BACKGROUND: Plantar fasciitis is a common cause of musculoskeletal discomfort. Minimally invasive interventions are preferred as second-line treatments following failure of conservative management. We report on a novel technique of ultrasound-guided percutaneous release of the medial third of the plantar fascia with the use of a fine cutting device for the treatment of persistent plantar fasciitis.
METHODS: This is a retrospective case series of all patients treated with the technique between 2013 and 2015. Patients had failed conservative management for a minimum of 6 months. The procedure was performed in an outpatient setting under local anesthesia. Under continuous ultrasound guidance, release of the medial third of the plantar fascia from the calcaneus was performed using an ophthalmic V-Lance knife through a medial stab wound entry point.
RESULTS: Fifteen patients (six men and nine women) with an average age of 54.7 years were included. The mean (standard deviation [SD]) visual analogue scale score for pain improved significantly, from 66.0 (SD, 18.8) preoperatively to each consecutive follow-up point: 29.3 (SD, 25.2) at 2 weeks, 30.0 (SD, 27.8) at 4 weeks, and 34.0 (SD, 26.1) at 12 weeks (P < .001). The mild increase in visual analogue scale score between 4 and 12 weeks was statistically significant (P = .018). Average duration of required analgesia was 5.5 days and average time required to return to usual activities was 5.7 days. Two patients suffered with refractory neuropathic pain over the lateral border of the foot without any obvious abnormality.
CONCLUSIONS: Ultrasound-guided percutaneous release with the use of a fine cutting device could be an alternative option for the treatment of persistent plantar fasciitis. The technique is not without complications, and a mild but statistically significant decline in pain levels from early to short term has been detected. Therefore, the long-term outcomes of this technique need to be investigated before we can advocate its routine use.

Plantar fasciitis is a common cause of heel pain, and the disorder is generally self-limiting after adequate conservative treatment. When conservative treatment is unsuccessful, surgical release is an effective treatment option. Here we report a case of iatrogenic plantar fascia rupture after surgical release for treatment of recalcitrant plantar fasciitis. Preoperative MRI revealed a 4.2 cm gap between the distal fascia stump and the calcaneal tuberosity in the sagittal view at 8 months post-injury. To circumvent the possibility of rupture site retear or poor tissue healing by direct repair, we used tendon allografting for the reconstruction of the chronic plantar fascia rupture. The patient gradually recovered after the surgery. Complications of plantar fascia rupture after surgical release is a potential risk but rarely observed. Chronic plantar fascia rupture with medial arch collapse is difficult to treat. We used a tendon allograft to reconstruct the plantar fascia, restoring its function and mechanical strength. After 5 years of follow-up, no complications were reported, and magnetic resonance imaging indicated the reconstructed plantar fascia tissue to be in good condition.

OBJECTIVE: To assess the advantage of the addition of shear wave elastography (SWE) to gray-scale sonography in the diagnosis of plantar fasciitis.
METHODS: 30 subjects between 18-60 years of age with unilateral heel pain who were clinically suspected of having plantar fasciitis were included in this study. Their affected feet were taken as cases; while their contralateral feet served as controls. On gray-scale ultrasound, the thickness of plantar fascia, its echopattern, presence of hypoechoic areas, and perifasicular collections were recorded. SWE was done by placing seven ROIs within the plantar fascia; and the mean of their Young\'s modulus was taken in kPa.
RESULTS: Plantar fascial thickening more than 4 mm had 70% sensitivity and 66.7% specificity, echopattern had 90% sensitivity and 96.7% specificity, hypoechoic areas had 80% sensitivity and 96.7% specificity, and perifascial edema had 26.7% sensitivity and 100% specificity for diagnosing plantar fasciitis. Using the ROC curve, the cut-off value of Young\'s modulus for the diagnosis of plantar fasciitis was found to be ≤ 99.286 kPa. This predicted plantar fasciitis with 97% sensitivity and 100% specificity. The primary diagnostic feature of ultrasound of plantar fascia thickness more than 4 mm detected 21 out of 30 cases of plantar fasciitis; whereas elastography detected an additional 8 cases which would have been missed on B-mode ultrasound alone.
CONCLUSIONS: SWE is a useful supplement and improves the diagnostic accuracy of gray-scale ultrasound in plantar fasciitis.

OBJECTIVE: To explore clinical effects of carpal canal endoscopy in treating patients with plantar fasciopathy who failed by conservative treatment.
METHODS: From August 2018 to August 2019, 50 patients with plantar fascia were divided into two groups and 25 patients in each group. In carpal canal endoscopy group, included 11 males and 14 females, aged from 39 to 67 years old with an average of(57.7±6.4) years old;carpal canal endoscopy was used to plantar fascia release. In arthroscopy group, included 9 males and 16 females, aged from 41 to 73 years old with an average of (58.1±7.2) years old;conventional 4.0 mm arthroscopy Instruments was used to plantar fascia release. Operation time, hospitalization expense and postoperative complications between two groups were observed and compared. Postoperative visual analogue scale(VAS) and American Orthopedic Foot Ankle Society (AOFAS) score were used to evaluate clinical function.
RESULTS: All patients were followed up from 12 to 18 months with an average of (14.3±2.1) months. There were significant differentces in operation time and hospitalization expense between two groups (P<0.05). Surgical incision healed well in carpal canal endoscopy group, and 2 patients delayed union in arthroscopy group, and no difference between two groups (P>0.05). There were no statistical differences in VAS, AOFAS and grading between two groups at 12 months after operation(P>0.05).
CONCLUSIONS: The outcome of carpal canal endoscopy and arthroscopy has similar effects in treating plantar fascia. While carpal canal endoscopy has advantages of need not perfusion during opertaion, protect soft tissue well, less operation time, and lower cost.

