Maes Renaud, Safar Adonis, Ghistelinck Barbara, Labadens Adeline, Hernigou Jacques
Department of Orthopaedics and Traumatology, Centre Hospitalier EpiCURA, Sites Hornu/Baudour, Hainaut, Belgium.
Int Orthop. 2022 Apr;46(4):861-866. doi: 10.1007/s00264-021-05186-z. Epub 2021 Aug 18.
Plantar fasciitis (PF) is the most common cause of plantar heel pain. Conservative treatment and corrections of risks factors are the first line of care. For the 10% of patients who do not respond to conservative treatment, surgical release can offer relief of symptoms. Due to the critical role of the PF in the function of the foot and its architectural maintenance, its surgical release could cause a collapse of the internal arch of the foot and an alteration of its function. With the hypothesis that an isolated percutaneous PF release may not lead to these alterations of the foot while providing relief to the patients, we evaluated the radiological evolution and clinical results of this surgery after one year.
Between January 2013 and Augustus 2017, we conducted a single arm monocentric prospective study on 22 patients (25 feet) aged from 33 to 84 years, with plantar fasciitis and failure of conservative management who benefited a percutaneous total plantar fasciotomy through a plantar approach. The American Orthopedic Foot and Ankle Score (AOFAS) and the Djian-Annonier's angle were evaluated preoperatively and postoperatively.
Among the 22 patients, sixteen patients were female and six patients were male. Three patients (2 females and 1 male) for six feet were operated for bilateral plantar fasciitis. The mean pre-operative Djian-Annonier's angle was 117.6° (range 101-132.9°), and the mean post-operative angle was 119.3° (range 102-137°). There was no statistically significant difference in Djian-Annonier's angle before and after surgery. The mean pre-operative AOFAS was 42.8 (range 32-51). The scores at 15 days, six weeks, and three months show a gradual increase up to 89.9 in the results with significant differences between the groups (p < 0.05). There was no difference between the scores after three months.
Complete percutaneous plantar fasciotomy is simple and safe and allows a quick recovery to activity without impacting the MLA.
足底筋膜炎（PF）是足跟底部疼痛最常见的原因。保守治疗及纠正危险因素是首要治疗方法。对于10%对保守治疗无反应的患者，手术松解可缓解症状。由于足底筋膜在足部功能及其结构维持中起关键作用，其手术松解可能导致足内侧纵弓塌陷及其功能改变。基于孤立的经皮足底筋膜松解术在为患者缓解症状的同时可能不会导致足部这些改变的假设，我们评估了该手术后一年的影像学演变及临床结果。
2013年1月至2017年8月，我们对22例（25足）年龄在33至84岁之间、患有足底筋膜炎且保守治疗失败的患者进行了单臂单中心前瞻性研究，这些患者通过足底入路接受了经皮全足底筋膜切开术。术前及术后评估美国矫形足踝评分（AOFAS）和迪扬 - 阿诺尼埃角。
22例患者中，16例为女性，6例为男性。3例患者（2例女性和1例男性）因双侧足底筋膜炎接受了6足的手术。术前迪扬 - 阿诺尼埃角的平均值为117.6°（范围101 - 132.9°），术后平均角度为119.3°（范围102 - 137°）。手术前后迪扬 - 阿诺尼埃角无统计学显著差异。术前AOFAS的平均值为4².8（范围32 - 51）。15天、6周和3个月时的评分显示结果逐渐增加至89.9，组间差异有统计学意义（p < 0.05）。3个月后的评分无差异。
完全经皮足底筋膜切开术简单、安全，可使患者迅速恢复活动且不影响内侧纵弓。
