Open Plantar Fasciotomy Versus Endoscopic Approach For Recalcitrant Calcaneodynia

BACKGROUND:At present,there are many surgical methods for the treatment of recalcitrant plantar fasciitis,and there is no agreed standard procedure.Open and arthroscopic plantar fascia release can solve the symptoms of most patients with chronic refractory fasciitis,both of which are safe and effective and can achieve good clinical efficacy.However,the current reports have lacked effective randomized controlled clinical study,so it is difficult to determine which surgical method can achieve better clinical effects.OBJECTIVE:To investigate the clinical value and effect of the medial and double approach in the treatment of recalcitrant calcaneodynia(plantar fasciitis type)by endoscopic;and to compare the clinical efficacy of endoscopic and open surgery for the treatment of recalcitrant calcaneodynia.METHODS:From March 2015 to February 2017,34 patients(37 feet)with recalcitrant calcaneodynia(plantar fasciitis type)were selected from the Department of Sports and Joint Surgery,Nanjing Hospital Affiliated to Nanjing Medical University.All patients had typical recalcitrant calcaneodynia(plantar fasciitis type).Among them,20 patients(22 feet)with were treated with endoscopic plantar fasciotomy and calcaneal spur resection(EPF Group),and 14 cases(15 feet)were treated with open plantar fasciotomy and calcaneal spur resection(OPF Group).The operation time,hospitalization time and continuous exudation time of the two groups were compared at baseline and 1 month,3 months,6 months and 1 year after operation.The operation time,hospital stays,oral exudation time,delayed healing and wound infection status of the two groups were observed.The "first step" VAS pain score was used to assess the degree of pain in the weight of the two-legged weight.The American Foot and Ankle Surgery Association Foot Score(AOFAS-AH)was used to assess the functional status of the affected foot before and after treatment;The clinical symptoms,signs,and changes in work and living ability of 1 month(the short-term efficacy)and the 6 months(long-term efficacy)after operation were divided into four levels:cure,marked effect,effective and ineffective,with reference to VAS and efficacy evaluation.The recurrence rate and satisfaction patients were analyzed for the of the two surgical methods according to the 1-year follow-up results.RESULTS:There were no significant differences in mean age,number of patients,gender,surgical site,preoperative conservative treatment time,body mass index(BMI),preoperative comorbidities,and spur between the two groups(P>0.05).There was no significant difference in the operation time between the two groups(P>0.05).The hospitalization time of the OPF Group was significantly higher than that of the EPF Group(P<0.05).There were 1 case of delayed wound healing in OPF Group and 0 cases in EPF Group;1 case of wound infection in OPF Group and 0 case in EPF Group.The continuous exudation time of open surgery group was significantly higher than that of EPF Group.There was no significant difference in the "first step" VAS pain score between the two groups before surgery(P>0.05),and the score at 1 month,3 months,6 months,and 1 year after surgery were significantly different from that before surgery.At 1 month after surgery,the EPF Group was more effective in improving the pain of patients with plantar fasciitis heel pain than that of OPF Group(P<0.05).However,at 3 months,6 months,and 1 year follow-up,there was no significant difference in the "first step" VAS pain score between the two groups(P>0.05).There was no significant difference in the AOFAS score between the two groups before surgery(P>0.05).At 1 month postoperatively,the AOFAS score of the open surgery group was not significantly different from that before surgery,while the AOFAS score of the EPF Group was significantly higher than that of the preoperative(P<0.05);at 6 months and 1 year follow-up,the AOFAS scores of the two groups were significantly higher than those before surgery(P<0.05).At 1 month and 3 months after surgery,the AOFAS scores of the EPF Group were significantly better than those of the OPF Group(P<0.05),however,there was no significant difference in AOFAS scores between the two groups at 6 months and 1 year after surgery(P>0.05).At 1 month after the surgery,the effective rate of the OPF Group was 78.6%,which was significantly lower than that of the EPF Group(95.0%)(P<0.05).At 6 months after the surgery,the effective rate was 71.5%in the OPF Group and 80.0%in the EPF Group,with no significant difference(P>0.05).At 1 year follow-up,there was no significant difference in the rate of recurrence of heel pain between the two groups(P>0.05),but the postoperative satisfaction of the EPF Group was significantly higher than that of OPF Group(90%vs 71.4%).CONCLUSION:The medial and double approach can safely and effectively treat fascia-type refractory heel pain,and the safety,wound exudation,wound healing,pain relief time,early functional recovery,recent clinical efficacy and postoperative satisfaction is significantly better than that of the traditional open surgery.