AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-Plantar Fascia Release-Phinit Phisitkul, M.D

Plantar Fascia Release-Phinit Phisitkul, M.D

Pdf Summary

Endoscopic Plantar Fascia Release (EPFR) is a minimally invasive surgical procedure indicated primarily for recalcitrant plantar fasciitis cases without pes planus (flatfoot). It is often combined with gastrocnemius tendon release for improved outcomes. The plantar fascia comprises three bands: lateral, central, and medial, with the procedure focusing on the complete release of the central band.<br /><br />The technique, modified from Bazaz and Ferkel (2007), involves creating two portals: a medial portal just distal to the heel pad and a lateral portal at the lateral foot border. The central band is released under visualization using an 18-gauge needle and anatomical landmarks like fibroadipose septa. Key surgical pearls include avoiding plantar fascia release in patients with pes planus, careful identification of the central band by palpation, and protecting the medial and lateral plantar nerves to prevent complications.<br /><br />Clinical outcomes from multiple studies demonstrate generally favorable results. Bazaz and Ferkel reported significant improvements in American Orthopaedic Foot and Ankle Society (AOFAS) and Maryland scores over a 4-year follow-up, with better outcomes in women and worse in patients with more severe symptoms or longer symptom duration. Obesity did not negatively affect results. Ogivie-Harris and Lobo (2000) found 89% pain relief and 71% return to sports at 2 years. El Shazly et al. (2010) noted 85% good to excellent outcomes with some minor nerve complications. Nery and Maffulli (2013) observed sustained AOFAS improvement at nearly 10 years, regardless of heel spurs.<br /><br />A large review of 535 patients showed significant postoperative clinical and functional improvement with an 11% complication rate. Common issues included persistent heel pain (5.6%), paresthesias/numbness (4.3%), soft tissue healing problems (1.7%), and superficial infection (0.4%).<br /><br />Overall, EPFR offers an effective treatment for chronic plantar fasciitis refractory to conservative care, with low complication rates and durable symptom relief when performed with proper technique and patient selection.

Keywords

Endoscopic Plantar Fascia Release

EPFR

plantar fasciitis

gastrocnemius tendon release

central band release

medial and lateral portals

fibroadipose septa

American Orthopaedic Foot and Ankle Society score

complications

clinical outcomes