Malahias, M. A., Cantiller, E. B., Kadu, V. V., & Müller, S. (2020). The clinical outcome of endoscopic plantar fascia release: A current concept review. Foot and Ankle Surgery, 26(1), 19-24.
This weeks blog is going in a different direction…
It is what can happen when you don’t treat Plantar Fasciitis correctly from the start.
Plantar Fasciitis can happen to anyone... young, old, sports superstar, casual runner, physiotherapist, pilates instructor or the child of a sports physician or even a combination of them all!
So what happens when you don’t treat it correctly, get the right help, think I will be okay?
What happens when conservative treatment doesn’t work after not treating plantar fasciitis correctly from the start?
Utilising the Ultimate Plantar Fasciitis Treatment Plan & Bundle from the early stages of this condition gives you the best chance of getting it fixed before it becomes a chronic long standing condition. We know this and research tells us that it works (see previous blog post). So hopefully what I discuss next won't be an issue for you.
As mentioned on this site there are other treatment options available that we know work well in combination with conservative options. Shockwave therapy, Platelet Rich Plasma Injections (PRP), Radio Frequency Ablation and then there is surgery.
What we will look at today is the surgical option in treating plantar fasciitis.
This article was a review of studies conducted since 2000 to April 2017.
It reviewed the type of surgical approach is best to utilise, complications based on these interventions and the rate of healing compared to less invasive treatment options.
The authors started off by stating that conservative treatment is the most successful option around 90-95%.
576 feet were included in this review of which they all have had symptoms for longer than 6 months and have failed conservative treatment. The average age was 35-56 years but did include ages from 22-87. Females numbers were 10% higher than males.
Researchers stated that surgical intervention via endoscopic plantar fascial release improved pain and function scores in patient (70-90%). This percentage is based of questionnaires asking about pain levels and function only.
There were complications in 11% in all surgeries.
Discussion was made regarding the amount of the plantar fascia to release during the surgery, where the was a marked increase in lateral foot pain in those who had the full release or greater than 50% of the plantar fascia released.
There seemed to be a difference in recovery and body mass index, where those with a greater BMI of 27 kg/m2 had a 50% chance of not improving significantly post surgery and often required further surgeries or other interventions.
Open surgery had a longer recovery time and a greater amount of pain and complications compared to the endoscopic plantar fascial release.
The endoscopic method has its limitations as well, where there is a risk of nerve damage due to the incision and portal being close to the medial calcaneal nerve.
Patients who had endoscopic surgeries reported satisfaction rates between 60-80%.
There was a number of studies that were evaluated that compared surgical intervention and PRP injections, and another that compared surgical intervention and shockwave therapy.
Both these studies showed no significant difference in outcomes between the two.
The authors summaries that ‘There was weak evidence that endoscopic plantar fascial release (EPFR) is a safe treatment for patients suffering from chronic plantar fasciitis. ‘
Based on cost, pain, recovery and ease of access these other methods are a superior choice.
The take home message by the authors is ‘Based on the findings of this review, it should be noted that EPFR cannot be considered as superior treatment than other, less interventional, therapeutic means, like ESWT or PRP. ‘
Based on these findings and authors recommendation, it seems that the earlier you treat plantar fasciitis, the less invasive treatments are required. Those with chronic long standing plantar fasciitis who exhaust conservative treatment may be forced to go down the surgical route but unfortunately this is not the most successful or carries a great amount of satisfaction.
So that is what research tells us.... but what do we see clinically? Often post surgery the original issue with the plantar fascia may be fixed, but we may come up against other issues. Scarring, bone marrow oedema, fat pad oedema and nerve irritation. This can be frustrating for both the patient and the clinician...
So the moral of the story is with treatment, start early, don't wait or it may make treating this condition a ripe old pain in the heel....
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