Effect of Partial Versus Complete Plantar Fasciotomy on the Windlass Mechanism

1997 ◽  
Vol 18 (1) ◽  
pp. 16-20 ◽  
Author(s):  
David B. Thordarson ◽  
Pradeep John Kumar ◽  
Tom P. Hedman ◽  
Edward Ebramzadeh
Keyword(s):  
Testing Machine ◽  
Plantar Fascia ◽  
Arch Height ◽  
Surgical Indications ◽  
Supporting Function ◽  
Length Measurements ◽  
Plantar Fasciotomy ◽  
Strict Protocol

Eight adult below-knee cadaver specimens were placed in a testing machine and loaded to 350 newtons according to a strict protocol. Arch height and length measurements were obtained in each specimen with the toes resting on the foot plate, dorsiflexed to 30°, and maximally dorsiflexed manually. The plantar fascia was then divided from medial to lateral in one-quarter increments, and the effect on arch height and length measurements was assessed using the same loading protocol. A consistent decrease in the arch-supporting function on sequential sectioning of the plantar fascia was encountered. A less consistent decrease in the arch-supporting function was reflected by the increase in the height of the arch with sequential sectioning of the plantar fascia. The study demonstrates that partial plantar fasciotomy decreases the arch-supporting function of the plantar fascia in addition to weakening the structure. Strict surgical indications for this type of procedure should be maintained.

Biomechanical Consequences of Total Plantar Fasciotomy

2009 ◽  
Vol 99 (5) ◽  
pp. 422-430 ◽  
Author(s):  
Jo L. Tweed ◽  
Mike R. Barnes ◽  
Mike J. Allen ◽  
Jackie A. Campbell
Keyword(s):  
Center Of Pressure ◽  
Plantar Fascia ◽  
In Vivo Studies ◽  
Medial Longitudinal Arch ◽  
Foot Structure ◽  
Longitudinal Arch ◽  
Plantar Fasciotomy ◽  
Postoperative Problems

Background: Plantar fascia release for chronic plantar fasciitis has provided excellent pain relief and rapid return to activities with few reported complications. Cadaveric studies have led to the identification of some potential postoperative problems, most commonly weakness of the medial longitudinal arch and pain in the lateral midfoot. Methods: An electronic search was conducted of the MEDLINE, ScienceDirect, SportDiscus, EMBASE, CINAHL, Cochrane, and AMED databases. The keywords used to search these databases were plantar fasciotomy and medial longitudinal arch. Articles published between 1976 and 2008 were identified. Results: Collectively, results of cadaveric studies suggested that plantar fasciotomy leads to loss of integrity of the medial longitudinal arch and that total plantar fasciotomy is more detrimental to foot structure than is partial fasciotomy. In vivo studies, although limited in number, concluded that although clinical outcomes were satisfactory, medial longitudinal arch height decreased and the center of pressure of the weightbearing foot was excessively medially deviated postoperatively. Conclusions: Plantar fasciotomy, in particular total plantar fasciotomy, may lead to loss of stability of the medial longitudinal arch and abnormalities in gait, in particular an excessively pronated foot. Further in vivo studies on the long-term biomechanical effects of plantar fasciotomy are required. (J Am Podiatr Med Assoc 99(5): 422–430, 2009)

Mechanical Behavior of the Foot and Ankle After Plantar Fascia Release in the Unstable Foot

1997 ◽  
Vol 18 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Harold B. Kitaoka ◽  
Zong Ping Luo ◽  
Kai-Nan An
Keyword(s):  
Three Dimensional ◽  
Plantar Fascia ◽  
Three Dimensions ◽  
Arch Height ◽  
Average Decrease ◽  
Human Foot ◽  
Tarsal Bones ◽  
Fresh Frozen ◽  
Tracking Device ◽  
Plantar Fascia Release

