Debating The Merits Of The EPF Procedure

It was with great incredulity that I read the article by Dr. Barrett entitled “A Closer Look At Endoscopic Plantar Fasciotomy” (see the May issue, pg. 38). He writes: “Prior to the development of endoscopic foot surgery, there was a strong desire not only to find a better, less invasive method to treat … plantar fasciitis surgically … Indeed, the standard of care … has changed radically since the … EPF.”
The inference here, of course, is that after EPF, that desire has been fulfilled and it is now the standard of care. The truth is that in the facilities where I perform surgery, virtually every DPM has abandoned EPF. I tried it about a half dozen times and have also abandoned it. It is time-consuming and produced no better results than other approaches. Indeed, I found it far more invasive than the way I was trained and have performed heel surgery for 20 years.
He continues to write: “In 1990, there was an almost universal perception … that the spur was the primary cause of plantar fasciitis and any successful surgery must address that cause.” Assuming that Cleveland is still part of the universe, we were taught as far back as the late ‘70s that the spur is not the cause of heel spur pain, but rather the inflammation surrounding it. That fact is reinforced every time a lateral radiograph is interpreted and a large spur is present with no symptoms.
Most of the remaining article is spent “defusing” all the complications of EPF.
When the EPF was introduced, I was appalled at the fees Dr. Barrett was attempting to (charge) to teach this procedure. I learned it the old-fashioned way. First, I assisted others and then I was monitored by those who were qualified. How is it I have performed hundreds of Austin osteotomies and still have yet to meet Dr. Austin?
– David R. Levin, DPM
Fountain Valley, Calif.

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