Endoscopic plantar fasciotomy versus open plantar fasciotomy for treatment of plantar fasciitis: a systematic review and meta-analysis.

BACKGROUND

Plantar fasciitis is a degenerative pathology that most common causing heel pain in adults aged 40-60. Severe pain typically presents at morning or after prolonged activity. Treatment includes conservative measures, physical therapy, orthotics, and injections. Surgical intervention is considered for severe cases requiring prolonged treatment.

OBJECTIVES

The primary objective is to compare functional outcomes between open and endoscopic plantar fasciotomy, while the secondary objective is to compare their respective complication rates.

MATERIALS AND

METHODS

A comprehensive search of the English-language literature was conducted using multiple databases, including PubMed, Cochrane, Scopus and Google Scholar in addition to a manual search. Studies regrading endoscopic plantar fasciotomy (EPF) and open plantar fasciotomy (OPF) were included in the meta-analysis. The methodological quality of the included studies was assessed using the appropriate tool. A sensitivity analysis was performed to evaluate the robustness of the findings. The analysis focused on outcomes such as pain relief (VAS scores), functional improvement (AOFAS scores), complications and operative time. A total of 19 articles met the inclusion criteria for this meta-analysis.

RESULTS

This meta-analysis of 19 studies and 646 patients showed that both OPF and EPF resulted in excellent improvements in AOFAS and VAS scores. Comparative studies revealed a non-significant difference between the two groups, with Standardized Mean Difference (SMD) for VAS score {1.36 (95% CI (- 4.03, 6), p-value = 0.390} and {- 0.39 (95% CI (- 5.41, 4.63), p-value = 0.770} for AFOS score. Consistently and significantly shorter mean operative time for EPF (15.76 min) compared to OPF (36.78 min). EPF demonstrated a lower complication rate 5% (95% CI: 2%, 9%). Compared with OPF 11% (95% CI: 2%, 45%). However non-comparative studies demonstrated OPF slightly more pain relief (VAS score) and functional improvement (AOFAS score).

CONCLUSION

This study showed that both EPF and EPF appear to be effective treatments. EPF was associated with shorter operative times and a lower complication rate.