A Closer Look At Endoscopic Plantar Fasciotomy

By Stephen L. Barrett, DPM

Prior to the development of the first endoscopic foot surgery, there was a strong desire not only to find a better, less invasive method to treat recalcitrant mechanical plantar fasciitis surgically but also to develop a more universally consistent surgical approach to what has been labeled an “endemic problem.” Indeed, the standard of care regarding the surgical management of the heel pain has radically changed since the introduction of the endoscopic plantar fasciotomy (EPF).
In 1990, there was an almost universal perception within the podiatric community that the spur was the primary cause of plantar fasciitis and any successful surgery must address that cause.1 Some literature solely supported doing a plantar fasciotomy without resecting the inferior calcaneal exostosis.2 However, the majority of published articles on this complex topic involved something in addition to a fasciotomy, like resecting the inferior calcaneal exostosis, resecting “heel neuromas,” decompressing the first branch of the lateral plantar nerve or denerving the medial calcaneal nerve.2-8
After cadaveric investigation, researchers performed the first series of endoscopic plantar fasciotomies with a one portal system called “The Inside Job,” which was designed by Agee for carpal tunnel release.9 The manufacturer quickly recalled this system, due to reports of nerves being transected and incomplete release of the carpal ligament, which ended our investigation with this device.10
This instrument recall led to the development of the two-portal techniques, specifically designed for endoscopic plantar fasciotomy, a procedure which is still in widespread use today.11 We learned early on that we could adequately release the fascia via an endoscopic approach. In using this approach, we found that patients responded with less pain and made a quicker return to regular shoes and activity than those patients who had undergone traditional open techniques.

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