Endoscopic Plantar Fascia Release in Cases of Chronic Resistant Plantar Fasciopathy

Study Overview
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Brief Summary
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The plantar fascia is a thick tissue band that connects the heel bone (the medial tubercle of the under surface of the calcaneus) to the metatarsophalangeal joints, forming the medial arch of the foot, which supports the foot during walking. Irritation and scarring of the plantar fascia is one of the most common causes of heel pain . Plantar fasciopathy accounts for 11% to 15% of all foot disorders in both athletes and sedentary patients . Although commonly referred to using incorrect nomenclature as plantar fasciitis ,it is degenerative process (i.e. fasciopathy).The etiology of plantar fasciopathy is not clear. It can result from irritation due to overstrain of the fascia, which induces mucoid degeneration The pathologic ﬁndings include degenerative tissue changes without inﬂammatory mediators . The diagnosis of plantar fasciopathy is determined by the medical history and physical examination ﬁndings. Typically, patients present with heel pain during weight bearing , especially in the early morning and with the ﬁrst steps after a period of inactivity . Patients will usually have tenderness around the site of the plantar aponeurosis . The pain can be reproduced by stretching the diseased plantar aponeurosis by passive hyperextension of the metatarsophalangeal joints . Endoscopic plantar fasciotomy is a relatively new procedure, involves an endoscopic approach to the heel, allowing a plantar aponeurosis release to be performed with delicate instruments, minimal dissection, and immediate weight bearing

Official Title
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Endoscopic Plantar Fascia Release in Cases of Chronic Resistant Plantar Fasciopathy

Conditions
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in Cases of Chronic Resistant Plantar Fasciopathy

Intervention / Treatment
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* Procedure: Endoscopic plantar fascia release in cases of chronic resistant plantar fasciopathy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults more than 18 years old presented by a single site heel pain with local pressure at the origin of plantar fascia on the medial Calcaneal tuberosity for one year, with failure of at least two lines of conservative treatment including: Non-steroidal anti-inflammatory drugs (NSAIDs), Corticosteroid injections, physical therapy, exercise program (Achilles tendon and plantar fascia stretching exercises) and orthotic devices (heel cup, molded shoe insert or night splint) for at least 3 months. Exclusion Criteria: Patients younger than 18 years. Patients who had a local infection or a metabolic disorder especially diabetes, generalized polyarthritis, sero-negative arthropathy, , tarsal tunnel syndrome. Patients with congenital anomalies e.g pesplanus, pescavus, limb length discrepancy, in-toeing, neuro-muscular disorders. Patients with an ipsilateral or contralateral vascular or neurological abnormalities, or malignancies. Recent trauma or foot and ankle deformity or fractures. Active anticoagulation therapy or bleeding disorders Patients who received a corticosteroid injection within the previous four weeks.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: cases<br> | Procedure: Endoscopic plantar fascia release in cases of chronic resistant plantar fasciopathy<br>* A medial portal will be developed 1cm away from the plantar skin along a vertical line passing through the posterior border of the medial malleolus with the foot in neutral position. A 5 mm cannula will be then introduced through the lateral portal over the trocar. Irrigation fluid will be then connected. A 30-degree 4.0 mm endoscope will be inserted inside the cannula. A 4.5 motorized incisor blade will be then used to debride the subcutaneous tissue until full visualization of the shiny fibers of the plantar fascia will be possible. A needle was inserted vertically through the heel skin to act as a land mark for the middle of the plantar fascia. A scalpel blade will then introduced through the medial portal to divide the full thickness of the medial half of the plantar fascia into two leaflets under direct visualization . The posterior leaflet will be then totally debrided using a motorized incisor blade . The tunnel will then be irrigated and stitches will be done.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| American Orthopedic Foot and Ankle-Hind foot Scale | Pain Function Alignment assessment | 6 months following operation |