Arunakul Marut, Samornpitakul Pheemaphol, Chaisiri Warunee, Ratanacharatroj Yingyos, Sasipotiwan Nattapong, Pinitchanon Punnawit, Pitakveerakul Akaradech
Department of Orthopedics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
Faculty of Medicine, Thammasat University, Khlong Nueng, Thailand.
Foot Ankle Int. 2025 Mar;46(3):303-314. doi: 10.1177/10711007241308915. Epub 2025 Jan 20.
To determine whether a combined endoscopic suprafascial and infrafascial approach with medial and lateral portals is a safe and effective technique for the endoscopic treatment of chronic plantar fasciitis with plantar heel spur pain.
An interventional, prospective study was conducted. A total of 61 patients with plantar fasciitis with plantar heel spur pain underwent an endoscopic plantar fasciotomy with plantar heel spur resection, using a combined suprafascial and infrafascial approach between January 2018 and August 2022. Preoperative Foot and Ankle Ability Measure (FAAM), 36-Item Short Form Health Survey (SF-36), and visual analog scale (VAS) scores were measured. The measurements were repeated at 6 weeks, 3, 6, and 12 months postoperatively and at the final follow up. Preoperative and 1-year postoperative film parameters (Meary angle, calcaneal pitch angle, medial cuneiform-fifth metatarsal height) were compared.Complications were recorded at each encounter.
The mean follow up time was 2.6 ± 1.1 years. At the 6-week postoperative visit, the mean change in FAAM-ADL, FAAM-Sport, SF-36 physical component summary, SF-36 mental component summary, and VAS were 26.0,19.0, 44.8, 61.2, and -5.8, respectively. These changes were statistically significant ( < .001). These findings were sustained and generally improved at all other follow-up points: 3, 6, and 12 months postoperatively and final follow-up. The average period until the recovery of activities of daily living and sport activities were 2.6 and 8.6 weeks, respectively. There were no significant differences between the pre- and 1-year postoperative radiographic values ( > .05). No cases resulted in medial arch collapse. Five cases (8%) had an injury to the first branch of lateral plantar nerve.
Endoscopic plantar fascia release and plantar heel spur resection using a combined suprafascial and infrafascial approach resulted in the improvement of postoperative FAAM, SF-36, and VAS scores and involved a low incidence of postoperative complications.
确定采用内侧和外侧入路的内镜下筋膜上和筋膜下联合入路是否是一种安全有效的技术，用于内镜治疗伴有足底足跟骨刺疼痛的慢性足底筋膜炎。
进行了一项干预性前瞻性研究。2018年1月至2022年8月期间，共有61例伴有足底足跟骨刺疼痛的足底筋膜炎患者接受了内镜下足底筋膜切开术并切除足底足跟骨刺，采用筋膜上和筋膜下联合入路。测量术前足踝能力测量量表（FAAM）、36项简短健康调查问卷（SF-36）和视觉模拟量表（VAS）评分。术后6周、3个月、6个月、12个月及最后随访时重复测量。比较术前和术后1年的影像学参数（Meary角、跟骨倾斜角、内侧楔骨-第五跖骨高度）。每次随访时记录并发症情况。
平均随访时间为2.6±1.1年。术后6周随访时，FAAM-日常生活活动（ADL）、FAAM-运动、SF-36身体成分总结、SF-36精神成分总结和VAS的平均变化分别为26.0、19.0、44.8、61.2和-5.8。这些变化具有统计学意义（P<0.001）。在所有其他随访点（术后3个月、6个月、12个月及最后随访），这些结果持续存在且总体有所改善。恢复日常生活活动和体育活动的平均时间分别为2.6周和8.6周。术前和术后1年的影像学值无显著差异（P>0.05）。没有病例导致内侧足弓塌陷。5例（8%）发生足底外侧神经第一分支损伤。
采用筋膜上和筋膜下联合入路进行内镜下足底筋膜松解和足底足跟骨刺切除可改善术后FAAM、SF-36和VAS评分，且术后并发症发生率较低。
