Long-Term Outcome of Open Plantar Fascia Release.
BACKGROUND
Plantar fasciitis is thought to be a self-limiting condition best treated by conservative measures, but despite this many patients have a prolonged duration of symptoms and surgery may be indicated. Partial plantar fascial release is reported to have a short-term success rate of up to 80%, but anecdotally this was not thought to represent our local experience.


METHODS
An audit of long-term patient-reported outcomes following open partial plantar fascia release was performed. A total of 30 patients (33 feet) were identified over a 10-year period and case notes were reviewed. Patients were contacted by letter and invited to complete 2 validated patient-reported outcome score questionnaires (Visual Analog Scale-Foot and Ankle [VAS-FA] and Manchester Oxford Foot Questionnaire [MOXFQ]). Responses were received from 24 patients (26 feet). The average ages were 42.4 (range 24-61) for male and 46.2 (range 33-60) for female patients, with a female/male ratio of 2.7:1. The average duration of treatment prior to operative intervention was 3.1 years (range 1-5). Preoperatively, our cohort underwent a range of conservative measures. All patients were reviewed postoperatively, and average time from surgery to completion of questionnaires was 80 months (range 14-130).


RESULTS
The outcomes were worse in patients who had received preoperative steroid injections and this was found to be statistically significant. The mean MOXFQ score was 33.6 ± 3.9 (0-64). Mean VAS-FA score was 57.8 ± 4.9 (24-100).


CONCLUSIONS
This study found a negative correlation between duration of follow-up and outcome, in both MOXFQ and VAS-FA, showing that patients continued to improve many years postoperatively. The authors also found worse outcomes with preoperative steroid injections, better outcomes in older patients, and a weak gender bias, suggesting results in men were better than those in women. A prolonged recovery period and generally poor outcomes leads the authors to suggest that open plantar fascia release is of questionable clinical value and that patients may improve in the natural course of the disease, in spite of surgery.


METHODS
Level III, comparative study.
Department of Trauma and Orthopaedic Surgery, Ninewells Hospital, Dundee, Scotland amacinnes@nhs.net.
Alasdair
A
MacInnes
Woodend Hospital, Eday Road, Aberdeen, Scotland.
Sam C
SC
Roberts
University Hospitals South Manchester, England.
Jessica
J
Kimpton
University Hospitals South Manchester, England.
Anand
A
Pillai
D000328:Adult; D000367:Age Factors; D054869:Clinical Audit; D036981:Fasciitis, Plantar / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011300:Preoperative Care; D012189:Retrospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D064232:Visual Analog Scale
D005938:Glucocorticoids
outcome; plantar fascia; release