Skip to main content
SpringerLink
Log in

Surgical treatment options for plantar fasciitis and their effectiveness: a systematic review and network meta-analysis

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

To date, there are no systematic reviews on the utility of surgical management for plantar fasciitis to guide best practice. This review aimed to evaluate the operative options for plantar fasciitis and their effectiveness.

Methods

A systematic review and network meta-analysis were carried out in accordance with PRISMA guidelines. A search strategy was conducted on the MEDLINE, EMBASE, and Cochrane databases. Quality was assessed using the ROBINS-I tool.

Results

17 studies involving 865 patients were included. Surgical options considered were open and endoscopic plantar fasciotomy, gastrocnemius release, radiofrequency microtenotomy and dry needling. All interventions resulted in improvement in VAS and AOFAS scores. No major complications were seen from any treatment modality.

Conclusions

Surgical interventions are effective in providing short- to medium-term symptomatic relief for plantar fasciitis refractory to non-operative management. Current evidence is equivocal regarding treatment choice. Further large randomised studies are required to establish long-term outcomes and a management algorithm.

Level of evidence

Level III.

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
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Availability of data and materials

Not applicable.

References

  1. Monteagudo M, Albornoz PMd, Gutierrez B, Tabuenca J, Álvarez I (2018) Plantar fasciopathy: a current concepts review. EFORT Open Rev 3:485–493. https://doi.org/10.1302/2058-5241.3.170080

    Article  PubMed  PubMed Central  Google Scholar 

  2. Buchanan BK, Kushner D (2021) Plantar fasciitis. In: StatPearls. StatPearls Publishing

  3. Copyright © 2021, StatPearls Publishing LLC., Treasure Island (FL).

  4. Riddle DL, Schappert SM (2004) Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int 25:303–310. https://doi.org/10.1177/107110070402500505

    Article  PubMed  Google Scholar 

  5. Crawford F, Thomson C (2003) Interventions for treating plantar heel pain. The Cochrane database of systematic reviews:Cd000416. https://doi.org/10.1002/14651858.Cd000416

  6. Morrissey D, Cotchett M, Said J’Bari A, Prior T, Griffiths IB, Rathleff MS, Gulle H, Vicenzino B, Barton CJ (2021) Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med. https://doi.org/10.1136/bjsports-2019-101970

    Article  PubMed  Google Scholar 

  7. Babatunde OO, Legha A, Littlewood C, Chesterton LS, Thomas MJ, Menz HB, van der Windt D, Roddy E (2019) Comparative effectiveness of treatment options for plantar heel pain: a systematic review with network meta-analysis. Br J Sports Med 53:182–194. https://doi.org/10.1136/bjsports-2017-098998%JBritishJournalofSportsMedicine

    Article  PubMed  Google Scholar 

  8. Neufeld SK, Cerrato R (2008) Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg 16:338–346. https://doi.org/10.5435/00124635-200806000-00006

    Article  PubMed  Google Scholar 

  9. Luffy L, Grosel J, Thomas R, So E (2018) Plantar fasciitis: a review of treatments. 31:20-24.https://doi.org/10.1097/01.Jaa.0000527695.76041.99

  10. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1. https://doi.org/10.1186/2046-4053-4-1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Landorf KB, Radford JA, Hudson S (2010) Minimal important difference (MID) of two commonly used outcome measures for foot problems. J Foot Ankle Res 3:7. https://doi.org/10.1186/1757-1146-3-7

    Article  PubMed  PubMed Central  Google Scholar 

  12. Willis B (2009) Pain scale for plantar fasciitis. Foot Ankle J. https://doi.org/10.3827/faoj.2009.0205.0003

    Article  Google Scholar 

  13. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353. https://doi.org/10.1177/107110079401500701

