El Shazly Ossama, El Beltagy Atef
Ain Shams University Hospitals, Cairo, Egypt.
Foot (Edinb). 2010 Dec;20(4):121-5. doi: 10.1016/j.foot.2010.09.004.
The pathogenesis of painful heel syndrome is multifactorial including plantar fasciitis, increased intra-osseous pressure of the os calcis, calcaneal periostitis and presence of calcaneal spur. The currently used endoscopic treatment of painful heel syndromes involves endoscopic plantar fascia release alone without addressing other pathological changes.
To evaluate the clinical outcome of endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal.
The study was conducted on 22 cases/24 feet with idiopathic painful heel syndrome resistant to conservative treatment. All cases were treated by plantar fasciotomy; calcaneal drilling and calcaneal spur removal using a modified cannula trocar system. Evaluation of pain was done using VAS and functional evaluation was done using the Modified Mayo Scoring System for Plantar Fasciotomy. Also patient's satisfaction was evaluated by direct questionnaire.
There was statistically significant improvement in the mean VAS from 82.81 (±7.8 std) preoperative to 6.63 (±2.75 std) and the Mayo score form 7.05 (±3.67 std) preoperative to 87.5 (±4.81 std) at 2 years follow up (P<0.05). The satisfaction rate was 85% with no major complications.
Endoscopic plantar fascia release with calcaneal drilling and calcaneal spur removal has high success rate and patient's satisfaction rate when compared to published reports on isolated endoscopic plantar release.
足跟痛综合征的发病机制是多因素的，包括足底筋膜炎、跟骨骨内压升高、跟骨骨膜炎和跟骨骨刺的存在。目前用于治疗足跟痛综合征的内镜治疗仅包括内镜下足底筋膜松解，而未解决其他病理变化。
评估内镜下足底筋膜松解、跟骨钻孔和跟骨骨刺切除的临床效果。
对22例/24足保守治疗无效的特发性足跟痛综合征患者进行研究。所有病例均采用足底筋膜切开术；使用改良套管针系统进行跟骨钻孔和跟骨骨刺切除。采用视觉模拟评分法（VAS）评估疼痛，采用改良梅奥足底筋膜切开术评分系统进行功能评估。同时通过直接问卷调查评估患者的满意度。
随访2年时，平均VAS从术前的82.81（±7.8标准差）显著改善至6.63（±2.75标准差），梅奥评分从术前的7.05（±3.67标准差）显著改善至87.5（±4.81标准差）（P<0.05）。满意度为85%，无重大并发症。
与已发表的单纯内镜下足底松解报告相比，内镜下足底筋膜松解联合跟骨钻孔和跟骨骨刺切除具有较高的成功率和患者满意度。
