Bernhard Kaitlyn, Ng Alan, Kruse Dustin, Stone Paul A
Third Year Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO.
Attending Staff, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, Denver, CO.
J Foot Ankle Surg. 2018 Jul-Aug;57(4):811-815. doi: 10.1053/j.jfas.2017.11.012. Epub 2018 Apr 6.
Plantar fasciitis is one of the most common chief complaints seen in the foot and ankle clinic. With a relatively benign course, most cases are self-limiting or amendable to conservative therapy; ~90% of all plantar fasciitis cases will respond to these methods. When conservative treatment and time fail, surgical intervention can be necessary to improve outcomes. We present a novel method using Subchondroplasty (SCP; Zimmer Holdings, Inc.; Warsaw, IN) and revision fasciotomy in a case in which initial fasciotomy had failed. After the patient had failed to improve, a worsening underlying bone marrow lesion was identified at the origin of the plantar fascia; thus, SCP was used with repeat fasciotomy. SCP involves injecting calcium phosphate into bone marrow lesions to stimulate long-term bone repair. At 10 months after SCP, the patient remained pain free and had returned to running at the final follow-up examination. This surgical treatment should be considered as an adjunctive procedure for those patients with plantar fasciitis, identifiable bone marrow lesions on magnetic resonance imaging, and continued pain when other treatment modalities have failed.
足底筋膜炎是足踝诊所最常见的主要就诊原因之一。由于病程相对良性，大多数病例是自限性的或可采用保守治疗；所有足底筋膜炎病例中约90%对这些方法有反应。当保守治疗和时间都无效时，可能需要手术干预以改善预后。我们介绍一种在初次筋膜切开术失败的病例中使用软骨下成形术（SCP；齐默控股公司；印第安纳州华沙）和改良筋膜切开术的新方法。在患者病情未改善后，在足底筋膜起点处发现潜在骨髓病变恶化；因此，在重复筋膜切开术时使用了SCP。SCP包括将磷酸钙注入骨髓病变以刺激长期骨修复。在SCP后10个月，患者在最后一次随访检查时仍无疼痛并已恢复跑步。对于那些患有足底筋膜炎、磁共振成像上可识别骨髓病变且其他治疗方式失败后仍持续疼痛的患者，这种手术治疗应被视为一种辅助手术。