    Article  CAS  PubMed  Google Scholar 

  14. SooHoo NF, Vyas R, Samimi D (2006) Responsiveness of the foot function index, AOFAS clinical rating systems, and SF-36 after foot and ankle surgery. Foot Ankle Int 27:930–934. https://doi.org/10.1177/107110070602701111

    Article  PubMed  Google Scholar 

  15. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK (2007) Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg 46:65–74. https://doi.org/10.1053/j.jfas.2006.12.002

    Article  PubMed  Google Scholar 

  16. The Cochrane Collaboration (2020) Review manager (RevMan) Version 5.3. In.

  17. EpiGear International (2016) Metal XL Version 5.3.

  18. The Cochrane Collaboration (2011) Cochrane Handbook for Systematic Reviews of Interventions (Version 5.10)

  19. Doi SAR, Barendregt JJ (2018) A generalized pairwise modelling framework for network meta-analysis. Int J Evid Based Healthc 16:187–194. https://doi.org/10.1097/xeb.0000000000000140

    Article  PubMed  Google Scholar 

  20. Sterne JAC, Sutton AJ, Ioannidis JPA, Terrin N, Jones DR, Lau J, Carpenter J, Rücker G, Harbord RM, Schmid CH, Tetzlaff J, Deeks JJ, Peters J, Macaskill P, Schwarzer G, Duval S, Altman DG, Moher D, Higgins JPT (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. 343:d4002.https://doi.org/10.1136/bmj.d4002%JBMJ

  21. Gamba C, Serrano-Chinchilla P, Ares-Vidal J, Solano-Lopez A, Gonzalez-Lucena G, Ginés-Cespedosa A (2020) Proximal medial gastrocnemius release versus open plantar fasciotomy for the surgical treatment in recalcitrant plantar fasciitis. Foot Ankle Int 41:267–274. https://doi.org/10.1177/1071100719891979

    Article  PubMed  Google Scholar 

  22. Molund M, Husebye EE, Hellesnes J, Nilsen F, Hvaal K (2018) Proximal medial gastrocnemius recession and stretching versus stretching as treatment of chronic plantar heel pain. Foot Ankle Int 39:1423–1431. https://doi.org/10.1177/1071100718794659

    Article  PubMed  Google Scholar 

  23. Johannsen F, Konradsen L, Herzog R, Krogsgaard MR (2020) 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 Off J ESSKA 28:3301–3308. https://doi.org/10.1007/s00167-020-05855-3

    Article  Google Scholar 

  24. Othman AM, Hegazy IH (2015) Endoscopic plantar fasciotomy versus injection of platelet-rich plasma for resistant plantar fasciopathy. J Orthop 12:S176-181. https://doi.org/10.1016/j.jor.2015.10.015

    Article  PubMed  PubMed Central  Google Scholar 

  25. Radwan YA, Mansour AM, Badawy WS (2012) Resistant plantar fasciopathy: shock wave versus endoscopic plantar fascial release. Int Orthop 36:2147–2156. https://doi.org/10.1007/s00264-012-1608-4

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rahbar M, Eslamian F, Toopchizadeh V, Aminabad F, Kargar A, Dolatkhah N (2018) A Comparison of the efficacy of dry-needling and extracorporeal shockwave therapy for plantar fasciitis: a randomized clinical trial. Iranian Red Crescent Medical Journal In Press. https://doi.org/10.5812/ircmj.68908

    Book  Google Scholar 

  27. Uygur E, Aktaş B, Eceviz E, Yilmazoğlu EG, Poyanli O (2019) Preliminary Report on the role of dry needling versus corticosteroid injection, an effective treatment method for plantar fasciitis: a randomized controlled trial. J Foot Ankle surg 58:301–305. https://doi.org/10.1053/j.jfas.2018.08.058

    Article  PubMed  Google Scholar 

  28. Çatal 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 56:1001–1008. https://doi.org/10.1053/j.jfas.2017.04.021

