Wang Weining, Rikhraj Inderjeet Singh, Chou Andrew Chia Chen, Chong Hwei Chi, Koo Kevin Oon Thien
1 Duke-NUS Medical School, Singapore.
2 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Foot Ankle Int. 2018 Jan;39(1):11-17. doi: 10.1177/1071100717732763. Epub 2017 Nov 28.
Although usually self-limiting, around 10% of patients develop recalcitrant plantar fasciitis despite conservative treatment. In such cases, operative intervention can be offered. Traditionally, plantar fasciotomy has been the treatment of choice, but recently, there has been a push for more minimally invasive approaches. Radiofrequency microtenotomy has also been increasingly used as a treatment option. In this study, we compare the outcomes of endoscopic plantar fasciotomy and open radiofrequency microtenotomy.
Patients treated in our institution with either procedure between 2007 and 2015 were included and interviewed at baseline and 3 months, 6 months, and 12 months postoperatively using the American Orthopaedic Foot & Ankle Society (AOFAS) and 36-item Medical Outcomes Short Form (SF-36) questionnaires. They were asked questions to evaluate their expectation and satisfaction postoperatively. Demographic and clinicopathological data were prospectively collected from clinical charts and electronic records.
There was no difference in either treatment arms preoperatively and an overall improvement in all functional outcomes postoperatively. However, patients who had endoscopic plantar fasciotomy fared better at 3 months compared to patients who underwent open microtenotomy with the visual analog score component of the AOFAS hindfoot score (HINDVAS) and the social functioning and role-functioning-emotional reaching statistical significance ( P = .027, P = .03, and P = .03, respectively). There was no difference in functional outcomes at 6 or 12 months postoperatively.
Endoscopic plantar fasciotomy was associated with an earlier improvement in functional outcome in our study. However, both treatments had equivalent outcomes at 1-year follow-up, suggesting that either method is reasonable in the treatment of chronic plantar fasciitis.
Level III, comparative study.
足底筋膜炎通常具有自限性，但约10%的患者尽管接受了保守治疗，仍会发展为顽固性足底筋膜炎。对于此类病例，可考虑手术干预。传统上，足底筋膜切开术一直是首选治疗方法，但最近，人们更倾向于采用微创方法。射频微切开术也越来越多地被用作一种治疗选择。在本研究中，我们比较了内镜下足底筋膜切开术和开放性射频微切开术的治疗效果。
纳入2007年至2015年间在我院接受这两种手术治疗的患者，并在基线期、术后3个月、6个月和12个月时，使用美国矫形足踝协会（AOFAS）和36项医疗结果简表（SF-36）问卷进行访谈。询问他们有关术后期望和满意度的问题。从临床图表和电子记录中前瞻性收集人口统计学和临床病理数据。
术前两组治疗效果无差异，术后所有功能指标均有整体改善。然而，与接受开放性微切开术的患者相比，接受内镜下足底筋膜切开术的患者在术后3个月时，AOFAS后足评分的视觉模拟评分部分（HINDVAS）以及社会功能和角色功能-情感方面达到统计学显著性（分别为P = 0.027、P = 0.03和P = 0.03）。术后6个月或12个月时，功能结果无差异。
在我们的研究中，内镜下足底筋膜切开术与功能结果的早期改善相关。然而，两种治疗方法在1年随访时效果相当，这表明两种方法在慢性足底筋膜炎的治疗中都是合理的。
III级，比较研究。
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