Preferred management of recalcitrant plantar fasciitis among orthopaedic foot and ankle surgeons.
BACKGROUND
There are a number of different treatment options available for recalcitrant plantar fasciitis, with limited high-level evidence to guide nonoperative and operative treatment methods. The purpose of this study was to determine the current preferred nonoperative and operative treatment methods for recalcitrant plantar fasciitis by a group of experienced orthopaedic foot and ankle surgeons.


METHODS
A hypothetical patient with recalcitrant plantar fasciitis was developed as the basis for a survey comprised of seven questions. The questions related to the surgeon's preferred treatment after 4~months of failed nonoperative management and then after 10 months of recalcitrant symptoms. The survey was sent to committee members of the American Orthopaedic Foot and Ankle Society (AOFAS).


RESULTS
Eighty-four orthopaedic surgeons completed the survey (84 out of 116; response rate=72%). At the 4-month visit, when questioned regarding their most preferred next step in management, 37 (44%) respondents favored initiation of plantar fascia-specific stretching (PFSS), 20 (24%) supervised physical therapy, 17 (20%) night splinting, five (6%) steroid injection, three (4%) custom orthotics, and two (2%) cast or boot immobilization. With ongoing symptoms at 10~months, 62 (74%) respondents chose surgery or ECSWT (extracorporeal shock wave therapy) as their next step in management. Some form of surgery (alone or in combination) was chosen by 46 (55%) respondents. The most popular operative interventions were gastrocnemius recession (alone or in combination with another procedure) and open partial plantar fascia release with nerve decompression.


CONCLUSIONS
For shorter duration symptoms, tissue-specific stretching and conditioning methods were favored over anti-inflammatory or structural support modalities which is consistent with available high-level evidence studies. Heterogeneity of operative preferences for chronic symptoms highlighted the need for further high-quality studies.
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave., Box 665, Rochester, NY 14642, USA. Benedict_DiGiovanni@urmc.rochester.edu
Benedict F
BF
DiGiovanni
Andrew M
AM
Moore
Jason P
JP
Zlotnicki
Stephen J
SJ
Pinney
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002370:Casts, Surgical; D002908:Chronic Disease; D036981:Fasciitis, Plantar / Q000628:therapy*; D006801:Humans; D007103:Immobilization; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D009989:Orthotic Devices; D026741:Physical Therapy Modalities; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones