Skip to main content
SpringerLink
Log in

Endoscopic fasciotomy for plantar fasciitis provides superior results when compared to a controlled non-operative treatment protocol: a randomized controlled trial

  • ANKLE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Plantar fasciitis is a frequent and painful condition with a lifetime incidence of 10%. Good results have been reported for operative treatment of plantar fasciitis refractory to non-surgical interventions in uncontrolled studies. The aim of this study was to compare the results of operative treatment (endoscopic debridement, removal of the heel spur and partial resection of the plantar fascia) with those of a controlled and supervised non-operative rehabilitation program.

Methods

Thirty consecutive patients with plantar fasciitis during more than 3 months were randomized to either (1) non-operative treatment with corticosteroid injections and a controlled strength training program or (2) an endoscopic 2-incision operation with partial fasciotomy and heel spur removal followed by the same strength training program. Patients were evaluated at entry and 3, 6, 12 and 24 months post-operatively with the foot function index (FFI) and pain score during activity on a 100 mm VAS scale (VAS activity). FFI at 6 and 12 months was defined a priori as primary endpoint.

Results

Both groups improved significantly over time. The FFI score was significantly better in the operated group compared to the non-surgically treated group 12 months post-operatively (p = 0.033), at 24 months this was, however, not significant (p = 0.06). VAS activity at 24 months was significantly (p = 0.001) in favor of the operative group. More patients returned to running and jumping in the operative group (p = 0.04).

Conclusion

This randomized controlled trial found significant and clinically relevant superior results for the operative treatment of plantar fasciitis as measured by Foot Function Index at 1 year and by VAS activity at 2-year follow-up when compared to the results of a supervised rehabilitation program.

Level of evidence

I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Al Ashhab ME, Elbegawy HEA, Hasan HAA (2018) Endoscopic plantar fasciotomy through two medial portals for the treatment of recalcitrant plantar fasciopathy. J Foot Ankle Surg 57(2):264–268

    Article  Google Scholar 

  2. Barrett SL, Day SV, Pignetti TT, Robinson LB (1995) Endoscopic plantar fasciotomy: a multi-surgeon prospective analysis of 652 cases. J Foot Ankle Surg 34(4):400–406

    Article  CAS  Google Scholar 

  3. Barrett SL, Day SV (1993) Endoscopic plantar fasciotomy: two portal endoscopic surgical techniques clinical results of 65 procedures. J Foot Ankle Surg 32(3):248–256

    CAS  PubMed  Google Scholar 

  4. Blanco CE, Leon HO, Guthrie TB (2001) Endoscopic treatment of calcaneal spur syndrome: a comprehensive technique. Arthroscopy 17(5):517–522

    Article  CAS  Google Scholar 

  5. Budiman-Mak E, Conrad KJ, Roach KE (1991) The foot function index: a measure of foot pain and disability. J Clin Epidemiol 44:561–570

    Article  CAS  Google Scholar 

  6. Catal B, Keskinbora M, Uysal MA, Şahin M, Gulabi D, Demiralp B (2017) Endoscopic plantar fasciotomy; deep fascial versus superficial fascial approach: a prospective randomized study. J Foot Ankle Surg 56(5):1001–1008

    Article  Google Scholar 

  7. Chou AC, Ng SY, Koo KO (2016) Endoscopic plantar fasciotomy improves early postoperative results: a retrospective comparison of outcomes after endoscopic versus open plantar fasciotomy. J Foot Ankle Surg 55(1):9–15

    Article  Google Scholar 

  8. Cottom JM, Maker JM, Richardson P, Baker JS (2016) Endoscopic debridement for treatment of chronic plantar fasciitis: an innovative technique and prospective study of 46 consecutive patients. J Foot Ankle Surg 55(4):748–752

    Article  Google Scholar 

  9. David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS (2017) Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev 2017:009348

    Google Scholar 

  10. DeMaio M, Paine R, Mangine RE, Drez D Jr (1993) Plantar fasciitis. Orthopedics 16:1153–1163

    CAS  PubMed  Google Scholar 

  11. DiGiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF (2003) Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. J Bone Jt Surg 88:1775–1781

    Article  Google Scholar 

  12. El Shazly O, El Beltagy A (2010) Endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal for management of painful heel syndrome. Foot 20(4):121–125

    Article  Google Scholar 

  13. Fallat LM, Cox JT, Chahal R, Morrison P, Kish J (2013) A retrospective comparison of percutaneous plantar fasciotomy and open plantar fasciotomy with heel spur resection. J Foot Ankle Surg 52(3):288–290

    Article  Google Scholar 

  14. Jerosh J, Schunk J, Liebsch D, Filler T (2004) Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (EFRPF). Knee Surg Sports Traumatol Arthrosc 12:471–477

    Google Scholar 

  15. Johannsen F, Herzog RB, Malmgaard-Clausen NM, Hoegberget-Kalisz M, Magnusson SP, Kjaer M (2019) Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training. Knee Surg Sports Traumatol Arthrosc 27(1):5–12

    Article  Google Scholar 

  16. Johannsen F, Jensen S, Stallknecht SE, Olsen LO, Magnusson SP (2016) Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable: a test-retest intra- and intertester study. J Clin Ultrasound 44(8):480–486

    Article  Google Scholar 

  17. Johannsen F, Konradsen L, Herzog R, Krogsgaard MR (2019) Plantar fasciitis treated with endoscopic partial fasciotomy—one year clinical and ultrasonographic follow-up. Foot 39:50–54

    Article  Google Scholar 

  18. Kinley S, Frascone S, Calderone D, Wertheimer SJ, Squire MA, Wiseman FA (1993) Endoscopic plantar fasciotomy versus traditional heel spur surgery: a prospective study. J Foot Ankle Surg 32(6):595–603

    CAS  PubMed  Google Scholar 

  19. Kogler GF, Solomonides SE, Paul JP (1995) In vitro method for quantifying the effectiveness of the longitudinal arch support mechanism of a foot orthosis. Clin Biomech 10:245–252

    Article  CAS  Google Scholar 

  20. Komatsu F, Takao M, Innami K, Miyamoto W, Matsushita T (2011) Endoscopic surgery for plantar fasciitis: application of a deep-fascial approach. Arthroscopy 27(8):1105–1109

    Article  Google Scholar 

  21. Landorf KB, Radford JA (2008) Minimal important difference:values for the foot health status questionnaire, foot function index and visual analogue scale. Foot 18:15–19

    Article  Google Scholar 

  22. Lopes AD, Hespanhol Junior LC, Yeung SS, Costa LO (2012) What are the main running-related musculoskeletal injuries? A systematic review. Sports Med 42(10):891–905

    Article  Google Scholar 

  23. Lundeen RO, Aziz S, Burks JB, Rose JM (2000) Endoscopic plantar fasciotomy: a retrospective analysis of results in 53 patients. J Foot Ankle Surg 39(4):208–217

    Article  CAS  Google Scholar 

  24. Lynch DM, Goforth WP, Martin JE, Odom RD, Preece CK, Kotter MW (1998) Conservative treatment of plantar fasciitis: a prospective study. J Am Podiatr Med Assoc 88:375–380

    Article  CAS  Google Scholar 

  25. Mahowald S, Legge BS, Grady JF (2011) The correlation between plantar fascia thickness and symptoms of plantar fasciitis. J Am Pod Med Ass 101(5):385–389

    Google Scholar 

  26. Mao DW, Chandrakumara D, Zheng Q, Kam C, King CKK (2019) Endoscopic plantar fasciotomy for plantar fasciitis: a systematic review and network meta-analysis of the English literature. Foot 41:63–73

    Article  Google Scholar 

  27. Marieb EN (2001) Anatomy and physiology, 5th edn. Benjamin Cummings, San Francisco

    Google Scholar 

  28. Nery C, Raduan F, Mansur N, Baunfeld D, Del Buono A, Maffulli N (2013) Endoscopic approach for plantar fasciopathy: a long-term retrospective study. Int Orthop 37(6):1151–1156

    Article  Google Scholar 

  29. Radwan YA, Mansour AMR, Badawy WS (2012) Resistant plantar fasciopathy: shock wave versus endoscopic plantar fascial release. Int Orthop 36:2147–2156

    Article  Google Scholar 

  30. Rathleff MS, Molgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL (2015) High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12 months follow-up. Scand J Med Sci Sport 25(3):292–300

    Article  Google Scholar 

  31. Roos E, Engstrom M, Soderberg B (2006) Foot orthoses for the treatment of plantar fasciitis. Foot Ankle Int 27:606–611

    Article  Google Scholar 

  32. Tomczak RL, Haverstock BD (1995) 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(3):305–311

    Article  CAS  Google Scholar 

  33. Vohra PK, Kincaid BR, Japour CJ, Sobel E (2002) Ultrasonographic evaluation of plantar fasciitis bands—a retrospective study of 211 symptomatic feet. J Am Podiatr Med Assoc 92:444–449

    Article  Google Scholar 

  34. Werner RA, Gell N, Hartigan A, Wiggermann N, Keyserling W (2010) Risk factors for plantar fasciitis among assembly plant workers. PMR 2:110–116

    Article  Google Scholar 

Download references

Funding

The study was funded by the involved departments.

Author information

Authors and Affiliations

  1. Institute of Sports Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark

    Finn Johannsen

  2. Section for Sports Traumatology M51, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark

    Lars Konradsen & Michael Rindom Krogsgaard

  3. Department of Physiotherapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark

    Robert Herzog

Authors
  1. Finn Johannsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lars Konradsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Herzog
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Rindom Krogsgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FJ recruited patients, performed the follow-up, and registered the data. LK and MRK performed the surgery. RH was responsible for the rehabilitation of both conservative and operated subjects. All authors contributed to the production of the manuscript.

Corresponding author

Correspondence to Lars Konradsen.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The study was in accordance with the ethical standards of the Regional Ethical Committee (H-2-2012-151) and registered in Clinicaltrials.gov 2015 (NCT02448316) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Affiliations 1 and 2 part of IOC Research Center Copenhagen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johannsen, F., Konradsen, L., Herzog, R. et al. Endoscopic fasciotomy for plantar fasciitis provides superior results when compared to a controlled non-operative treatment protocol: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 28, 3301–3308 (2020). https://doi.org/10.1007/s00167-020-05855-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-05855-3

Keywords

Search

Navigation