A new study in the Journal of the American Podiatric Medical Association (JAPMA) evaluated the safety and efficacy of ultrasound-guided plantar fascia release for treatment of chronic plantar fasciitis. Forty-one patients were selected for the study and forty six feet underwent endoscopic plantar fascial release. After four weeks, patients were evaluated using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Rating Scale. All patients experienced significant improvements compared to baseline (before surgery). There were no complications or infections during the study period.
The authors concluded that ultrasound-guided plantar fascia release is an effective and safe surgical procedure for the treatment of chronic plantar fasciitis. Guiding the small arthroscopic instruments with ultrasound allows the surgeon to better visualize the plantar fascia and it minimizes trauma to the surrounding structures.
Plantar fasciitis is the tearing, inflammation and eventual degeneration of the plantar fascia, a long ligament in the bottom of the foot. Common conservative therapies include icing, stretching, taping, shoe change, orthotics, night splints and steroid injections. When treatment fails, extracorporeal shockwave therapy may be tried. Approximately 90% of individuals with plantar fasciitis will improve with conservative therapy within 12 months. Surgical options include coblation therapy, endoscopic plantar fascial release and open heel surgery.
This study evaluated the use of ultrasound to assist the surgeon in endoscopic plantar fascial release. Ultrasound can be used to visualize and evaluate the thickness of the plantar fascia, which has been shown to correlate with heel pain. Ultrasound records the echo of sound waves reflected off an object, such as ligament, tendon or bone. More dense objects, such as bone, will appear brighter and less dense objects, such as air or inflammation, will appear darker, or black on the ultrasound screen. A thickened and inflamed plantar fascia will appear black on ultrasound. The advantage of endoscopic plantar fascial release is the small incision (0.5 cm) which results in less trauma to surrounding tissues and translates to a faster healing time. Using ultrasound in combination with the endoscopic technique allows for more precise anatomical dissection and better visualization of the plantar fascia. Further studies which compare ultrasound guided plantar fascia release to the traditional endoscopic plantar fascial release and studies with long term follow-up will help further determine the safety and effectiveness of this procedure.
Vohra PK, Japour CJ. Ultrasound-guided Plantar Fascia Release Technique
A Retrospective Study of 46 Feet. J Am Podiatr Med Assoc 99(3): 183–190, 2009.
More information on heel pain and plantar fasciitis.
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