title: Endoscopic surgery for plantar fasciitis: application of a deep-fascial approach.
abstract: OBJECTIVE
  The purpose of this study was to determine the clinical results of deep-fascial medial and lateral portals in performing endoscopic surgery for plantar fasciitis.
  
  
  METHODS
  In 10 feet in 8 patients who were treated conservatively for more than 6 months with failure to relieve their symptoms, endoscopic surgery was performed. After the patient was placed in the supine position, a medial portal was made 5 mm deep to the plantar fascia and 10 mm anterior to its origin on the calcaneus under fluoroscopy. The lateral portal was established by placing a blunt trocar deep and perpendicular to the plantar fascia. A 2.7-mm-diameter arthroscope was passed through the deep-lateral portal, and the operative devices were inserted through the deep-medial portal. A motorized shaver was used for making a working space to excise the fat tissue along with a portion of the flexor digitorum brevis muscle. If a heel spur existed, it was resected to establish a clear view of the plantar fascia by use of an arthroscopic burr. After exposure of the plantar fascia, its medial half was removed with electric devices such as an Arthro-Knife (ConMed Linvatec, Largo, FL).
  
  
  RESULTS
  The mean score on the American Orthopedics Foot and Ankle Society Ankle Hindfoot Scale was 64.2 ± 6.3 points before surgery and 92.6 ± 7.1 points at 2 years after surgery (P < .0001). The mean duration to full weight bearing after surgery was 13.9 ± 8.4 days. All patients returned to full athletic activities by a mean of 10.7 ± 2.6 weeks.
  
  
  CONCLUSIONS
  Endoscopic surgery for plantar fasciitis through a deep-fascial approach allows a wide field of vision and working space, permitting reliable resection of the plantar fascia and heel spur.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan. fumito@crest.ocn.ne.jp
authors.forename: Fumito
authors.initials: F
authors.lastname: Komatsu
authors.forename: Masato
authors.initials: M
authors.lastname: Takao
authors.forename: Ken
authors.initials: K
authors.lastname: Innami
authors.forename: Wataru
authors.initials: W
authors.lastname: Miyamoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsushita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000295:instrumentation / Q000379:methods*; D036981:Fasciitis, Plantar / Q000150:complications / Q000601:surgery*; D005260:Female; D036982:Heel Spur / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult