Modified Uniportal Endoscopic Plantar Fasciotomy: A Technical Report
Chayanin Angthong MD*, Chatchavan Charoenthamruksa MD**, Sukanis Chumchuen MD*, Supakit Kanitnate MD*, Anuwat Khadsongkram MD*, Wirana Angthong MD***
Affiliation : * Foot and Ankle Surgery, Department of Orthopedic Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Department of Orthopedic Surgery, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand *** Department of Radiology, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
Objective : Several authors have reported the benefits of the recent procedure of the dual portal endoscopic plantar fasciotomy
(EPF). However, very little is known concerning its potential capability via the single portal EPF without special cutting
device. The present study aimed to demonstrate the effectiveness of uniportal EPF in a patient with severe intractable plantar
fasciitis following a failure of several conservative treatments. The recent technique; uniportal EPF under modified method,
without a special cutting device, was reviewed in an effort to improve its capability for plantar release and to provide
information for the avoidance of this procedure’s complications.
Case Report : A patient, with the recalcitrant conditions and the progression of the severe plantar fasciitis of bilateral feet after
a failure of the conservative treatments for 13-month period, was included in this report. All data of the preoperative and each
successive postoperative period (1, 6 months and last follow-up) were prospectively collected including American Orthopedic
Foot and Ankle Society (AOFAS) score, Visual Analogue Scale-Foot and Ankle (VAS-FA) score and any related complications.
The operations were carried out by a single surgeon with the modified uniportal EPF via a simple hooked soft-tissue blade,
without a special cutting device, on both feet simultaneously. All feet had uniportal EPF with transection of the medial 50% of
the plantar fascia. Postoperatively, a patient was instructed to have partial-weight bearing for the first 2 weeks with wearing
of full-length silicone insoles. Then, she is allowed to start to fully weightbear with the insoles. She is advised to cautiously
return to daily activities and works at 2nd week after the operation. In regard to the EPF in two feet, there were clearly
improvements in the comparison between preoperative and last follow-up period in terms of the increasing AOFAS scores,
and VAS-FA scores. There were no significant iatrogenic-related complications including the lateral column pain in the
present report.
Conclusion : The recalcitrant condition of severe plantar fasciitis is not uncommon for several orthopedic surgeons. Regarding
the emerging of several minimally invasive procedures for this condition, our modified uniportal EPF with a simple device
was encouraging as a treatment option in releasing the plantar fascia with satisfactory effectiveness and lower risks of
complications.
Keywords : Plantar fasciotomy, Endoscopy, Uniportal, Plantar fasciitis, Chronic
