Analysis of the curative effect of triple surgery under endoscope in the treatment of intractable heel pain / 中国骨伤

OBJECTIVE@#To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain.@*METHODS@#The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed, including 20 males and 30 females;aged from 40 to 68 years old with an average of (50.12±7.35)years old, the medical history ranged from 1 to 4 years. All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression, and were followed up, the duration ranged from 24 to 60 months with an average of(42.00±3.28) months. All patients had obvious heel pain before surgery, and X-ray examinations often showed the presence of calcaneal spurs. In addition to the routine foot examination, the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray, for the evaluation of clinical effect. The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain, voluntary movement, gait and stability.@*RESULTS@#The VAS decreased from (8.75±1.24) before surgery to (5.15±2.35) at 3 months after surgery, (4.07±2.53) at 6 months after surgery, and (3.95±2.44) at the last fllow-up(P<0.05). The AOFAS score increased from (53.46±4.17) before surgery to(92.46±2.53) at 3 months after surgery, (96.33±2.46) at 6 months after surgery, and (97.05±2.37) at the last follow-up(P<0.05). The arch height was (41.54±1.15) mm before operation and (41.49±1.09) mm after the operation, the difference was not statistically significant(P>0.05). The internal arch angle of the foot arch was (121±6)° before operation and (122±7)° after operation. The difference was not statistically significant(P>0.05).@*CONCLUSION@#Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited great clinical effect for treating intractable heel.

Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet / 中国修复重建外科杂志

OBJECTIVE@#To explore the feasibility and effectiveness of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet.@*METHODS@#Between July 2017 and January 2023, 35 cases of hand and foot defects were repaired with plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue (13 pedicled flaps and 22 free flaps). There were 18 males and 17 females, with an average age of 38.8 years (range, 8-56 years). Thirty cases of defects were caused by trauma, and the interval between injury and admission ranged from 2 to 6 hours (mean, 3.3 hours). Three cases were ulcer wounds with a course of 3.0, 3.8, and 7.0 months, respectively. Two cases were malignant melanoma. Eight cases of wounds located in the fingers, 13 cases in the palm, 12 cases in the heel, and 2 cases in the distal foot. The size of skin defects ranged from 4.0 cm×3.5 cm to 12.0 cm×10.0 cm, and the size of flap ranged from 5.0 cm×4.5 cm to 13.0 cm×11.0 cm. The donor sites were repaired with skin grafts.@*RESULTS@#All flaps were survived and the wounds healed by first intention after operation. The partial necrosis at the edge of the skin graft occurred in 1 case, which healed after dressing change; the other skin grafts survived successfully. All patients were followed up 6-24 months (mean, 18 months). The flaps exhibited similar color and thickness to the surrounding hand and foot skin. Two-point discrimination ranged from 7 to 10 mm in the flaps with an average of 8 mm. The donor sites had no painful scars or sensory abnormalities. Foot and ankle functions were good and gaits were normal.@*CONCLUSION@#Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet had good flap shape, high survival rate of skin graft at the donor site, and no obvious complications.

Ultrasound-guided injection of hyaluronic acid and corticosteroid for treating plantar fasciitis: Evaluation of pain, fascia thickness and ankle-foot function / 中国组织工程研究

BACKGROUND: Sodium hyaluronate injection has been used in many musculoskeletal diseases, including knee osteoarthritis, frozen shoulder, rheumatoid arthritis, and other tendon and soft tissue pain. OBJECTIVE: To evaluate the effect of sodium hyaluronate injection and corticosteroid injection in reducing the symptoms of plantar fasciitis. METHODS: Sixty-five patients with plantar fasciitis were randomly divided into two groups: sodium hyaluronate group (32 cases) and corticosteroid group (33 cases). Two groups of patients were injected with 2.5 mL of sodium hyaluronate (25 mg/2.5 mL) and compound betamethasone (5 mg of diprosone and 2 mg of betamethasone sodium phosphate) under the guidance of ultrasound, respectively. The treatment interval was 7 days, twice in total. The Visual Analogue Scale (VAS) score, plantar fascia thickness and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were measured before treatment, 1 month and 3 months after treatment. RESULTS AND CONCLUSION: At 1 month after treatment, compared with the baseline data, the VAS and plantar fascia thickness of the two groups decreased, and the AOFAS ankle-hindfoot score increased (P 0.05). To conclude, corticosteroids and sodium hyaluronate are both effective to treat plantar fasciitis, but the effect of corticosteroids is better within 1 month. To avoid the potential risk of corticosteroids, sodium hyaluronate can be a substitute of corticosteroids.

