Clinical Study of a Four-Step Program for the Treatment of Plantar Fasciitis with Bone Spurs

Abstract

Objective: The most common causes of plantar and heel pain are plantar fasciitis and calcaneal spurs, and they often co-exist. Surgery is a recognized treatment for refractory plantar fasciitis. However, few studies have proposed treatment options for patients with metatarsophalangeal fasciitis with bone spurs. Accordingly, this study's purpose was to propose a four-step surgical regimen, and to improve the surgical outcome of plantar fasciitis with osteophytes and to establish a procedure for surgical treatment.

Methods: Retrospective analysis of 45 patients suffering from plantar fasciitis with bone spurs from 2020 to 2023. All patients underwent a four-step procedure, including plantar fascia release, calcaneal spur grinding, inflammatory tissue removal, and calcaneal burr decompression. The imaging parameters and functional scores were recorded before and after the operation. The objective evaluation included the measurement of calcaneal spur length on radiographs. Clinical evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS), the Visual Analog Scale (VAS), and the Foot and Ankle Outcome Scale (FAOS). Measurement data that conformed to normal distribution were expressed as (x² ± s), and pre-and postoperative AOFAS, FAOS, and VAS scores were compared using repeated-measures ANOVA, and preoperative and postoperative spur lengths were compared using paired t-tests.

Results: The 45 patients were followed up for 3 to 30 months, (17.72 ± 8.53) months, at final follow-up, the patient's AOFAS score improved from preoperative (74.93 ± 5.56) to (94.78 ± 3.98), FAOS score increased from preoperative (76.42 ± 3.37) to (96.16 ± 2.74), the VAS score decreased from (3.18 ± 0.54) to (1.07 ± 1.20) (p < 0.05), the length of spur decreased from (0.72 ± 1.81) cm to (0.23 ± 1.19) cm, and there were significant differences before and after operation (p < 0.05).

Conclusion: The four-step surgical regimen is an appropriate and effective surgical procedure to treat plantar fasciitis with bone spurs.

Keywords: Bone Spur; Calcaneal Spur Grinding; Four‐Step Regimen; Plantar Fascia Release; Plantar Fasciitis.

FIGURE 1

A case of plantar fasciitis with bone spur treated by four‐step program (A) Patient, female, 54 years old, left plantar fasciitis with a bone spur, MRI shows the plantar fascia's inflammation. (B) Release the metatarsal fascia. (C) Exposure to the bone spur. (D) Grinding of the heel spur. (E) Cleaning of inflammatory tissue. (F) Drilling and decompression of the heel bone. (G) Postoperative wound size. (H) Preoperative radiograph of the patient showing the heel spur. (I) Postoperative review of the patient with a cleared heel spur.

FIGURE 2

Measurement of bone spur length. Blue Line: marking the base of the spur along the medial calcaneus through the midpoint of the base of the spur. Red Line: make a horizontal line to the right from the vertex of the spur, intersect with the Blue Line, and measure the length of the spur.

FIGURE 3

Patients' clinical and objective assessments improved at postoperative follow‐up compared to preoperative. (A) American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome Scale (FAOS) scores were constantly improving at postoperative, 1 and 3 months postoperative, and final follow‐up compared to preoperative. (B) Visual Analog Scale (VAS) scores were constantly decreasing at postoperative, 1 and 3 months postoperative, and final follow‐up compared to preoperative. (C) Bone spurs were significantly eliminated postoperatively compared to preoperatively.