RESUMO
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.
Assuntos
Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Calcanhar/cirurgia , Esporão do Calcâneo/cirurgia , Estudos Retrospectivos , Calcâneo/cirurgia , Doenças do Pé , Dor , Endoscópios , Resultado do TratamentoRESUMO
La fascitis plantar, una entidad patológica autolimitante, es una causa común de dolor en el talón en pacientes adultos. El tratamiento quirúrgico está indicado cuando el paciente recibe tratamiento conservador bien vigilado sin obtener mejoría de síntomas entre 4-6 meses. Entre las complicaciones de las técnicas percutáneas se citan: infecciones, persistencia de dolor, lesiones neurológicas, entre otras. Nosotros reportamos un paciente con fractura de calcáneo posterior a fasciotomía plantar percutánea y resección de espolón calcáneo. Se hizo una revisión y discusión de la literatura.
Plantar fasciitis, a self-limiting pathologic entity, is a common cause of heel pain in adult patients. Surgical treatment is indicated when the patient does not improve after receiving conservative treatment for 4-6 months with proper surveillance. The complications of percutaneous techniques include: infection, persistent pain, and neurologic injuries, among others. We report the case of a patient with calcaneus fracture following percutaneous plantar fasciotomy and resection of a calcaneal spur. We conducted a review and discussion of the literature.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Calcâneo/patologia , Fasciíte Plantar/cirurgia , Fraturas Ósseas/etiologia , Esporão do Calcâneo/cirurgia , Calcâneo/cirurgia , Dor/etiologiaRESUMO
Introducción: La fascitis plantar es una patología frecuente, cuyo tratamiento es conservador, aunque en los casos sin respuesta se realiza cirugía. El objetivo del presente trabajo fue determinar el riesgo de lesionar los elementos nobles en la cirugía percutánea y establecer una zona de seguridad. Materiales y métodos: En 11 piezas cadavéricas frescas, se realizó la fasciotomía percutánea según la técnica de De Prado y se evaluó la relación con los elementos nobles, la lesión o no de estos y la distancia entre la sección del bisturí y las estructuras vasculonerviosas. Resultados: No se evidenciaron daños en los nervios y vasos del retropié. El promedio de distancia entre el corte y el nervio plantar lateral fue de 16 mm, y entre el corte y el nervio digiti quinti, de 10,7 mm. No hubo lesiones vasculares. Conclusiones: Este estudio demuestra el bajo riesgo de lesión neurovascular durante la práctica de la fasciotomía plantar percutánea cuando se trabaja en contacto con el calcáneo.
Background: Plantar fasciitis is a common condition. In cases of non-response to conservative treatment, surgery is performed. The aim of the study was to determine the risk of injury to noble structures in percutaneous surgery, and to define a safety zone. Methods: In 11 fresh cadavers, percutaneous fasciotomy was performed according to the De Prado technique, and later evaluated with regards to injury to noble structures, and distance between the knife and neurovascular structures. Results: There was no evidence of any damage to hind-foot nerves and vessels. The average distance between the incision and the lateral plantaris nerve was 16 mm, and between the incision and the digiti Quinti nerve 10.7 mm. There were no vascular lesions. Conclusions: The study demonstrates the low risk of neurovascular injury during the practice of percutaneous plantar fasciotomy, when working in contact with the calcaneus.