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Indikation, OP-Technik und Ergebnisse des endoskopischen Releases der Plantarfaszie (ERPF)

Indications, surgical technique and results in endoscopic release in plantar fasciitis (ERPF)

  • ORIGINALARBEIT
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Fuß & Sprunggelenk

Summary

Purpose

The purpose of the present study is to present the surgical technique, and to review our indications and results after endoscopic release in plantar fasciitis.

Material and methods

In 5 embalmed human specimen a biportal technique for endoscopic release of the plantar fascie was established. The purpose was to evaluate the relation between the plantar fascie and the heel spur. Afterwards we tried to release only 50–70% of the plantar fascie from the calcaneus. During a period of 5 years, this surgical technique was performed in 10 male and 7 female patients with the clinical entity of plantar fasciitis. The average age was 35 years (24–56 years). All patients underwent conservative treatment for at least 6 months.

Results

In the first 5 patients, surgery was performed under c-arm control. In all patients the operation could be completed endoscopically. The endoscopic protals healed without complications. The time for surgery during the learning curve ranged between 21 and 74 minutes (average: 41 minutes) and was still longer compared to the open technique. The clinical follow-up ranged between 4 and 48 months (average: 18.5 months). Of the 17 patients, 13 improved clinically and they would choose the treatment option again. In the Ogilvie-Harris score, 7 patients showed good and 6 excellent results. In 2 patients, the initial results were not satisfactory, caused by a bony stress reaction of the calcaneus. This complication was treated by 6 weeks of partial weight bearing without any further problems. Two other patients developed secondary pain in the lateral column. In spite of the minimally invasive approach, it seems to be important to increase the weight bearing in early rehabilitation carefully.

Conclusion

Endoscopic release of the plantar fascie (ERPF) is a standardized and reproducable procedure. The midterm results are promising. A loss of plantar stability should be kept in mind and has to be avoided.

Zusammenfassung

Fragestellung

Ziel der vorliegenden Untersuchung ist es, die Indikation, OP-Technik sowie die Ergebnisse des endoskopischen Releases der Plantarfaszie darzustellen.

Material und Methode

An 5 nicht fixierten Präparaten wurde eine biportale Technik zum endoskopischen Release der Plantarfaszie erprobt. Ziel war es hierbei zum einen, die Relation zwischen Plantarfaszie und plantarem Fersensporn zu evaluieren; zum anderen wurde eine Technik erprobt, bei welcher nur 50–70% der medialen Plantarfaszie vom Kalkaneus abgelöst wurde.

Über einen Zeitraum von 5 Jahren wurde diese Technik bei 10 männlichen und 7 weiblichen Patienten mit dem klinischen Bild einer Plantarfasziitis durchgeführt. Das mittlere Alter der Patienten betrug 35 Jahre (24–56 Jahre). Alle Patienten durchliefen zunächst konservative Therapieversuche von zumindest 6 Monaten.

Ergebnisse

Bei den ersten 5 Patienten wurde der Eingriff unter Bildwandlerkontrolle durchgeführt; bei den weiteren Patienten erfolgte die Resektion ohne intraoperative BV-Kontrolle. Bei allen Patienten konnte der Eingriff wie geplant durchgeführt werden. Die endoskopischen Portale heilten ohne Probleme. Die OP-Zeit ist im Rahmen der Lernkurve mit Zeiten zwischen 21 und 74 Minuten (MW: 41 Minuten) noch länger als in der offenen Technik. Der Nachuntersuchungszeitraum betrug zwischen 4 und 48 Monate (MW: 18,5 Monate). Bei 13 der 17 Patienten kam es zu einer klinischen Verbesserung und sie würden den Eingriff erneut durchführen lassen. 7 Patienten zeigten ein gutes und 6 ein sehr gutes Ergebnis im Ogilvie-Harris-Score. Bei 2 Patienten war das initiale Ergebnis nicht zufriedenstellend. Die Ursache hier lag in einer ossären Übermüdungsreaktion des Kalkaneus. Diese Komplikation wurde durch Entlastung über 6 Wochen symptomastisch behandelt. Bei zwei weiteren Patienten stellten sich sekundäre Überlastungen am lateralen Fußrand ein. Im Rahmen der frühen Rehabilitationsphase war es wichtig, trotz des minimalinvasiven Vorgehens, eine vorsichtige Belastungssteigerung durchzuführen.

Schlussfolgerung

Die Technik des endoskopischen Releases der Plantarfaszie (ERPF) ist standardisiert und reproduzierbar durchführbar. Sie führt zu guten mittelfristigen Ergebnissen. Ein Stabilitätsverlust der plantaren Verspannung sollte jedoch unbedingt vermieden werden.

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Authors and Affiliations

  1. Klinik für Orthopädie und Orthopädische Chirurgie, Johanna-Etienne-Hospital, Am Hasenberg 46, 41462, Neuss, Germany

    J. Jerosch & J. Schunck

  2. Klinik für Radiologie, Johanna-Etienne-Krankenhaus, Am Hasenberg 46, 41462, Neuss, Germany

    D. Liebsch

  3. Universitätsklinikum Münster, Institut für Anatomie, Klinische Anatomie und Telematik, Vesaliusweg 39, 48149, Münster, Germany

    T. Filler

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  1. J. Jerosch
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  2. J. Schunck
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  3. D. Liebsch
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  4. T. Filler
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Correspondence to J. Jerosch.

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Jerosch, J., Schunck, J., Liebsch, D. et al. Indikation, OP-Technik und Ergebnisse des endoskopischen Releases der Plantarfaszie (ERPF). FussSprung 2, 199–206 (2004). https://doi.org/10.1007/s10302-004-0063-y

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  • DOI: https://doi.org/10.1007/s10302-004-0063-y

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