Endoscopic fasciotomy for plantar fasciitis provides superior results when compared to a controlled non-operative treatm
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Endoscopic fasciotomy for plantar fasciitis provides superior results when compared to a controlled non‑operative treatment protocol: a randomized controlled trial Finn Johannsen1 · Lars Konradsen2 · Robert Herzog3 · Michael Rindom Krogsgaard2 Received: 23 November 2019 / Accepted: 10 January 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
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) nonoperative 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. Keywords Plantar fasciitis · Partial fasciotomy · Endoscopic · FFI
Introduction
Affiliations 1 and 2 part of IOC Research Center Copenhagen. * Lars Konradsen [email protected] 1
Institute of Sports Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
2
Section for Sports Traumatology M51, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
3
Department of Physiotherapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
Plantar fasciitis (PF) is a painful swelling of the plantar fascia at the attachment to the calcaneus. The plantar fascia (or plantar aponeurosis) is a tendon-like structure which stabilizes the arch of the foot [27]. High body weight, standing activities, walking, running and flat foot
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