Johannsen Finn, Konradsen Lars, Herzog Robert, Rindom Krogsgaard Michael
Institute of Sports Medicine, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.
Section for Sports Traumatology M51, Department of Orthopedic Surgery, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.
Foot (Edinb). 2019 Jun;39:50-54. doi: 10.1016/j.foot.2019.02.002. Epub 2019 Feb 11.
Endoscopic operations for plantar fasciitis generally have good clinical outcome. The aim of this study was to record the effect of endoscopic partial fasciotomy and heel spur removal and evaluate by ultrasonography whether the fascia regenerates and the heel spur reforms.
Eleven consecutive patients were evaluated before and 3, 6 and 12 months after surgery. Operations were performed endoscopically using a deep fascial approach with a medial and a lateral portal. Bony spurs were removed and the medial half of the plantar fascia was transected. All patients followed a standardized rehabilitation program.
Median Foot Function Index values decreased from 119 pre-surgery to 69 and 12 (p=0.004), at 3 months and 1year post-operatively respectively. Median VAS-score for first step pain was likewise reduced from median 71mm to 29mm and 7mm (p=0.004), respectively. Median fascial thickness at the medial insertion was 6.0mm (range 4.6-6.8mm) pre-operatively. A heel spur was present in 9 cases. One year postoperatively a well-defined fascia in the area of resection was demonstrated in 8 cases. In the rest of the cases scar tissue made it impossible to clearly outline the fascia. Nine of the feet showed good medial fascial tensioning. There was no evidence of recurrence of the bony spur.
Endoscopic partial plantar fascia resection reduced pain symptoms and increased function significantly 3 months after operation, with additional effect achieved 12 months after surgery. Based on ultrasonography the resected fascia regenerated/healed, and a calcaneal spur did not recur.
足底筋膜炎的内镜手术通常具有良好的临床效果。本研究的目的是记录内镜下部分筋膜切开术和跟骨骨刺切除术的效果，并通过超声检查评估筋膜是否再生以及跟骨骨刺是否复发。
对11例连续患者在手术前以及术后3个月、6个月和12个月进行评估。采用深筋膜入路，通过内侧和外侧切口进行内镜手术。切除骨赘，并横断足底筋膜的内侧半。所有患者均遵循标准化康复方案。
足部功能指数中位数从术前的119分别降至术后3个月时的69和术后1年时的12（p = 0.004）。第一步疼痛的视觉模拟评分中位数同样从71mm分别降至29mm和7mm（p = 0.004）。术前内侧附着处的筋膜厚度中位数为6.0mm（范围4.6 - 6.8mm）。9例存在跟骨骨刺。术后1年，8例在切除区域显示出界限清晰的筋膜。在其余病例中，瘢痕组织使筋膜无法清晰勾勒。9只脚显示内侧筋膜张力良好。没有骨赘复发的证据。
内镜下部分足底筋膜切除术在术后3个月显著减轻疼痛症状并改善功能，术后12个月效果进一步提升。基于超声检查，切除的筋膜再生/愈合，且跟骨骨刺未复发。
