Rigid Endoscope

Rigid Endoscope

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Rigid Endoscope

Ultrasound Guided Surgery Effective For Chronic Plantar Fasciitis

Plantar fasciitis is the tearing, inflammation and subsequent degeneration of the plantar fascia, a long ligament in the bottom of the foot. Plantar fasciitis develops due to overuse, poor shoes and/or abnormal foot mechanics. Common conservative treatments for plantar fasciitis include eliminating the aggravating factors, icing the heel, contrasting between hot and cold, stretching, supportive shoes, orthotics or semi-rigid arch supports, night splints, taping and steroid injections.

Ninety percent of patients will respond to conservative treatments. Extracorporeal shock wave therapy or surgery are options for more chronic cases, which are not responsive to conservative therapy. Surgical options include coblation therapy (radio frequency technique still being studied), endoscopic plantar fascial release (EPF) and open heel surgery. In some cases open heel surgery may be beneficial, but there is less trauma to the surrounding tissues and a faster healing time with the endoscopic technique.

Ultrasound-guided endoscopic plantar fascia surgery is a new variation of the traditional EPF technique. A recent study (J Am Podiatry Med Assoc 99(3): 183-190, 2009) evaluated the safety and effectiveness of ultrasound-guided plantar fascia release for treatment of chronic plantar fasciitis.

Forty-one patients had ultrasound-guided endoscopic plantar fascial release on forty six feet. They were evaluated after four weeks using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Rating Scale and significant improvements were noted compared to baseline (before surgery). There were no complications during the study period. The authors concluded that ultrasound-guided endoscopic release is a safe and effective surgical procedure for the treatment of chronic plantar fasciitis.

Ultrasound can be Used to visualize and evaluate the thickness of the plantar fascia. Fascia thickness has been shown to correlate with heel pain. An ultrasound records the echo of sound waves reflected off an object, such as a ligament, tendon or bone. More dense objects, such as bone, will appear brighter. Less dense objects, such as air or inflammation, will appear darker or black on the ultrasound image.

A thickened and inflamed fascia, which occurs in plantar fasciitis, will appear black on ultrasound. The advantage of using endoscopy for the surgical release is minimal trauma to the surrounding tissues which translates to a faster healing time. Combining the use of ultrasound imaging with the endoscopic fascial release allows for better visualization and more precise anatomical dissection of the plantar fascia. Further studies are needed to compare ultrasound guided plantar fascial release to the traditional endoscopic plantar fascial release. This study had only a short term follow-up and studies with long term follow-up will be helpful in further determining the safety and effectiveness of this procedure.

About the Author

More discussion on heel pain and plantar fasciitis and ultrasound-guided endoscopic fascia release Christine Dobrowolski, DPM is a podiatrist and owner of Northcoast footcare, Inc. an online resource for foot health information and foot care products.

Nasopharyngeal Carcinoma (UCNT)