Sonographic Evaluation Of Plantar Fascia Following Low-Level Laser Therapy In Plantar Fasciitis

Background: Plantar fasciitis is the most common cause of inferior heel pain resulted from repeated trauma leading to a microscopic tear in the plantar fascia. There is a need to study the non-invasive nature of low-level laser therapy in reducing pain and enhance healing. Therefore the study aimed to find out the efficacy of low-level laser therapy in plantar fasciitis. Methods: The study design is a pre-post experimental design. Thirty patients(21 females & 9 males) with plantar fasciitis who fulfilled the inclusion criteria participated in the study. Baseline parameters using musculoskeletal ultrasonogram of the plantar fascia, numerical pain rating scale, ankle joint mobility testing and foot and ankle ability measure questionnaire were recorded. Subjects in the control group received ultrasonic therapy, while the experimental group received irradiation of Low-Level Laser Therapy (LLLT) for two weeks comprising 12 sessions and the above-specified outcome measures were re-evaluated after two weeks. Results: The results showed significant improvement in pain severity (p<0.04) and ankle dorsiflexion range of motion (p<0.00) and ankle ability measure but no significant change in plantar fascia thickness following low-level laser therapy was observed. A positive correlation (r=0.9) was found between plantar fascia thickness and post foot and ankle ability measure-ADL scores (p=0.02). Conclusion: The findings suggest that low-level laser therapy helps in pain reduction and improving range of motion in plantar fasciitis with minimal effect on the thickness of plantar fascia.

Is Platelet-rich Plasma Injection more Effective than Steroid Injection in the Treatment of Chronic Plantar Fasciitis in Achieving Long-term Relief?

@#Introduction:Plantar fasciitis is characterised by pain in the heel, which is aggravated on weight bearing after prolonged rest. Many modalities of treatment are commonly used in the management of plantar fasciitis including steroid injection. Many studies show that steroid injection provides pain relief in the short term but not long lasting. Recent reports show autologous platelet-rich plasma (PRP) injection promotes healing, resulting in better pain relief in the short as well as long term. The present study was undertaken to compare the effects of local injection of platelet-rich plasma and Corticosteroid in the treatment of chronic plantar fasciitis. Materials and methods:Patients with the clinical diagnosis of chronic plantar fasciitis (heel pain of more than six weeks) after failed conservative treatment and plantar fascia thickness more than 4mm were included in the study. Patients with previous surgery for plantar fasciitis, active bilateral plantar fasciitis, vascular insufficiency or neuropathy related to heel pain, hypothyroidism and diabetes mellitus were excluded from the study. In this prospective double-blind study, 60 patients who fulfilled the criteria were divided randomly into two groups. Patients in Group A received PRP injection and those in Group B received steroid injection. Patients were assessed with visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score. Assessment was done before injection, at six weeks, three months and six months follow-up after injection. Plantar fascia thickness was assessed before the intervention and six months after treatment using sonography. Results: Mean VAS in Group A decreased from 7.14 before injection to 1.41 after injection and in Group B decreased from 7.21 before injection to 1.93 after injection, at finalfollow-up. Mean AOFAS score in Group A improved from 54 to 90.03 and in Group B from 55.63 to 74.67 at six months’ follow-up. The improvements observed in VAS and AOFAS were statistically significant. At the end of six months’ follow-up, plantar fascia thickness had reduced in both groups (5.78mm to 3.35mm in Group A and 5.6 to 3.75 in Group B) and the difference was statistically significant. Conclusion: Local injection of platelet-rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effect.