    Article  PubMed  Google Scholar 

  29. Feng SM, Song RL, Wang AG, Sun QQ, Zhang SC (2021) Endoscopic partial plantar fasciotomy via 2 medial portals vs mini-open procedure for refractory plantar fasciitis. Foot Ankle Int 42:458–463. https://doi.org/10.1177/1071100720964805

    Article  PubMed  Google Scholar 

  30. Othman AM, Ragab EM (2010) Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg 130:1343–1347. https://doi.org/10.1007/s00402-009-1034-2

    Article  PubMed  Google Scholar 

  31. Tay KS, Ng YCS, Singh IR, Chong KW (2012) Open technique is more effective than percutaneous technique for TOPAZ radiofrequency coblation for plantar fasciitis. Foot Ankle Surg 18:287–292. https://doi.org/10.1016/j.fas.2012.05.001

    Article  PubMed  Google Scholar 

  32. 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 55:9–15. https://doi.org/10.1053/j.jfas.2015.02.005

    Article  PubMed  Google Scholar 

  33. Chou AC, Ng SY, Su DH, Singh IR, Koo K (2016) Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis. Foot Ankle Surg 22:270–273. https://doi.org/10.1016/j.fas.2015.11.006

    Article  PubMed  Google Scholar 

  34. Huang DM, Chou AC, Yeo NE, Singh IR (2018) Radiofrequency microtenotomy with concurrent gastrocnemius recession improves postoperative vitality scores in the treatment of recalcitrant plantar fasciitis. Ann Acad Med Singapore 47:509–515

    Article  PubMed  Google Scholar 

  35. Monteagudo M, Maceira E, Garcia-Virto V, Canosa R (2013) Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession. Int Orthop 37:1845–1850. https://doi.org/10.1007/s00264-013-2022-2

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wang W, Rikhraj IS, Chou ACC, Chong HC, Koo KOT (2018) Endoscopic plantar fasciotomy vs open radiofrequency microtenotomy for recalcitrant plantar fasciitis. Foot Ankle Int 39:11–17. https://doi.org/10.1177/1071100717732763

    Article  PubMed  Google Scholar 

  37. Yuan Y, Qian Y, Lu H, Kou Y, Xu Y, Xu H (2020) Comparison of the therapeutic outcomes between open plantar fascia release and percutaneous radiofrequency ablation in the treatment of intractable plantar fasciitis. J Orthop Surg Res 15:55. https://doi.org/10.1186/s13018-020-1582-2

    Article  PubMed  PubMed Central  Google Scholar 

  38. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135. https://doi.org/10.1186/1471-2288-14-135

    Article  PubMed  PubMed Central  Google Scholar 

  40. JPT H, S G (2008) Cochrane handbook for systematic reviews of interventions.

  41. 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. https://doi.org/10.1016/j.foot.2007.06.006

    Article  Google Scholar 

  42. Chan HY, Chen JY, Zainul-Abidin S, Ying H, Koo K, Rikhraj IS (2017) Minimal clinically important differences for american orthopaedic foot and ankle society score in hallux valgus surgery. Foot Ankle Int 38:551–557. https://doi.org/10.1177/1071100716688724

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedic Surgery, Barking, Havering and Redbridge University Hospitals NHS Trust, Queen’s Hospital, Rom Valley Way, Romford, RM7 0AG, UK

    Sandeep Krishan Nayar, Harry Alcock & Krishna Vemulapalli

Authors
  1. Sandeep Krishan Nayar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harry Alcock
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krishna Vemulapalli
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SN and HA. The first draft of the manuscript was written by SN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sandeep Krishan Nayar.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publish

Not applicable.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nayar, S.K., Alcock, H. & Vemulapalli, K. Surgical treatment options for plantar fasciitis and their effectiveness: a systematic review and network meta-analysis. Arch Orthop Trauma Surg 143, 4641–4651 (2023). https://doi.org/10.1007/s00402-022-04739-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-022-04739-0

Keywords

Search

Navigation