Calcaneal Osteotomy for Recalcitrant Planter Fasciosis

Official title

Evaluation of Results of Calcaneal Osteotomy in Adult Patient With Recalcitrant Planter Fasciosis: Short Term Results

Overview

The aim of this study is to assess the efficacy of planter displacement calcaneal osteotomy for intractable plantar fasciosis by decreasing the tension of the plantar fascia around the calcaneal attachment while keeping the plantar fascia intact.

Detailed description

Plantar fasciosis is a leading cause of heel pain in adults and represents a degenerative rather than inflammatory condition of the plantar fascia. Most cases resolve with conservative measures; however, up to 10-15% remain symptomatic and may require surgical intervention.

Plantar fascia release-either open or endoscopic-remains a standard surgical option for recalcitrant cases. However, this procedure may compromise foot biomechanics. Recent biomechanical and clinical studies have demonstrated that partial or complete release reduces longitudinal arch height and increases midfoot strain, particularly when more than 50% of the fascia is divided. Such alterations in load distribution can result in lateral column overload, metatarsalgia, and sinus tarsi pain. Endoscopic release has also been associated with medial arch reduction and the development of lateral column symptoms within months postoperatively, further highlighting these risks. Additionally, comparative studies report wound complications, nerve irritation, and recurrence of heel pain in a notable subset of patients undergoing plantar fasciotomy. Up to 50% of patients may experience persistent or recurrent pain following the procedure.

Entrapment of the first branch of the lateral plantar nerve (Baxter's nerve) is another under-recognized cause of chronic heel pain, often coexisting with or mimicking plantar fasciosis. Decompression of Baxter's nerve, either alone or combined with limited plantar fascia release, has been shown to improve outcomes in resistant cases.

Given these limitations, calcaneal osteotomy has emerged as alternative surgical strategies. By altering the mechanical axis of the calcaneus and inducing localized bone remodeling, these techniques aim to unload the plantar fascia insertion without compromising arch stability. Early reports suggest that calcaneal osteotomy, particularly when combined with Baxter's nerve release, may offer superior pain relief and functional recovery in recalcitrant plantar fasciosis.

Interventions

• Procedure Calcaneal osteotomy for recalcitrant planter fasciosis
  planter displacement calcaneal osteotomy

Primary outcome measures

• AOFAS score [Time frame: 6 months after surgery]

Secondary outcome measures (2)

• VAS [Time frame: 12 months]
• Foot pressure [Time frame: 12 months]

Eligibility criteria

Inclusion criteria

• All adult patients with age range from 18 to 65 years with unilateral or bilateral planter fasciosis after clinical and radiological diagnosis confirmation, who failed conservative treatment for at least 6 months or recurrent cases.
• MRI \& US proof of planter fasciosis showing thickness of planter fascia >4mm

Exclusion criteria

• All other causes of heel pain including polyneuropathy, planter fascia rupture, seronegative arthropathies, rheumatoid arthritis in bilateral cases, abscess or neoplasm affecting the soft tissue, and bone occult fracture or infection.
• Age groups below 18 years old and above 65 years old.
• Plantar fasciosis cases having pes planus with diffuse foot pain not only localized to the planter fascia origin (the medial tubercle of the calcaneus - a bony prominence on the inferomedial aspect of the calcaneus).
• Diabetic patients
• Primary tarsal tunnel syndrome (not presented secondary to a deformity or another cause)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med. 2004 May 20;350(21):2159-66. doi: 10.1056/NEJMcp032745. No abstract available. PMID 15152061
• Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82. PMID 21916393
• Rodriguez-Sanz J, Roche-Seruendo LE, Lopez-de-Celis C, Canet-Vintro M, Ordoyo-Martin J, Fernandez-Gibello A, Labata-Lezaun N, Perez-Bellmunt A. Effects of Plantar Fascia Release and the Use of Foot Orthoses Affect Biomechanics of the Medial Longitudinal Arch of the Foot: A Cadaveric Study. Am J Phys Med Rehabil. 2024 Jul 1;103(7):595-602. doi: 10.1097/PHM.0000000000002414. Epub 2024 Jan 12. PMID 38261788
• Liew SK, Saw A, Chua YP. Foot Arch Changes after Endoscopic Plantar Fascia Release for Recalcitrant Plantar Fasciitis. Malays Orthop J. 2022 Jul;16(2):78-86. doi: 10.5704/MOJ.2207.010. PMID 35992989
• Baxter DE, Thigpen CM. Heel pain--operative results. Foot Ankle. 1984 Jul-Aug;5(1):16-25. doi: 10.1177/107110078400500103. PMID 6479759
• Yanbin X, Haikun C, Xiaofeng J, Wanshan Y, Shuangping L. Treatment of Chronic Plantar Fasciitis With Percutaneous Latticed Plantar Fasciotomy. J Foot Ankle Surg. 2015 Sep-Oct;54(5):856-9. doi: 10.1053/j.jfas.2015.02.008. Epub 2015 Jun 6. PMID 26058817
• Kalen V, Brecher A. Relationship between adolescent bunions and flatfeet. Foot Ankle. 1988 Jun;8(6):331-6. doi: 10.1177/107110078800800609. PMID 3402852

Identifiers

NCT: NCT07436923 · osteotomy in planter fasciosis

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