Treatment Of Plantar Fasciitis By Corticosteroid Injection: To Rely On Your Fingers Or The Ultrasound Probe

Introduction:Plantar fasciitis (PF) is treated by corticosteroid injection using ultrasound-guidance (US) or palpation-guided. Our study aims to compare the efficacy and outcome parameters of the two modalities. Methods:208 patients of PF were randomly allocated in two groups, group A (US-guidance) and group B (palpation-guided) while treating them with corticosteroid injection. Pain, plantar fascia thickness (PFT) and heel pad thickness (HPT) were measured and analysed during follow-up. Results:Statistically significant improvement in pain score and decrease in PFT was recorded in both groups which was more in US-guided group, while no difference was noted in HPT. Decrease in pain significantly correlated to decrease in PFTbut had no correlations with decrease in HPT. Conclusion:US-guided injection is better than palpation-guided injection providing greater relief in pain and normalization of PFT as it enhances the accuracy of injection site by precise localization of the plantar fascia and guided needle placement during injection. It also aids in diagnosis and plays an important role in prognosis of PF.

The Clinical Features of Plantar Fascia Rupture / 대한족부족관절학회지

PURPOSE: The purpose of this study is to analyze the clinical features of plantar fascia rupture. MATERIALS AND METHODS: We retrospectively reviewed 312 patients with plantar fasciitis between March 2008 and February 2013. We investigated age, sex, site, visual analogue scale (VAS), body mass index (BMI), characteristics of pain, awareness of rupture, and duration of symptoms. Acute rupture was defined as a rupture that occurred during exercise; chronic rupture was defined as a degenerative rupture after plantar fasciitis. We investigated the frequency of acute and chronic rupture. RESULTS: Among 312 patients, 38 patients (12.2%) were diagnosed with plantar fascia rupture. Thirty-eight patients consisted of 14 men (36.8%) and 24 women (63.2%). The mean age of plantar fascia rupture was 58.29±12.54 years. The mean VAS score was 5.92 points (3~9 points). The mean BMI was 25.92±1.59 kg/m². Among the 38 patients, 2 patients had acute plantar fascia rupture and 36 had chronic plantar fascia rupture. In 34 patients—out of 36 chronic plantar fascia rupture, there were no subjective symptoms. CONCLUSION: Chronic rupture of the plantar fascia that occurred after plantar fasciitis was more common than acute rupture. Chronic rupture occurred at approximately 12% of patients treated with plantar fasciitis. In chronic rupture of the plantar fascia, there were no subjective symptoms of rupture. Therefore, we should doubt chronic rupture of plantar fascia when plantar fasciitis is prolonged.

Combined First Metatarsal and Calcaneal Osteotomy for Fixed Cavovarus Deformity of The Foot / 대한족부족관절학회지

PURPOSE: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. MATERIALS AND METHODS: We performed a dorsal closing wedge 1st metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-1st metatarsal, calcaneus-1st metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. RESULTS: Talo-1st metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of 21degrees and 25degrees to 12degrees and 19degrees, respectively, at last followup. Also, calcaneus-1st metatarsal angle was increased from the mean 114degrees to 144degrees. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. CONCLUSION: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.

Sonographic Evaluation and Conservative Treatment of Plantar Fasciitis / 대한정형외과학회잡지

PURPOSE: We report the differences of the clinical outcome of various types of plantar fasciitis patients who were treated with conservative methods, and their sonographic findings. MATERIALS AND METHODS: 37 patients, 50 cases with the diagnosis of plantar fasciitis were available for review. The average age was 47.5 years (range: 22-78) and the average follow-up period was 15.8 months (range: 4-23) . Both feet of 30 plantar fasciitis patients and those of 30 healthy volunteers were evaluated with ultrasound. We treated the patients with stretching of Achilles tendon and plantar fascia, rest, nonsteroidal anti-inflammatory drugs, inserts and night splint. RESULTS: Clinical results were classified as good (resolution of symptoms) for 59.5%, fair (continued symptoms but no limitation of activity or work) for 35.1%, and poor (continued symptoms limiting activity or changing work status) for 5.4%. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis (range: 3.2-8.0 mm, average: 5.1 mm, SD: 1.12) than in their asymptomatic heels (range: 1.3-5.0 mm, average: 3.5 mm, SD: 0.78) and in the control group (range: 1.8-5.0 mm, average: 3.0 mm, SD: 0.71) (p< 0.0001) . CONCLUSION: In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechoic. And there is a higher risk for continued symptoms in patients with bilateral symptoms and those who have symptoms for a prolonged period before seeking medical attention. Therefore plantar fasciitis is thought that it should be vigorously treated as soon as possible before the permanent change of plantar fascia.