Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan.
Arthroscopy. 2011 Aug;27(8):1105-9. doi: 10.1016/j.arthro.2011.02.037. Epub 2011 Jun 24.
The purpose of this study was to determine the clinical results of deep-fascial medial and lateral portals in performing endoscopic surgery for plantar fasciitis.
In 10 feet in 8 patients who were treated conservatively for more than 6 months with failure to relieve their symptoms, endoscopic surgery was performed. After the patient was placed in the supine position, a medial portal was made 5 mm deep to the plantar fascia and 10 mm anterior to its origin on the calcaneus under fluoroscopy. The lateral portal was established by placing a blunt trocar deep and perpendicular to the plantar fascia. A 2.7-mm-diameter arthroscope was passed through the deep-lateral portal, and the operative devices were inserted through the deep-medial portal. A motorized shaver was used for making a working space to excise the fat tissue along with a portion of the flexor digitorum brevis muscle. If a heel spur existed, it was resected to establish a clear view of the plantar fascia by use of an arthroscopic burr. After exposure of the plantar fascia, its medial half was removed with electric devices such as an Arthro-Knife (ConMed Linvatec, Largo, FL).
The mean score on the American Orthopedics Foot and Ankle Society Ankle Hindfoot Scale was 64.2 ± 6.3 points before surgery and 92.6 ± 7.1 points at 2 years after surgery (P < .0001). The mean duration to full weight bearing after surgery was 13.9 ± 8.4 days. All patients returned to full athletic activities by a mean of 10.7 ± 2.6 weeks.
Endoscopic surgery for plantar fasciitis through a deep-fascial approach allows a wide field of vision and working space, permitting reliable resection of the plantar fascia and heel spur.
Level IV, therapeutic case series.
本研究旨在确定深层筋膜内侧和外侧入路在足底筋膜炎内镜手术中的临床效果。
对 8 例患者的 10 只足部进行了内镜手术治疗，这些患者均经过 6 个月以上的保守治疗，症状未缓解。患者仰卧位，在透视下于跟骨足底筋膜起点前 10mm、距足底筋膜 5mm 处建立内侧入路。建立外侧入路时，将钝头穿刺套管垂直插入足底筋膜深层。通过深部外侧入路插入 2.7mm 直径的关节镜，通过深部内侧入路插入手术器械。使用电动磨头在工作空间中进行操作，切除沿趾短屈肌的脂肪组织。如果存在跟骨骨刺，则使用关节镜磨钻切除骨刺，以清晰显露足底筋膜。暴露足底筋膜后，用电刀等器械切除其内侧半（ConMed Linvatec，Largo，FL）。
术前美国矫形足踝协会踝后足评分平均为 64.2 ± 6.3 分，术后 2 年平均为 92.6 ± 7.1 分（P <.0001）。术后完全负重的平均时间为 13.9 ± 8.4 天。所有患者在平均 10.7 ± 2.6 周内恢复到完全运动活动。
通过深层筋膜入路的内镜手术治疗足底筋膜炎可提供广阔的视野和工作空间，可可靠地切除足底筋膜和跟骨骨刺。
IV 级，治疗性病例系列。
