Results of surgical release of the plantar fascia in the treatment of recalcitrant plantar fasciitis heel pain syndrome: a clinico - pathological study

Plantar fasciitis is one of the most important and recognisable causes of heel pain. Most of cases can be treated conservatively, and surgical treatment will be reserved for resistant cases. Plantar fascia release was advocated and tried as a simple surgical treatment of plantar fasciitis. The purpose of this prospective study is to assess the results of plantar fascia release in patients of recalcitrant plantar fasciitis with follow up for at least one year postoperatively and also to report the histopathological patterns of such condition. Fifty-four patients were diagnosed as plantar fasciitis, which were resistant to conservative treatment for at least 6 months. The average duration of symptoms was 16.9 months. The average age was 41.4 years. There were 50 females [92.6%] and 4 males [7.4%]. The right side was affected in 18 patients [33.33%], the left in 14 patients [25.93%] and 22 patients [40.74%] had bilateral affection. Only two patients were operated upon bilaterally. So [56 feet] were treated by surgical release of the plantar fascia through a medial calcaneal approach. They were followed up for an average of 13.6 months. Thirty-eight patients [70.37%] were obese and 28 feet had local corticosteroid injections. Radiologically, calcaneal spur was detected in 36 feet [64.29%]. Excellent results were encountered in 34 feet [60.71%], good in 14 feet [25%] and poor in only 8 feet [14.29%]. Satisfactory results were obtained in 48 feet [85.71%] and 8 feet [14.29%] were rated as unsatisfactory. More excellent results were encountered among cases with the duration of symptoms one year or less and in those without history of previous local corticosteroid injections. Patients with calcaneal spur had more satisfactory results. Superficial wound infection and delayed healing occurred in 6 feet [10.71%], deep wound infection and sinus formation occurred in 6 feet [10.71%]. All were treated successfully by antibiotics and repeated dressing. Eight feet [14.29%] had persistent numbness at the incision site. The commonest histopathological pattern was hyalinization of the collagen bundles in 44 feet [78.57%] especially in cases with long standing complaint and those who had local steroid injections. Plantar fascia release is a simple and safe procedure with few complications. It is a procedure, which may offer a good chance of cure for the patients with chronic plantar fasciitis refractory to conservative treatment

Renal biopsy: ten years' experience of the pediatric nephrology unit of Alexandria university

Analysis of 147 pediatric renal biopsies was done to review the local pattern of renal diseases in Alexandria University and to assess the safety and diagnostic efficacy of the procedure. Glomerular diseases represented 90.5% of biopsied kidneys. Nephrotic syndrome was the most frequent presentation requiring renal biopsy [57%] followed by acute renal failure [23.8%]. Diffuse mesangial proliferation was the most frequent pathological diagnosis among nephrotic patients [33.3%] followed by membranoproliferative glomerulonephritis [21.4%] and focal segmental glomerulosclerosis [16.6%]. Minimal change nephrotic syndrome was noticed in only 7%. Also, rapidly progressive crescentic glomerulonephritis was the most common pathological diagnosis among patients presenting with acute renal failure [13.6%] followed by hemolytic uremic syndrome [4.7%]. No severe clinical complications related to the biopsies were. observed. Also, 94.5% of biopsies were considered adequate for histopathological analysis. In conclusion, renal biopsy is a valuable diagnostic tool in the diagnosis and management of glomerular diseases in children