The change in position of the bones of the foot was studied in three dimensions after plantar fascia release in intact and destabilized feet. Fifteen fresh-frozen human foot specimens were used. Physiologic loads of 445 newtons were applied axially to simulate standing at ease, and the three-dimensional position of tarsal bones was determined with a magnetic tracking device. The positions were presented in the form of screw axis displacements, quantitating rotation, and axis of rotation orientation. After fasciotomy in the six intact feet, significant differences in rotation were observed at the talotibial and calcaneotalar levels. After fasciotomy in the four unstable feet with three supporting elements sectioned, significant differences in position were observed at the talotibial joint and a significant decrease in arch height was observed. After fasciotomy in the five unstable feet with five supporting elements sectioned, significant differences in rotation were observed at the talotibial joint (mean, 5.5 ± 1.6° P = 0.001), calcaneotalar joint (mean, 6.1 ± 2.1° P = 0.003), and metatarsotalar level (mean, 9.3 ± 4.1° P = 0.007). The average decrease in arch height was 7.4 ± 4.1 mm ( P = 0.015). Displacement of all joints tested occurred after fasciotomy, with rotation about all three axes. These changes in displacement were more pronounced in unstable or destabilized feet. The data suggest that operations involving fasciotomy affect arch stability and should not be performed in patients with evidence of concomitant pes planus deformity, because of the likelihood of further deformation.

scholarly journals A novel closed technique for ultrasound-guided plantar fascia release with a needle: review of 107 cases with a minimum follow-up of 24 months

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
A. Iborra ◽  
M. Villanueva ◽  
P. Sanz-Ruiz ◽  
Antonio Martin ◽  
Concepción Noriega
Keyword(s):  
Plantar Fasciitis ◽  
Plantar Fascia ◽  
Rehabilitation Program ◽  
Heel Pain ◽  
Ultrasound Guided ◽  
Lateral Column ◽  
Guided Surgery ◽  
Plantar Fasciotomy ◽  
Plantar Fascia Release

Abstract Background This study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis. Methods We performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia. The series included 62 males (57.9%) and 45 females (42.1%) treated between April 2014 and February 2018, with a mean follow-up of 21.05 ± 10.96 months (7–66) and a minimum follow-up of 24 months. The mean age was 48.10 ± 10.27 years (27–72). Clinical assessments and ultrasound examination were carried out before treatment, after 1 week, and then after 1, 3, 12, and 24 months. The clinical assessment was based on a visual analog scale and the Foot and Ankle Disability Index. Results Heel pain improved in 92.5% (99) of patients, but not in 7.4% (8 patients). In the group of patients whose heel pain improved, 9 experienced overload on the lateral column and dorsum of the foot, which improved with the use of plantar orthoses and a rehabilitation program. We recorded no nerve complications (e.g., paresthesia), vascular injuries, or wound-related problems. Conclusion Ultrasound-guided partial plantar fasciotomy with a needle is safe, since structures are under direct visualization of the surgeon and the risk of damage is minimal. Stitches are not necessary, and recovery is fast. Consequently, costs are low, and the patient can return to work quickly. This technique may represent a valid option for treatment of plantar fasciitis.

Effect of Varying Arch Height with and Without the Plantar Fascia on the Mechanical Properties of the Foot

1998 ◽  
Vol 19 (10) ◽  
pp. 705-709 ◽  
Author(s):  
George A. Arangio ◽  
Chaorong Chen ◽  
Eric P. Salathé
Keyword(s):  
Mechanical Properties ◽  
Biomechanical Model ◽  
Plantar Fascia ◽  
Vertical Displacement ◽  
Arch Height

A biomechanical model was used to calculate the mechanical properties of the foot at a load of 683 newtons, while changing arch height with and without the plantar fascia. An increase in arch height from 20 mm to 60 mm decreased predicted vertical displacement of the foot from 11.8 mm to 5.5 mm with the plantar fascia intact and from 13.5 mm to 7.5 mm without the plantar fascia. The amount of horizontal elongation decreased from 8.6 mm to 8.4 mm with the plantar fascia and increased from 9.8 mm to 11.7 mm without. A 60-mm arch height yielded a 40% increase in horizontal elongation and a 36% increase in vertical displacement when the plantar fascia was cut, whereas a 20-mm arch height yielded a 13% increase in horizontal elongation and a 14% increase in vertical displacement. A change in arch height from 20 mm to 60 mm increased stiffness of the foot with and without the plantar fascia.

