|
Year |
2002 |
|---|---|
|
Question Number |
249 |
|
Category |
Foot and Ankle |
Question
A patient who underwent an endoscopic plantar fascia release 3 months ago now reports pain in the medial arch with weight bearing and notes progressive flattening of the foot. What is the most likely explanation for this problem
1) Recurrence of the calcaneal heel spur
2) Surgical injury to the medial plantar nerve
3) Excessive release of the plantar fascia
4) Injury to the posterior tibial tendon
5) Injury to the spring (calcaneonavicular) ligament
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Answer (click for answer)
Preferred Response: 3
As we have discussed with Dr. Raiken in conference, most patient with plantar fasciitis will improve with stretching excercises within 6-12 months. The authors of this paper begin with this premise, but then present a series of ‘non-responders’ who underwent fascial release for pain control. Only 71% of their patient rated good or excellent pain relief with surgery, and there were significant numbers of patients with foot weakness, medial arch pain, increased foot length, leg strain, and an abnormal ‘rapid’ gait in which the patients minimized heel strike time. Based on these findings, a post-op patient with a painful medial arch, and progressive flattening of the foot has been over-released, and lost the mechanical support provided by the fascia, thus overloading the medial arch and causing pain.
Reference: Daly PJ, et al: Plantar fasciotomy for intractable plantar fasciitis: Clinical results and iomechanical evaluation. Foot Ankle 1992;13:188-195.