Surgical treatment for plantar fasciitis

A. A. Faraj and M. Z. Querishe

The Foot

p 224-226, Volume 12, Number 4, December 2002

Faraj and Querishe undertook a retrospective analysis of 16 patients who had undergone surgical treatment for Plantar fascitis. The patients were followed up over a period ranging from 9 to 42 months, using a questionnaire, and the findings described by the authors. All 16 patients returned their questionnaire. Patient ages ranged between 31 and 70 years, with an average age of 54.

The selection criterion for these patients is not described in great detail and the patient data is not sufficient. The patient's symptoms had lasted between 9 months and 6 years and prior to surgery all had undergone conservative treatment, consisting of physiotherapy and corticosteroid injections, which had been deemed unsuccessful. All of the patients had x-ray evidence of a heel spur. Strictly speaking, the diagnosis could be termed Calcaneal spur, rather than Plantar fascitis, although there would undoubtedly be inflammation of the Plantar fascia in patients with a painful heel spur.

In all patients the indication for surgery had been the inability to tolerate the pain or an inability to walk or work without regular interruption due to pain. Of the 16 patients operated on, the questionnaire responses indicated that although 81% of patients reported an improvement in their condition, less than half (44%) found that their pain had disappeared completely with the surgery. Nineteen percent of patients reported no improvement following surgery.

Faraj and Querishe reported that of the 11 patients of working age, 9 were restricted at work and needed time off due to heel pain. Seven of these patients eventually resumed full time work post-operatively, but 2 had to remain off work. Two patients were able to resume work activities straight away. Seven of the 16 patients reported they could run and play sport following surgery.

The major methodological flaw becomes apparent as the reader attempts to analyse the findings. The question is "What were the patients doing for a living?" The success or failure of the surgical intervention can be seen in a very different light, depending on the physical requirements of each patient's job. However, because the authors don't provide sufficient information, the reader is unable to gauge just how successful the surgical procedure is. The overall impression is that the procedure improved symptoms, but rarely alleviated the pain completely. Larger scale studies, with longer term and more objective outcome measures, together with a better description of the subject group, would be helpful to aid decision making in patients with Calcaneal spurs and Plantar fascitis.

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