Surgical treatment of resistant cases of planter fasciitis

ABSTRACT

Subcalcaneal heel pain [plantar fasciitis] is a very common presenting complaint in orthopedic practice. The exact cause of pain is uncertain. It may be due to repetitive microtrauma and overload injury to the plantar fascia at its attachment to the calcaneal tuberosity, loss of heel pad elasticity or entrapment neuropathy of a branch of the lateral plantar nerve to the abductor digiti minimi muscle or medial calcaneal branches. Systemic disorders as rheumatoid arthritis, diabetes mellitus, SLE, gout, ankylosing spondylitis or Reiter's syndrome might also cause plantar fasciitis. Most patients respond to one form or another of conservative treatment. Twenty-four patients [30 feet] with refractory plantar fasciitis for whom surgical treatment was done were presented. Fasciotomy, stripping of the short muscles of the toes and excision of calcaneal spur, if present, were done for all patients. The minimum follow up period was one year and the results were 86.6% satisfactory and 13.4% unsatisfactory. The complications were two feet with superficial infection, six feet with a strip of hyposthesis below the incision and four feet with persistent pain and tenderness at the final examination