Changes in Foot Loading Following Plantar Fasciotomy: A Computer Modeling Study

2004 ◽  
Vol 126 (2) ◽  
pp. 237-243 ◽  
Author(s):  
Ahmet Erdemir ◽  
Stephen J. Piazza
Keyword(s):  
Plantar Fascia ◽  
Metatarsal Head ◽  
Contact Forces ◽  
Dynamic Simulations ◽  
Body Weights ◽  
Reaction Forces ◽  
Vertical Ground ◽  
Foot Loading ◽  
Plantar Fasciotomy ◽  
Vertical Ground Reaction Forces

Forward dynamic simulations of a toe-rise task were developed to explore the outcomes of plantar fasciotomy, a surgery commonly performed to relieve heel pain. The specific objectives of this study were to develop such a simulation, validate its predictions, and simulate rising on toes using a model from which the plantar fascia had been removed. Root-mean squared differences between the intact model and measurements of healthy subjects were found to be 0.009 body weights (BW) and 0.055 BW for the horizontal and vertical ground reaction forces and 7.1 mm, 11.3 mm, and 0.48 deg for the horizontal, vertical and rotational positions of the pelvis. Simulated plantar fasciotomy increased passive arch torques by 7.4%, increased metatarsal head contact forces by 18%, and resulted in greater toe flexor activity. These simulations may explain the mechanisms behind plantar fasciotomy complications when patients perform activities that require loading of the plantarflexors and the longitudinal arch.

scholarly journals Plantar fasciopathy: a current concepts review

2018 ◽  
Vol 3 (8) ◽  
pp. 485-493 ◽  
Author(s):  
Manuel Monteagudo ◽  
Pilar Martínez de Albornoz ◽  
Borja Gutierrez ◽  
José Tabuenca ◽  
Ignacio Álvarez
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Plantar Fascia ◽  
Medial Gastrocnemius ◽  
Open Release ◽  
Lateral Plantar Nerve ◽  
Plantar Fasciopathy ◽  
Plantar Fasciotomy ◽  
Gastrocnemius Tightness ◽  
A Current

Plantar fasciopathy is very prevalent, affecting one in ten people in their lifetime. Around 90% of cases will resolve within 12 months with conservative treatment. Gastrocnemius tightness has been associated with dorsiflexion stiffness of the ankle and plantar fascia injury. The use of eccentric calf stretching with additional stretches for the fascia is possibly the non-operative treatment of choice for chronic plantar fasciopathy. Medial open release of approximately the medial third of the fascia and release of the first branch of the lateral plantar nerve has been the most accepted surgical treatment for years. Isolated proximal medial gastrocnemius release has been reported for refractory plantar fasciopathy with excellent results and none of the complications of plantar fasciotomy. Cite this article: EFORT Open Rev 2018;3:485-493. DOI: 10.1302/2058-5241.3.170080.

scholarly journals Evaluation of the Results of Endoscopic Release of Plantar Fascia in Cases of Resistant Chronic Heel Pain

2017 ◽  
Vol 9 (3) ◽  
pp. 209
Author(s):  
Altowijri Albraa Ahmed ◽  
Alshareef Hatim Mohammed A ◽  
Alhasan Ahmed Hassan A ◽  
Mahmoud Ahmed Alqady ◽  
Mohammed G Flemban ◽  
...  
Keyword(s):  
Data Entry ◽  
Plantar Fascia ◽  
Heel Pain ◽  
University Hospital ◽  
Therapeutic Effects ◽  
Aofas Score ◽  
Endoscopic Release ◽  
American Orthopaedic ◽  
Plantar Fasciotomy

