Percutaneous plantar fasciotomy: An anatomical study about its safety and efficacy

Background: Percutaneous plantar fasciotomy is one of the available options for recalcitrant cases of plantar fasciopathy, but there is a mismatch in the clinical results between different author's experience, possibly due to variability when choosing the exact cutaneous entry point. The purpose of this study is to validate the plantar approach in the surgical treatment of plantar fasciopathy, describing a safe path and cutaneous entry point to perform a percutaneous plantar fasciotomy with a 2 mm incision testing the procedure on cadavers.

Methods: a unicentric cross-sectional analytical study was conducted in 12 cadaveric feet to verify the accuracy of the percutaneous fasciotomy entry point. Independent variables analysed were: extent of fasciotomy, entry point location, spur resection, and soft tissues injuries. A double evaluation was performed: an indirect evaluation under fluoroscopic vision, and a direct evaluation after anatomical dissection.

Results: No cases of plantar cortical lesion on the calcaneus was observed. Satisfactory fasciotomy was performed in 91.7% of the cases. An optimal entry point was noticed in all cases with a mean distance to the tip of tibial malleolus of 22.5 mm (±6.9; 35.1-12.1) and a mean distance to foot midline of 7.8 mm (±1.7; 11.8-5.1). No neurological nor vascular lesions were found. In all the feet, a laceration of the plantar part of flexor digitorum brevis muscle was noted.

Conclusion: the plantar approach for percutaneous total plantar fasciotomy is a safe procedure. The current study provides an intraoperative guideline for minimising the possible risks.