Biomechanical consequences of total plantar fasciotomy: a review of the literature.

BACKGROUND: Plantar fascia release for chronic plantar fasciitis has provided excellent pain relief and rapid return to activities with few reported complications. Cadaveric studies have led to the identification of some potential postoperative problems, most commonly weakness of the medial longitudinal arch and pain in the lateral midfoot. METHODS: An electronic search was conducted of the MEDLINE, ScienceDirect, SportDiscus, EMBASE, CINAHL, Cochrane, and AMED databases. The keywords used to search these databases were plantar fasciotomy and medial longitudinal arch. Articles published between 1976 and 2008 were identified. RESULTS: Collectively, results of cadaveric studies suggested that plantar fasciotomy leads to loss of integrity of the medial longitudinal arch and that total plantar fasciotomy is more detrimental to foot structure than is partial fasciotomy. In vivo studies, although limited in number, concluded that although clinical outcomes were satisfactory, medial longitudinal arch height decreased and the center of pressure of the weightbearing foot was excessively medially deviated postoperatively. CONCLUSIONS: Plantar fasciotomy, in particular total plantar fasciotomy, may lead to loss of stability of the medial longitudinal arch and abnormalities in gait, in particular an excessively pronated foot. Further in vivo studies on the long-term biomechanical effects of plantar fasciotomy are required.

An evaluation of the long-term effects of total plantar fasciotomy--a preliminary study.

BACKGROUND: Plantar fascia release for chronic plantar fasciitis has given excellent pain relief and rapid return to activities with few reported complications. Cadaveric studies have led to the identification of some potential post-operative problems, commonly weakness of the medial longitudinal arch (MLA) and pain in the lateral midfoot. METHODS: Eight total plantar fasciotomy patients (five bilateral and three unilateral) were evaluated subjectively and objectively with regards to surgical outcome and biomechanical change. The centre of pressure (COP) and loading of the foot were measured using the F Scan mobile system and COM'nalysis software. In addition, five control subjects were evaluated with the F Scan. The reading for one foot of one of the control subjects was discarded due to a biomechanical abnormality. RESULTS: The results of this study were that the COP of the foot in post-total plantar fasciotomy subjects was significantly laterally deviated throughout the propulsive phase of gait compared to that of control subjects (p<0.05). There was no significant difference in plantar pressure at the rearfoot or the first metatarsophangeal joint (MTPJt) between the post-operative and control groups (p>0.05). Six of the eight of the post-operative patients (11 feet) considered the procedure to be successful in resolving their symptoms. CONCLUSION: Total plantar fasciotomy may result in changes to the COP of the foot. It could be extrapolated from this data, in conjunction with subjective visual clinical observations of gait, that supination of the foot could occur post-operatively rather than the pronatory state secondary to a collapsed arch that, collectively, the results of cadaver studies have suggested. The conclusions drawn from this pilot study are to some extent speculative, as the measurements were only made post-operatively and a small number of subjects were studied. Further research is required in this area.

Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners.

BACKGROUND: We investigated the relationship between functional and static foot posture and medial tibial stress syndrome in distance runners. METHODS: Twenty-eight runners with a clinical diagnosis of medial tibial stress syndrome and 12 asymptomatic runners were assessed with the Foot Posture Index to measure static overpronation. Range of motion was measured at the talocrural joint, with the knee extended and flexed as was range of motion at the first metatarsophalangeal joint and the angular difference between the neutral and relaxed calcaneal stance positions. Each participant was then videotaped while running on a treadmill shod and unshod. This videotape was analyzed using freeze frame to identify abnormal or mistimed pronation at each phase of gait. The results were analyzed using logistic regression to give the probability that a runner is likely to experience medial tibial stress syndrome, predicted from the static measurements and dynamic observations. RESULTS: Variables identified as being significant predictors of medial tibial stress syndrome were the difference between the neutral and relaxed calcaneal stance positions, range of motion of the talocrural joint with the knee extended, early heel lift and abductory twist during gait, and apropulsive gait. CONCLUSION: Runners with suspected symptoms of medial tibial stress syndrome should be assessed dynamically and statically for abnormal or mistimed pronation.

Etiologic factors in the development of medial tibial stress syndrome: a review of the literature.

BACKGROUND: Medial tibial stress syndrome is a type of exercise-induced leg pain that is common in recreational and competitive athletes. Although various studies have attempted to find the exact pathogenesis of this common condition, it remains unknown. METHODS: Various theories in literature from 1976 to 2006 were reviewed using key words. RESULTS: Until recently, inflammation of the periosteum due to excessive traction was thought to be the most likely cause of medial tibial stress syndrome. This periostitis has been hypothesized by some authors to be caused by the tearing away of the muscle fibers at the muscle-bone interface, although there are several suggestions as to which, if any, muscle is responsible. CONCLUSIONS: Recent studies have supported the view that medial tibial stress syndrome is not an inflammatory process of the periosteum but instead a stress reaction of bone that has become painful.

Is eccentric muscle contraction a significant factor in the development of chronic anterior compartment syndrome? A review of the literature.

INTRODUCTION: The purpose of this article was to review published articles investigating the association of eccentric contractions of the anterior compartment with an increase in intramuscular pressure. METHODS: An electronic review using Medline, Amed and Science Direct returned 49 papers, seven of which were considered suitable. Manually browsing reference lists of these led to the identification of a further five relevant papers. A further nine papers were considered as suitable for background reading. RESULTS: Results of previous studies have indicated that there is a relationship between excessive eccentric contractions, delayed onset of muscle soreness, and an increase in intramuscular pressure. However, due to the differences in a number of variables between these studies a direct comparison cannot be made. CONCLUSION: Eccentric contractions of the anterior compartment have, in the short term, been associated with an increase in intra-compartmental pressure and delayed onset of muscle soreness in studies on healthy volunteers. There is no evidence as yet that there is a further association with the development of chronic anterior compartment syndrome. The long term effect of excessive eccentric contraction is believed to be a reduction of compliance in and loss of elasticity of the fascia, which is probably irreversible.