Resident Physician, Reading Hospital Tower Health, West Reading, PA.
Resident Physician, Reading Hospital Tower Health, West Reading, PA; Chief of Podiatry, General Leonard Wood Army Community Hospital, Fort Leonard Wood, MO.
J Foot Ankle Surg. 2020 Sep-Oct;59(5):957-960. doi: 10.1053/j.jfas.2020.03.014. Epub 2020 May 11.
The in-step plantar fasciotomy has remained a viable option for treatment of plantar fasciitis. The level of the in-step procedure has previously been described as 1.5 cm distal to the anterior heel fat pad. The authors are unaware of any study defining mean width and thickness of the plantar fascia at specific distances from its insertion. The authors performed a standardized cadaveric dissection of 25 fresh frozen cadaveric specimens from a local region in Pennsylvania. Each fascial band width and thickness of the plantar fascia was measured at the fascial insertion, 2 cm distal from insertion, and 3 cm distal from insertion. The mean (± standard deviation) width of the medial, central, and lateral band of the plantar fascia 3 cm from its insertion was 25.3 ± 5.3, 25 ± 3.41, and 23.3 ± 4.49 mm, respectively. At the same anatomic distance, the band thicknesses were 1.5 ± 0.82, 3.3 ± 0.85, and 1.9 ± 0.33 mm, respectively. The literature describes 2 techniques. The first is transecting between one-third to two-thirds of the plantar fascia during a fasciotomy from medial to lateral. The second is identifying, isolating, and releasing the central band. Our study allows to further quantify this, equating to 24.5 to 49 mm in total medial to lateral transection at 3 cm distal from insertion and an isolated central band equating to 25 ± 3.41 mm. With quantitative measurements of transection length, the surgeon will avoid having to estimate and potentially overtransect. This may help in preventing postoperative sequela related to overcorrection.
跟骨内侧足底筋膜切开术一直是治疗足底筋膜炎的可行选择。跟骨内侧切口的位置先前被描述为前跟脂肪垫后 1.5cm 处。作者不知道有任何研究定义足底筋膜在距其插入点特定距离处的平均宽度和厚度。作者对宾夕法尼亚州当地的 25 个新鲜冷冻尸体标本进行了标准化的尸体解剖。在筋膜插入处、插入处远端 2cm 处和插入处远端 3cm 处测量每个筋膜带的宽度和厚度。距插入点 3cm 处足底筋膜内侧、中央和外侧带的平均（±标准差）宽度分别为 25.3±5.3mm、25±3.41mm 和 23.3±4.49mm。在相同的解剖距离处，带厚度分别为 1.5±0.82mm、3.3±0.85mm 和 1.9±0.33mm。文献描述了 2 种技术。第一种是在从内侧到外侧的筋膜切开术中，在筋膜的三分之一到三分之二处横断。第二种是识别、分离和释放中央带。我们的研究进一步量化了这一点，在距插入点 3cm 处从内侧到外侧的总横断长度为 24.5 至 49mm，而单独的中央带相当于 25±3.41mm。通过对横断长度的定量测量，外科医生将避免不得不进行估计和潜在的过度横断。这可能有助于防止与过度矫正相关的术后后遗症。
