Clinical Study of a Four-Step Program for the Treatment of Plantar Fasciitis with Bone Spurs

Abstract

Objective: The most common causes of plantar and heel pain are plantar fasciitis and calcaneal spurs, and they often co-exist. Surgery is a recognized treatment for refractory plantar fasciitis. However, few studies have proposed treatment options for patients with metatarsophalangeal fasciitis with bone spurs. Accordingly, this study's purpose was to propose a four-step surgical regimen, and to improve the surgical outcome of plantar fasciitis with osteophytes and to establish a procedure for surgical treatment.

Methods: Retrospective analysis of 45 patients suffering from plantar fasciitis with bone spurs from 2020 to 2023. All patients underwent a four-step procedure, including plantar fascia release, calcaneal spur grinding, inflammatory tissue removal, and calcaneal burr decompression. The imaging parameters and functional scores were recorded before and after the operation. The objective evaluation included the measurement of calcaneal spur length on radiographs. Clinical evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS), the Visual Analog Scale (VAS), and the Foot and Ankle Outcome Scale (FAOS). Measurement data that conformed to normal distribution were expressed as (x² ± s), and pre-and postoperative AOFAS, FAOS, and VAS scores were compared using repeated-measures ANOVA, and preoperative and postoperative spur lengths were compared using paired t-tests.

Results: The 45 patients were followed up for 3 to 30 months, (17.72 ± 8.53) months, at final follow-up, the patient's AOFAS score improved from preoperative (74.93 ± 5.56) to (94.78 ± 3.98), FAOS score increased from preoperative (76.42 ± 3.37) to (96.16 ± 2.74), the VAS score decreased from (3.18 ± 0.54) to (1.07 ± 1.20) (p < 0.05), the length of spur decreased from (0.72 ± 1.81) cm to (0.23 ± 1.19) cm, and there were significant differences before and after operation (p < 0.05).

Conclusion: The four-step surgical regimen is an appropriate and effective surgical procedure to treat plantar fasciitis with bone spurs.

Keywords

Bone Spur / Calcaneal Spur Grinding / Four-Step Regimen / Plantar Fascia Release / Plantar Fasciitis

References

[1] NahinRL. Prevalence and pharmaceutical treatment of plantar fasciitis in United States adults. J Pain. 2018;19(8):885–896.

[2] LiH, LvH, LinT. Comparison of efficacy of eight treatments for plantar fasciitis: a network meta-analysis. J Cell Physiol. 2018;234(1):860–870.

[3] KarimzadehA, Raeissadat SA, Erfani FamS, SedighipourL, Babaei-Ghazani A. Autologous whole blood versus corticosteroid local injection in treatment of plantar fasciitis: a randomized, controlled multicenter clinical trial. Clin Rheumatol. 2016;36(3):661–669.

[4] SchuitemaD, GreveC, PostemaK, Dekker R, HijmansJM. Effectiveness of mechanical treatment for plantar fasciitis: a systematic review. J Sport Rehabil. 2019;29(5):657–674.

[5] NayarSK, AlcockH, VemulapalliK. Surgical treatment options for plantar fasciitis and their effectiveness: a systematic review and network meta-analysis. Arch Orthop Trauma Surg. 2023;143(8):4641–4651.

[6] MenzHB, ThomasMJ, MarshallM, Rathod-Mistry T, HallA, ChestertonLS, et al. Coexistence of plantar calcaneal spurs and plantar fascial thickening in individuals with plantar heel pain. Rheumatology. 2019;58(2):237–245.

[7] HasegawaM, UritsI, OrhurhuV, Orhurhu MS, BrinkmanJ, GiacomazziS, et al. Current concepts of minimally invasive treatment options for plantar fasciitis: a comprehensive review. Curr Pain Headache Rep. 2020;24(9):55.

[8] TrojianT, TuckerAK. Plantar Fasciitis. Am Fam Physician. 2019;99(12):744–750.

[9] LuffyL, GroselJ, ThomasR, So E. Plantar fasciitis: a review of treatments. JAAPA. 2018;31(1):20–24.