AIM: To evaluate the results of endoscopic release of plantar fascia in resistant cases of heel pain.METHODS: An experimental descriptive study involved twenty patients who presented to University hospital with resistant chronic plantar heel pain due to plantar fasciitis, were treated with endoscopic plantar fasciotomy. All patients completed a period of at least six months follow up. Data were collected by the modified American Orthopaedic Foot and Ankle Society (AOFAS) Questionnaire, informed consent was applied, and SPSS was used for data entry and analysis.RESULTS: At the end of follow up the mean modified AOFAS of ankle- hind foot score was improved from 49.10 (ranging from 34 to 56) pre-operatively to 90.25 post operatively (ranging from 67 to 100). Seven patients (35%) had excellent results, ten patients (50%) had good results, two patients had fair results, and one patient (5%) had a poor result. AOFAS score of pain was improved from a mean of 14.0+9.40 points pre-operatively (range 0 – 20) to 31.5 + 6.71 points post-operatively (range 20 – 40). AOFAS score of activity of daily living improved from a mean of 4+0 points pre-operatively to 9.85+0.671post-operatively ranging from 7 to 10 points.CONCLUSION: Endoscopic release of plantar fascia has positive therapeutic effects in cases of resistant chronic heel pain.

Sectioning the Plantar Fascia

2002 ◽  
Vol 92 (10) ◽  
pp. 532-536 ◽  
Author(s):  
Francois M. Harton ◽  
Steven A. Weiskopf ◽  
Robert M. Goecker
Keyword(s):  
Range Of Motion ◽  
Metatarsophalangeal Joint ◽  
Plantar Fascia ◽  
Average Increase ◽  
First Metatarsophalangeal Joint ◽  
Motion Data ◽  
Joint Pathology ◽  
Plantar Fasciotomy ◽  
Plantar Fascia Release ◽  
Paired T Test

A study on the effect of sectioning the plantar fascia on the range of motion at the first metatarsophalangeal joint is presented. Dorsiflexion and plantarflexion range-of-motion data from 18 patients who had no first metatarsophalangeal joint pathology and had undergone an in-step plantar fasciotomy for recalcitrant plantar fasciitis were analyzed. The average increase in dorsiflexion of the first metatarsophalangeal joint after plantar fascia release was 9.8°, which represented a statistically significant increase using a paired t-test. Thus release of the plantar fascia can be considered a potential adjunct to hallux limitus surgery. (J Am Podiatr Med Assoc 92(10): 532-536, 2002)

A Cadaveric Study of the Plantar Fascia for the In-Step Plantar Fasciotomy

2020 ◽  
Vol 59 (5) ◽  
pp. 957-960
Author(s):  
Jeffery C. Zimmerman ◽  
Peter E. Smith ◽  
Kerry Casey ◽  
Michael J. Falci ◽  
Kevin Naugle
Keyword(s):  
Plantar Fascia ◽  
Cadaveric Study ◽  
Plantar Fasciotomy

Electron Microscope Study of RNA's of Paramyxoviruses

1972 ◽  
Vol 30 ◽  
pp. 196-197
Author(s):  
Ruchama Baum ◽  
J.T. Seto
Keyword(s):  
Electron Microscopy ◽  
Electron Microscope ◽  
Electron Microscope Study ◽  
Sendai Virus ◽  
Sodium Dodecyl ◽  
Rna Molecules ◽  
Virus Particles ◽  
Molecular Weights ◽  
Length Measurements

The ribonucleic acid (RNA) of paramyxoviruses has been characterized by biochemical and physiochemical methods. However, paramyxovirus RNA molecules have not been studied by electron microscopy. The molecular weights of these single-stranded viral RNA molecules are not known as yet. Since electron microscopy has been found to be useful for the characterization of single-stranded RNA, this investigation was initiated to examine the morphology and length measurements of paramyxovirus RNA's.Sendai virus Z strain and Newcastle disease virus (NDV), Milano strain, were used. For these studies it was necessary to develop a method of extracting RNA molecules from purified virus particles. Highly purified Sendai virus was treated with pronase (300 μg/ml) at 37°C for 30 minutes and the RNA extracted by the sodium dodecyl sulfate (SDS)-phenol procedure.

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