title: Endoscopic plantar fascia release by hooked soft-tissue electrode after failed shock wave therapy.
abstract: OBJECTIVE
  The purpose of this study was to assess the outcome of endoscopic plantar fascia release (EPFR) after failed extracorporeal shock wave therapy (ESWT).
  
  
  METHODS
  Eighteen patients (twenty-one feet) had persistent painful heel after treatment by ESWT for at least 6 months. The treatment protocol included 2,000 pulses of 0.12 mJ/mm(2) given in 1 session weekly for 7 sessions. Preoperative and postoperative assessment of pain and functional evaluation were done blindly by the second author using a visual analog scale (VAS) score and the modified American Orthopaedic Foot & Ankle Society (AOFAS) score for the hindfoot. EPFR was done without the use of a tourniquet under local ankle block. A monopolar hooked soft-tissue electrode (ConMed Linvatec, Largo, FL) was used to sever the plantar fascia and to control bleeding. The mean follow-up period was 25.8 months. Only 17 patients (20 feet) completed 2 years' follow-up.
  
  
  RESULTS
  The mean preoperative VAS score was 72.52, and the mean preoperative modified AOFAS score was 24.23. There was a statistically significant improvement in VAS score, modified AOFAS score, and morning pain at 2 years' follow-up (P < .05). Of the patients, 9 (50%) had excellent results, 6 (35%) had good results, 1 (10%) had a fair result, and 1 (5%) had failure of improvement of pain. No major complications were found; 2 patients had hyperkeratosis at the portal site, and 1 patient had paresthesia at the lateral border of the foot.
  
  
  CONCLUSIONS
  EPFR yielded good to excellent outcomes in 85% of 17 patients with plantar fasciitis resistant to treatment by ESWT after 2 years' follow-up.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Deparment of Orthopaedics, Ain Shams University, Cairo, Egypt. ossama_elshazly@yahoo.com
authors.forename: Ossama
authors.initials: O
authors.lastname: El Shazly
authors.forename: Rana A
authors.initials: RA
authors.lastname: El Hilaly
authors.forename: Maged M
authors.initials: MM
authors.lastname: Abou El Soud
authors.forename: M Nabil M A
authors.initials: MN
authors.lastname: El Sayed
mesh_terms: D000328:Adult; D004564:Electrocoagulation / Q000295:instrumentation* / Q000379:methods; D004566:Electrodes; D004724:Endoscopy / Q000379:methods*; D036981:Fasciitis, Plantar / Q000601:surgery* / Q000628:therapy; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome