27th Annual Summer AOFAS Meeting July 14, 2011

1. 27th Annual Summer AOFAS MeetingJuly 14, 2011 Functional Outcome of Endoscopic Plantar Fasciotomy

2. Disclosure • None

3. Authors • Lucas J. Bader M.D. • Ken Park M.D. • Yang Gu B.S. • Martin O’Malley M.D.

4. Background • Plantar fasciitis most common cause of plantar heel pain • Non-surgical treatment is successful in mitigating the majority of patient complaints by 8-10 months • A small subset remain recalcitrant to non-operative treatment

5. Background • Open plantar fascial release • Endoscopic Release • Shorter recovery times and lower complication rate

6. Purpose • Review Functional Outcome after Endoscopic Release • Reproducibility • Complication Rate

7. Hypothesis • Statistically significant improvement of AOFAS Hindfoot Score (pre-op vs post op) • Results are Reproducible • Low complication rate

8. Methods • Single Surgeon (MO) • 2 incision endoscopic technique • AOFAS Hindfoot scores Pre op vs. post op • Sub groups • Gender • Duration of symptoms (<12, 12-24, >24) • Severity of Symptoms (pre-op AOFAS <70 or >70) • Laterality (univs bilateral)

9. Inclusion • Diagnosis of Plantar Fasciitis • Failure of non operative treatment • At least 6 months post surgical follow up

10. Exclusion • Lateral talar - 1st metatarsal angle > 15 ° • Compressed Nerve to the Abductor Digit Minimi • History of Inflammatory Arthropathy • Concomitant Cavovarus Reconstruction

11. Demographics • Forty-eight patients (56 feet) were identified • Forty-one patients (49 feet) were available for follow up. • 15 men and 26 women • Average age of 53.8 (range 42 to 68). • Mean follow-up time was 49.5 months (range 6 to 142).

12. Results • Pain resolved in 37 feet, decreased in 11 feet, and increased in 1 foot • Postoperative AOFAS Hindfoot score improved 39 points (54-93, p< 0.001) • Patients with severe symptoms achieved higher mean improvement than the moderate symptom group (p<0.0001) • Patients with symptoms greater than 24 months trended towards lower mean improvement and lower post operative scores • Gender and laterality did not significantly influence outcome

13. Complications • 1 superficial infection • 3rd and 4th metatarsal stress fracture in the same patient • Transient lateral hindfoot pain in 5 patients which resolved • Rate 6%

14. Limitations • Retrospective • Absence of control group • AOFAS hindfoot score not validated for plantar fasciitis

15. Conclusion • Effective Operation • Results Reproducible • Low complication rate

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