A total of fifty-seven feet (91.9%) were pain-free at the end of follow-up. The mean CP dropped from 20.2° (range 11–34) preoperatively to 19.3° (range 11–34) at the end of follow-up (p=.05). In 25 feet (40.3%) there were no changes in the calcaneus pitch angle, in 21 feet dropped 1° (33.9%), in 11 dropped 2° (17.8%), 3 feet 3° (4.8%) and 2 feet (3.2%) 4°. Postoperative complications were noted in 4 feet (6.4%), with lateral column pain. The surgery meets the expectations of all patients. Percutaneous total fascia release is safe and does not produce a significant drop in arch height based on the radiological finding. Lack of success after surgery may be explained by other pathologies that might appear like plantar fasciitis. Further studies with gait analysis after total plantar fascia release in patients are needed.