Radiofrequency Plantar Fascia Coblation With and Without Gastrocnemius Recession in the Management of Recalcitrant Plantar Fasciitis.

BACKGROUND: Plantar fasciitis is the most common cause of plantar heel pain. Although most are self-limiting, recalcitrant conditions can be debilitating, significantly reducing patient's quality of life. A myriad of surgical procedures are available for the treatment of recalcitrant plantar fasciitis (RPF) with little consensus on best practice. This purpose of this study was to assess the efficacy of radiofrequency coblation with and without gastrocnemius release on the surgical management of RPF. METHODS: Between June 2013 and June 2019, a total of 128 patients with RPF and tight gastrocnemius were treated surgically. Presence of tight gastrocnemius was assessed clinically by a positive Silfverskiold test. Group A (n = 73) consisted of patients who underwent radiofrequency coblation alone; group B (n = 55) consisted of patients who underwent radiofrequency coblation and endoscopic gastrocnemius recession. The primary outcome measure was visual analog scale (VAS) score. Secondary outcome measures included (1) American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score; (2) physical (PCS) and mental component summaries (MCS) of the 36-Item Short Form Health Survey; (3) overall assessment of improvement, expectation fulfilment, and satisfaction; and (4) complication rates. RESULTS: Both groups reported significant improvement in VAS, AOFAS, and PCS scores postoperatively at 6 and 24 months. Group B (radiofrequency coblation with gastrocnemius recession) was associated with better VAS at both 6 months (3.0 ± 2.9 vs 1.7 ± 2.6, P < .05) and 24 months postoperatively (1.9 ± 3.1 vs 0.8 ± 2.0, P < .05) compared with group A (radiofrequency coblation without gastrocnemius recession). At 24 months postoperatively, no differences were found in AOFAS, PCS, MCS scores, expectation fulfilment, or overall satisfaction. No wound complications were reported in either group. One patient (group B) has persistent symptoms consistent with tarsal tunnel syndrome. CONCLUSION: In this retrospective cohort comparative study, treatment of RPF with radiofrequency coblation alone was associated with slightly inferior results than radiofrequency coblation combined with endoscopic gastrocnemius recession in terms of pain relief without an increase in complication rates. However, at 2 years, we did not find a significant difference in other measures of outcome. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Mid-Term Functional and Radiological Outcomes of Total Ankle Replacement in an Asian Cohort.

There are limited studies looking at longer-term outcomes of the total ankle replacement (TAR) in the Asian cohort. Asian ankles are smaller in size and are more varus compared to Western cohorts. Cultural differences also require increased ankle range of motion demands. Therefore, assessment of longer-term functional and radiological outcomes in the Asian cohort is warranted. Between 2007 and 2015, 43 consecutive patients received a 3-component, cementless, unconstrained, fully congruent TAR. Patients were followed up over a mean 8 (range 5-14 years). Preoperative and postoperative AOFAS ankle-hindfoot score (AOFAS-AHS), visual analogue score (VAS), physical and mental component scores of the SF-36 (PCS and MCS respectively) were calculated. European Foot and Ankle Score was also recorded at 8 years. Radiographs were reviewed postoperatively to assess implant position and study evidence of implant loosening and impingement. At 8 years, survivorship was 83.5%. Reasons for implant removal included infection (n = 2) and aseptic loosening (n = 5). AOFAS-AHS, VAS MCS at 8 years postoperatively were comparable to outcomes at 2 years postoperatively (p > .05). PCS at 8 years demonstrated improvement compared to 2 years postoperatively (49 ± 7 vs 42 ± 11, p = .048). Radiographic impingement was noted in 9 cases (20.9%). Radiological loosening was noted in 8 cases with 5 cases requiring revision surgery. At 8 years postoperatively, clinical outcomes, radiological outcomes and survivorship following TAR in an Asian cohort are satisfactory and comparable to that found in existing literature. Long-term studies are required to ascertain survivorship of TAR. Implant design with the Asian cohort in mind may yield improved outcomes.

Effect of Mechanical Axis Correction on Outcomes of Hallux Valgus Surgery.

A new method of mechanical axis planning has recently been suggested to aid in corrective surgery for hallux valgus (HV) deformity, which aims to identify the ideal position for the first metatarsal after correction. We investigated the influence of the mechanical axis angle (MAA) correction on the outcomes of corrective HV surgery. We reviewed 50 radiographs to identify the "normal" MAA range within the population. We also reviewed the medical records of 100 patients who had undergone scarf osteotomy at our institution from January 2011 to December 2013. These patients were segregated into 2 groups according to their postoperative MAA: those within the normal range (normal group) and those outside this range (outlier group). We compared the pre- and postoperative functional scores between the 2 groups using statistical analysis. The normal MAA range within our population was 12.5° ± 0.8° (range 11.0° to 14.3°). We found that the physical component summary score of the short-form 36-item health survey was significantly poorer for the outlier group at 6 and 24 months postoperatively compared with the normal group, although the other postoperative scores were comparable. Surgical correction of the MAA to the normal range of the patient population can be recommended because it provides improved quality of life. However, further studies are required to investigate the influence of MAA planning on other standardized foot and ankle scores.

Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis.

BACKGROUND: Radiofrequency microtenotomy (RM) is effective for treating plantar fasciitis. No studies have compared it to the plantar fasciotomy (PF). We hypothesized that RM is equally effective and provides no additional benefit when performed with PF. METHODS: Between 2007 and 2014, all patients who underwent either or both procedures concurrently at our institution were analyzed. Data collected included demographics, SF-36 Health Survey, AOFAS Ankle-Hindfoot Scale, and two questions regarding satisfaction and expectations, all of which were assessed pre-operatively and post-operatively at 6-months and 1-year. ANOVA with Bonferroni correction was used to compare scores at each interval. Logistic regression was used to identify pre-operative factors that predicted for satisfaction and expectations. RESULTS: There were no differences in patient outcomes. No pre-operative factors predicted for satisfaction and expectations. CONCLUSIONS: RM is as effective as PF in the treatment of plantar fasciitis. Patients who underwent both procedures experienced no benefit and a higher rate of complications.

Results of operative correction of grade IIB tibialis posterior tendon dysfunction.

BACKGROUND: The prevalence of tibialis posterior tendon dysfunction (PTTD) is estimated to be as high as 3% to 4% in Western populations, and it is one of the most commonly misdiagnosed conditions of the foot and ankle. METHODS: Clinical and radiological outcomes were assessed in grade IIB PTTD treated with a medializing calcaneal osteotomy, lateral column lengthening, flexor digitorum longus transfer, and tendo-Achilles lengthening. The clinical and radiological findings recorded were the SF-36 score on physical function and mental health, midfoot and hindfoot American Orthopaedic Foot and Ankle Society (AOFAS) clinical scores, the midfoot and visual analog pain scores, as well as the radiological measurements of the hindfoot calcaneal pitch, talo-first metatarsal angle, and medial cuneiform height. The time points of assessment were preoperatively, 6 months postoperatively, and 24 months postoperatively by an examiner different from the operating surgeon. RESULTS: The SF-36 score on physical function (mean difference of 8.7 and 8.2, respectively), AOFAS midfoot score (mean difference of 29.6 and 15.3, respectively), AOFAS ankle-hindfoot score (mean difference of 23.2 and 14.3, respectively), midfoot visual analog pain score (mean difference of 4.0 and 1.2), and the ankle and hindfoot visual analog score (mean difference of 3.6 and 1.6) all had significant reduction from the preoperative to the 24-month postoperative time point (P < .001). Radiologically, there was also correction of the deformity associated with PTTD. The hindfoot calcaneal pitch was corrected from 8.4 degrees to 18.7 degrees. The talo-first metatarsal angle was corrected from 14.0 degrees to 1.3 degrees, and the medial cuneiform height was corrected from 10.3 mm to 20.4 mm at 24 months postoperatively. CONCLUSION: Grade IIB PTTD treated with a medializing calcaneal osteotomy, lateral column lengthening, flexor digitorum longus transfer, and tendo-Achilles lengthening demonstrated statistical significant improvement in hindfoot and midfoot AOFAS scores, SF-36 physical function scores, as well as visual analog scores. The complications were minimal. We advocate the combination of these procedures as being successful for the treatment of grade IIB PTTD. Longer term follow-up is needed to determine if these improvements plateau, improve, or deteriorate. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Open technique is more effective than percutaneous technique for TOPAZ radiofrequency coblation for plantar fasciitis.

BACKGROUND: Microtenotomy coblation using a radiofrequency (RF) probe is a minimally invasive procedure for treating chronic tendinopathy. It has been described for conditions including tennis elbow and rotator cuff tendinitis. There have been no long term studies to show its effectiveness in plantar fasciitis. METHODS: A prospective non-randomised trial was conducted on 48 patients who had failed conservative treatment for plantar fasciitis, between 2007 and 2009. The procedure was performed using the TOPAZ microdebrider device (ArthroCare, Sunnyvale, CA), either via an open or a percutaneous method. Fifty-nine feet were treated and followed up for up to 1 year thereafter. Preoperative, 3, 6 and 12 months post-operative VAS pain, American Orthopaedic Foot-Ankle Society (AOFAS) hindfoot and SF-36 scores, patient expectation and satisfaction scores were analysed. RESULTS: VAS scores improved significantly in both groups at 1-year follow-up. The open group had a more significant improvement in the VAS score at 1-year follow-up. AOFAS hindfoot scores improve significantly for both groups pre- and post-operatively, but there was no significant difference between both groups at the 1-year mark. SF-36 scores showed equally significant improvement in both groups 1 year post-operatively. Expectation and satisfaction scores were equally high in both arms. CONCLUSIONS: TOPAZ RF coblation is a good and effective method for the treatment of recalcitrant plantar fasciitis. Clinical results improve with time for up to 1-year post-operatively. The open method seems to have a more significant improvement in pain VAS scores at 1-year postoperatively.