Plantar fasciitis is recognized as the leading cause of talalgia worldwide. In the vast majority of cases it can be controlled with the use of appropriate footwear, stretching exercises and changes in the sport activity, while a few cases require infiltrations or surgical interventions. The latter puts the patient at greater risk, and is reserved for the most severe cases. We propose using pulsed radiofrequency ablation of Baxter\'s nerve to treat this painful symptom in patients who do not respond adequately to conventional treatment. We present the case of a patient with refractory plantar fasciitis in whom surgery had been ruled out. The patient underwent pulsed radiofrequency treatment with satisfactory results in the short and medium term.

Plantar heel pain is a common problem affecting foot function, causing pain in the foot under the heel. Plantar fasciitis is commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-stretching home programs, foot orthoses, and night splinting or booting. Dry needling (DN) has shown to be an effective method of treating plantar fasciitis (PF) in multiple randomized control trials. Dry needling is a technique that has been reported to be beneficial in managing pain and dysfunction after PF. Still, there is limited published literature on DN, a myofascial sequence as part of the treatment of PF.
The patient was a 38-year-old female runner referred by a podiatrist for evaluation and treatment to include DN and therapy for persistent PF in the right foot. She was treated 4 times over 3 weeks with a home exercise program. Management and Outcomes: The DN intervention was beyond the local plantar fascia and incorporated 11 locations from the foot up the posterior chain and 2 electric stim channels. The patient had reduced pain as measured by a visual analog scale, increased function as measured by the functional ankle disability index, and range of motion increases.
This case illustrates the use of DN and a home exercise program to provide a favorable outcome in a patient with PF.

A healthy 21-year-old man underwent an elective gastrocnemius recession for plantar fasciitis. At 10 days postoperatively, he developed a severe limb-threatening cutaneous mucormycotic infection that led to multiple debridements and eventual skin grafting.
Cutaneous mucormycosis is a rare but severe fungal infection. Early recognition, deep surgical biopsy for diagnosis, and aggressive treatment with frequent thorough surgical debridements and antifungal pharmacotherapy are necessary. Although mucormycosis is more frequently seen in the immunocompromised host, it can occur in the immunocompetent patient most commonly after trauma. If not aggressively treated, it can be limb and life threatening.

This case report concerns a 51-year-old woman with a 6-month history of severe right heel pain diagnosed as plantar fasciitis (PF) treated with intra-arterial infusion of imipenem/cilastatin (IPM/CS) through a 24G indwelling needle directly inserted into the posterior tibial artery (PTA). Angiography of the indwelling needle immediately before the infusion of IPM/CS demonstrated an increased number of abnormal vessels at the calcaneal attachment of the plantar fascia. Two procedures were planned: The first procedure was performed, and the second was performed 1 month after the first. A week after the first treatment, her pain gradually decreased. Three months after the first treatment, she no longer had difficulties with activities of daily living. Intra-arterial infusion of IPM/CS directly through an indwelling needle into the PTA represents a minimally invasive embolic treatment option for PF.

Epidermal inclusion cysts are slowly developing intradermal lesions which form after the implantation of epidermal tissue into the dermal tissue. Epidermal cysts occur infrequently in the foot, but can occur after traumatic episodes, including surgically induced trauma. Epidermal inclusion cysts have been described as a complication of minimally invasive foot and ankle surgery; however, they have been described infrequently as a complication of radiofrequency microtenotomy. To our knowledge, only one other case study exists discussing the development of a singular epidermal cyst after undergoing radiofrequency microtenotomy. Therefore, the purpose of the present case report was to discuss a case of the development of multiple epidermal inclusion cysts of the plantar heel after radiofrequency microtenotomy for treatment of plantar fasciitis. After undergoing radiofrequency coblation in November 2017, the patient developed multiple plantar heel cysts. She went on to have them surgically removed in February 2018 and again in June 2018. By the time of presentation to our office in October 2018, multiple cysts were still present to her heel despite 2 surgical excisions. Seventeen months after surgical excision in February 2019, the patient remained cyst-free.

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease affecting not only the synovial joints but also multiple extra-articular sites, including ankle and foot soft tissue. Hindfoot abnormalities usually follow those in the forefoot, with up to 4 out of 10 patients experiencing talalgia during their disease course. Enthesophytosis, retrocalcaneal bursitis, and plantar fasciitis are among the most common etiologies, while heel fat pad abnormalities like subcalcaneal bursitis are rare. Here, we report two cases of subcalcaneal bursitis, and the first case of heel fat pad and subcalcaneal bursa herniation in patients with established RA, along with a comprehensive literature review of subcalcaneal bursitis and other heel fat pad abnormalities in RA. Subcalcaneal bursitis, also referred to as panniculitis, inflammatory-edematous lesion, or adventitial (adventitious) bursitis has been reported in up to 10% of patients with RA. It appears as a compressible, heterogeneous, and hypoechoic subcalcaneal mass on ultrasound (US), with peripheral vascularization on Doppler US. Patients may present with heel discomfort. Ultrasonographic assessment is usually sufficient to confirm the presence of heel fat pad pathologies. Rest, analgesics, and mechanical aids with or without addition of disease-modifying antirheumatic drugs are usually employed, while intervention is rarely required.