Department of Orthopaedics and Trauma Surgery, Quirónsalud Murcia Hospital, Calle Miguel Hernandez, 12. 30011 Murcia, Spain.
Department of Orthopaedics and Trauma Surgery, 'Gregorio Marañón' University Hospital, Calle Dr Esquerdo, 46. 28007 Madrid, Spain.
Foot Ankle Surg. 2022 Jan;28(1):14-19. doi: 10.1016/j.fas.2021.01.002. Epub 2021 Jan 5.
Percutaneous plantar fasciotomy is one of the available options for recalcitrant cases of plantar fasciopathy, but there is a mismatch in the clinical results between different author's experience, possibly due to variability when choosing the exact cutaneous entry point. The purpose of this study is to validate the plantar approach in the surgical treatment of plantar fasciopathy, describing a safe path and cutaneous entry point to perform a percutaneous plantar fasciotomy with a 2 mm incision testing the procedure on cadavers.
a unicentric cross-sectional analytical study was conducted in 12 cadaveric feet to verify the accuracy of the percutaneous fasciotomy entry point. Independent variables analysed were: extent of fasciotomy, entry point location, spur resection, and soft tissues injuries. A double evaluation was performed: an indirect evaluation under fluoroscopic vision, and a direct evaluation after anatomical dissection.
No cases of plantar cortical lesion on the calcaneus was observed. Satisfactory fasciotomy was performed in 91.7% of the cases. An optimal entry point was noticed in all cases with a mean distance to the tip of tibial malleolus of 22.5 mm (±6.9; 35.1-12.1) and a mean distance to foot midline of 7.8 mm (±1.7; 11.8-5.1). No neurological nor vascular lesions were found. In all the feet, a laceration of the plantar part of flexor digitorum brevis muscle was noted.
the plantar approach for percutaneous total plantar fasciotomy is a safe procedure. The current study provides an intraoperative guideline for minimising the possible risks.
足底筋膜炎的治疗方法之一是对足底筋膜炎的顽固病例进行经皮足底筋切开术，但不同作者的临床结果存在差异，这可能是由于选择确切的皮肤入路点时存在变异性。本研究的目的是验证足底入路在足底筋膜炎手术治疗中的有效性，描述一种安全的路径和皮肤入路，以进行 2 毫米切口的经皮足底筋切开术，并在尸体上测试该手术。
在 12 具尸体足中进行了一项单中心横断面分析性研究，以验证经皮筋膜切开术入路点的准确性。分析的独立变量包括：筋膜切开的程度、入路点的位置、骨刺切除和软组织损伤。进行了双重评估：透视下的间接评估和解剖后的直接评估。
未观察到跟骨足底皮质损伤的病例。91.7%的病例行满意的筋膜切开术。所有病例均发现最佳入路点，胫骨外踝尖端的平均距离为 22.5 毫米（±6.9；35.1-12.1），足中线的平均距离为 7.8 毫米（±1.7；11.8-5.1）。未发现神经和血管损伤。所有足均发现跖侧屈趾短肌部分撕裂。
经皮足底筋膜全切开术的足底入路是一种安全的手术方法。本研究为降低可能的风险提供了术中指导。
