Degenerative lesions of the plantar fascia: surgical treatment by fasciectomy and excision of the heel spur. A report on 38 cases.

The authors studied 38 cases of degenerative lesions of the plantar fascia which were treated surgically between 1989 and 1999. MRI showed chronic fasciitis in eight cases and an old rupture of the plantar fascia in 30 cases. Surgical treatment, which was performed in all cases after failure of conservative treatment of several months duration, combined excision of the fascia with resection of the heel spur. Histological examination found inflammation in all cases (fasciitis or rupture), calcification of the aponeurosis in four cases, cartilaginous metaplasia in four and fibromatosis in four. Patients were assessed a minimum of one year and a maximum of seven years after operation. The postoperative results were assessed using three criteria: resolution of pain, results on the static foot and patients' functional activity. Overall there were 24 very good and good results, nine fair and five poor. MRI performed at the time of follow-up revealed good healing of the plantar fascia in 16 cases, defects in two cases, inflammation in seven cases and defects associated with inflammation in 13 cases. Surgical treatment may be considered in cases where conservative treatment of talalgia has failed. Symptoms originating from degenerative damage to the plantar fascia, such as rupture or fasciitis, may benefit from fasciectomy. Short-term results show resolution of pain in 75% of cases, and a slight sagging of the plantar arch. Pre-operative MRI study is useful to determine the exact location of the lesions.