[10] SaylikM, FidanF, LapçinO. Comparison of isolated calcaneal spur excision and plantar fasciotomy in addition to spur excision in patients with plantar heel pain accompanied by calcaneal spur. Cureus. 2022;14(11):e31768.

[11] ArshadZ, AslamA, RazzaqMA, Bhatia M. Gastrocnemius release in the Management of Chronic Plantar Fasciitis: a systematic review. Foot Ankle Int. 2022;43(4):568–575.

[12] KuyucuE, Koçyiğit F, ErdilM. The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis. Int J Surg. 2015;21:28–31.

[13] FengS-M, SongR-L, WangA-G, Sun Q-Q, ZhangS-C. Endoscopic partial plantar fasciotomy via 2 medial portals vs mini-open procedure for refractory plantar fasciitis. Foot Ankle Int. 2021;42(4):458–463.

[14] MaoDW, Chandrakumara D, ZhengQ, KamC, KingCKK. Endoscopic plantar fasciotomy for plantar fasciitis: a systematic review and network meta-analysis of the English literature. The Foot. 2019;41:63–73.

[15] MayTJ, JudyTA, ContiM, Cowan JE. Current treatment of plantar fasciitis. Curr Sports Med Rep. 2002;1(5):278–284.

[16] ThomasMJ, MenzHB, MallenCD. Plantar heel pain. BMJ. 2016;353:i2175.

[17] AndersonJ, StanekJ. Effect of foot orthoses as treatment for plantar fasciitis or heel pain. J Sport Rehabil. 2013;22(2):130–136.

[18] TuP, Bytomski JR. Diagnosis of heel pain. Am Fam Physician. 2011;84(8):909–916.

[19] McMillanAM, Landorf KB, BarrettJT, MenzHB, BirdAR. Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis. J Foot Ankle Res. 2009;2:32.

[20] MoroneyPJ, O'Neill BJ, Khan-BhambroK, O'FlanaganSJ, KeoghP, KennyPJ. The conundrum of calcaneal spurs: do they matter? Foot Ankle Specialist. 2014;7(2):95–101.

[21] JeswaniT, Morlese J, McNallyEG. Getting to the heel of the problem: plantar fascia lesions. Clin Radiol. 2009;64(9):931–939.

[22] MenzHB, ZammitGV, LandorfKB, Munteanu SE. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? J Foot Ankle Res. 2008;1(1):7.

[23] WearingSC, Smeathers JE, UrrySR, HennigEM, HillsAP. The pathomechanics of plantar fasciitis. Sports Med. 2006;36(7):585–611.

[24] MotleyT. Plantar Fasciitis/Fasciosis. Clin Podiatr Med Surg. 2021;38(2):193–200.

[25] TangY, DengP, WangG, Yao Y, LuoZ, XuY. The clinical efficacy of two endoscopic surgical approaches for intractable plantar fasciitis. J Foot Ankle Surg. 2020;59(2):280–285.

[26] MiyamotoW, YasuiY, MikiS, Kawano H, TakaoM. Endoscopic plantar fascia release via a suprafascial approach is effective for intractable plantar fasciitis. Knee Surg Sports Traumatol Arthrosc. 2018;26(10):3124–3128.

[27] OthmanAMA, RagabEM. Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg. 2010;130(11):1343–1347.

[28] CottomJM, WolfJR, SisovskyCA. Midterm outcomes of endoscopic plantar fascia debridement in 125 patients: a 5-year follow-up. J Foot Ankle Surg. 2023;62(3):444–447.

[29] RizkAS, KandelWA, TablEAE, Kandil MI. Mid-sole release of the plantar fascia combined with percutaneous drilling of the Calcaneus for treatment of resistant heel pain. Foot Ankle Int. 2017;38(11):1271–1277.

[30] El ShazlyO, El Beltagy A. Endoscopic plantar fascia release, calcaneal drilling and calcaneal spur removal for management of painful heel syndrome. The Foot. 2010;20(4):121–125.

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