Abstract
COMPARISON BETWEEN ENDOSCOPIC SURGERY AND CALCANEAL PERFORATION IN THE MANAGEMENT OF PLANTAR FASCIITIS AND CALCANEAL SPUR

*Thamer Khalaf Yaseen, (M.B.Ch.B, F.I.C.M.S) and Dr. Mohammed Ahmed Moohialdeen, M.B.Ch.b, H.D(Orthopedic)

ABSTRACT

Background: Ignoring plantar fasciitis may result in chronic heel pain that hinders the regular activities. Prolonged standing, decreased range of ankle dorsiflexion, an intense running regime and obesity are all risk factors for plantar fasciitis. Surgery including endoscopic surgery or calcaneal perforation is considered only after 12 months of aggressive nonsurgical treatment. Aim of study: To evaluate the clinical outcome of endoscopic plantar fascia release in comparison to calcaneal drilling. Patients and Methods: A comparative study conducted in the Orthopedic unit in two Teaching Hospitals in Iraq during a period of three years from Feb, 2014 – Jan, 2017. It involved 70 feet (60 patients) with plantar fasciitis; 35 feet (30 patients) by endoscopic release of planter fascia in addition to spur removal (Group 1) and other 35 feet were treated by calcaneal perforation (Group 2) after more than six months of conservative treatment without relieve of their symptoms. Postoperative Evaluation was assessed by Ankle-Hind Foot Scale before surgery and at 18th month after surgery, duration until full weight bearing after surgery, and duration until returning to full activity. Patients with systemic cause of heel pain such as gout, pseudo gout, rheumatoid arthritis, ankylosing spondylitis or patients with mechanical abnormality, history of heavy smoking, diabetes mellitus or peripheral vascular insufficiency were excluded from the study. Results: No statistically significant difference in the mean of age between the study groups (42.9 versus 44.3 years, P=0.465). No statistical significant differences between study groups regarding postoperative complications (P=0.16). Mean of Ankle-Hind Foot Score was significantly higher in group (2) than that in group (1) (98.2 versus 93.5, P=0.001). Regarding duration until full activity, patients in group (2) were needed significantly lower duration than patients of group (1) to reach full activity (6.12 versus 9.9 weeks, P= 0.003). Conclusion: Calcaneal perforation is superior in the management of plantar fasciitis compared to endoscopic release of planter fascia.

Keywords: Plantar fasciitis, Calcaneal perforation, endoscopic release, Iraq.


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