Video Gallery

Video Gallery

To View the Video

Ultrasound-guided Plantar Fascia Release: A New Ultraminimally Invasive Surgical Technique

February 01, 2014

Contributors: Alvaro Iborra, DPM; Felipe Benito Del Carmen, MD; Angel G. De La Rubia, DPM; Manuel Villanueva, MD, PhD; Manuel Villanueva, MD, PhD

Throughout their lifetimes, 10% of people present with heel pain. Plantar fasciitis is the most common cause of heel pain at outpatient clinics, accounting for about 10% of running-related injuries. In the United States, plantar fasciosis results in more than 1 million visits per year to health professionals.

Causes of heel pain: Today, plantar fasciosis is considered a degenerative disorder of the fascia caused by overuse stress rather than an inflammatory process. Surgeons should be able to rule out the different causes of heel pain and determine if they are neurologic, soft-tissue-related, or skeletal.

Diagnosis: Ultrasound is an inexpensive diagnostic tool that enables comparison with the contralateral side and can be used for continuous monitoring of injuries. It is also helpful for minimally invasive treatments.

Surgical options: Current surgical options include open surgery, endoscopic surgery with one or two portals, and fluoroscopy-assisted surgery. We developed an ultrasound-guided ultraminimally invasive technique. In a preliminary cadaver study, we found the technique to be accurate, reproducible, and capable of minimizing surgical damage. We then applied our surgical technique in patients with chronic plantar fasciitis and evaluated the clinical results.

Surgical technique: The instrument set includes a straight scalpel, a blunt dissector, a hook blade, and an ultrasound device with a 14-Mhz linear transducer. We do not use ischemia. Ultrasound helps to administer local anesthesia.

No stitches are required. No cast or orthotic is necessary. The procedure takes 10 minutes and is performed under an outpatient regimen.

Rehabilitation protocol: Scarring is prevented by encouraging patients to walk with crutches immediately after surgery. A specific program of stretching exercises is recommended.

Preliminary results: Surgical damage is minimal, and the incision is outside the weight-bearing area. Consequently, there is less pain, less bleeding, and recovery is quick.

Discussion: Ultrasound-guided release allows us to control damage to the plantar muscles and visualize the width and depth of the fascia. We can work without ischemia, thus reducing wound healing problems and contraindications in patients with diabetes or vascular insufficiency. In our experience, this technique is safe, precise, it can be learned quickly, and it is not necessary to be an expert on skeletal ultrasonography.

Conclusion: We believe that ultrasound-guided release of the plantar fascia will be the technique of choice in the future, and we encourage other surgeons to apply it.

Results for "Physical Exam/Anatomy"