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Abstract
Plantar fasciitis is a common problem faced almost daily in our orthopedic clinic, and it is not easy to satisfy patients with a curative treatment in a short period of time; it is characterized by deep pain in the plantar aspect of the heel, particularly on arising from bed, although the pain often subsides after few steps, in some patients the pain will persist for a long period. Aim of the study: To evaluate the result of surgical treatment in cases of plantar fasciitis which are not respond to conservative treatment. Methods: Prospective study was conducted at the Department of Orthopedic Surgery in Al-Kadhemiyah Teaching Hospital from November 2010 to May 2012 to evaluate 50 patients com¬plaining of inferior heel pain. There were 30 females and 20 males; the main presenting symptoms were pain on the inferno-medial aspect of the heel exacerbating by prolongs weight-bearing and in the morning following sleep. The age of the patients is 23-58 years. Bilateral heel pain presented in 10 patients in our series; therefore, the overall number of heels treated in our series was 60 heels. All of the patients were treated first conservatively by rest, anti-inflammatory drugs, and local corticosteroid injection. 13 patients showed no response, so we advised them for surgery; 12 patients out of 13 accepted surgery and were treated by plantar fascial release. Patients with systemic diseases had been excluded from our study. Results: Regarding treatment, 37 patients (74%) respond to conservative treatment, while 13 patients (26%) had no response to conservative treatment. Therefore they were advised to undergo surgery, and 12 of them accepted surgery. Nine patients (75%) undergoing surgery had a good result (pain-free) 17% of patients undergoing surgery in our study showed fair results (pain after heavy exercise), while 8% showed poor results (persistent pain). Per-operative drilling of calcaneum showed to be effective in post-operative heel pain relieve, which may be due to reduced intra-osseous pressure. Regarding complications, 6% showed superficial wound infection, which was treated conservatively by rest and antibiotics for seven days. Post-operative back slab for two weeks is important to decrease post-operative pain and to facilitate soft tissue healing
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References
- Liden B, Simmons M, Landsman AS. A retrospective analysis of 22 patients treated with percutaneous radiofrequency nerve ablation for prolonged moderate to severe heel pain associated with plantar fasciitis. J Foot Ankle Surg. 2009;48:642–7.
- Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. 2005;72:2237–42. [PubMed] [Google Scholar]
- Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A:872–7.
- Hossain M, Makawana N. “Not Plantar Fasciitis”: The differential diagnosis and management of heel pain syndrome. Orthopaedics and Trauma. 2011;25 (3):198–206.
- Roxas M. Plantar fasciitis: Diagnosis and therapeutic considerations. Altern Med Rev. 2005;10:83–93. [PubMed] [Google Scholar]
- Chundru U, Liebeskind A, Seidelmann F, Fogel J, Franklin P, Beltran J. Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot. Skeletal Radiol. 2008;37:505–10. [PMC free article] [PubMed] [Google Scholar]
- Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur: Fact or fiction? Foot Ankle Surgery. 2012;18:39–41. [PubMed] [Google Scholar]
- Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006;9:11–22. [PubMed] [Google Scholar]
- McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain-plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38:A1–18. [PubMed] [Google Scholar]
- Stuber K, Kristmanson K. Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials. JCCA. 2006;50:118–33. [PMC free article] [PubMed] [Google Scholar]
- Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49:S1–19. [PubMed] [Google Scholar]
- Alvarez-Nemegyei J, Canoso JJ. Heel pain: diagnosis and treatment, step by step. Cleve Clin J Med. 2006;73:465–71. [PubMed] [Google Scholar]
- Aklirat M, Sen C, Günes T. Ultrasonographic appearance of the plantar fasciitis. Clin Imaging. 2003;27:353–7. [PubMed] [Google Scholar]
- Saber N, Diab H, Nassar W, Razaak HA. Ultrasound-guided local steroid injection versus extracorporeal shockwave therapy in the treatment of plantar fasciitis. Alexandria J Med. 2011;48:35–42. [Google Scholar]
- Wearing SC, Smeathers JE, Sullivan PM, Yates B, Urry SR, Dubois P. Plantar fasciitis: Are pain and fascial thickness associated with arch shape and loading? Phys Ther. 2007;87:1002–8. [PubMed] [Google Scholar]
- Fabrikant JM, Park TS. Plantar fasciitis (fasciosis) treatment outcome study: Plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement. Foot (Edinb) 2011;21:79–83. [PubMed] [Google Scholar]
- Gudeman SD, Eisele SA, Heidt RS, Jr, Colosimo AJ, Stroupe AL. Treatment of plantar fasciitis by iontophoresis of 0.4% dexamethasone. A randomized, double-blind, placebo-controlled study. Am J Sports Med. 1997;25:312–6. [PubMed] [Google Scholar]
- Porter D, Barrill E, Oneacre K, May BD. The effects of duration and frequency of Achilles tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomized, blinded, control study. Foot Ankle Int. 2002;23:619–24. [PubMed] [Google Scholar]
- DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, et al. Tissue-specific plantar fascia stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003;85-A:1270–7. [PubMed] [Google Scholar]
- Rompe JD, Cacchio A, Weil L, Jr, Furia JP, Haist J, Reiners V, et al. Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy. J Bone Joint Surg Am. 2010;92:2514–22. [PubMed] [Google Scholar]
- Ribeiro AP, Trombini-Souza F, Tessutti VD, Lima FR, João S, Sacco IC. The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners. Clin Biomech (Bristol, Avon) 2011;26:194–9. [PubMed] [Google Scholar]
- Kampa RJ, Connell DA. Treatment of tendinopathy: is there a role for autologous whole blood and platelet-rich plasma injection? Int J Clin Pract. 2010;64:1813–23. [PubMed] [Google Scholar]
- Maier M, Steinborn M, Schmitz C, Stäbler A, Köhler S, Pfahler M, et al. Extracorporeal shock wave application for chronic plantar fasciitis associated with heel spurs prediction of outcome by magnetic resonance imaging. J Rheumatol. 2000;27:2455–62. [PubMed] [Google Scholar]
- Sorrentino F, Iovane A, Sutera R, Tona GL, Lagalla R. How to address the treatment of idiopathic plantar fasciitis with mini-invasive techniques: HRUS criterion. Ultrasound Med Biol. 2009;35:s30. [Google Scholar]
- Thomas JL , ChristensenJC, KravitzSR, etal. American College of Foot and Ankle Surgeons Heel Pain Committee. The diagnosis and treatment of heel pain: a clinical practice guideline—revision 2010. J Foot Ankle Surg.2010;49 (3 suppl): S1-S19.
- Flanigan RM , NawoczenskiDA, ChenL, WuH, DigiovanniBF. The influence of foot position on stretching of the plantar fascia.Foot Ankle Int.2007;28 (7):815-822.
- Owens BD , WolfJM, SeeligAD. Risk factors for lower extremity tendinopathies in military personnel.Orthop J Sports Med.2013;1 (1). doi:10.1177/2325967113492707.
- Riddle DL, PulisicM, PidcoeP, JohnsonRE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am.2003;85-A (5):872-877.
- Pfeffer G , EasleyM, FreyC, HintermannB, SandsA. Operative Techniques: Foot and Ankle Surgery. Philadelphia, PA: Saunders;2010;709-719.
- Banerjee R , ChaoJC, TaylorR, SiddiquiA. Management of calcaneal tuberosity fractures.J Am Acad Orthop Surg.2012;20 (4):253-258. doi:10.5435/JAAOS-20-04-253.