Calcaneal osteotomy for the treatment of plantar fasciitis.

BACKGROUND: Plantar fascia release is the main procedure for plantar fasciitis which does not respond to conservative treatment. However, this procedure is sometimes accompanied by lateral column pain due to loss of the longitudinal arch height after surgery. To avoid this complication, we performed calcaneal osteotomy. The aim of this study was to clarify the efficacy of this procedure.

METHODS: A retrospective clinical and radiographic study was conducted for 11 patients (11 feet) who had undergone calcaneal osteotomy for the treatment of intractable plantar fasciitis. Three of the patients were males and eight were females, with an average age of 46 (range 24-70) years. Calcaneal osteotomy was performed from 1 cm anterior of the calcaneal attachment of the plantar fascia to 1 cm anterior of the calcaneal attachment of the Achilles tendon, and the proximal fragment was displaced approximately 5 mm in the plantar direction. The patients with a pronated foot before surgery underwent an additional approximately 5 mm medial displacement of the proximal fragment.

RESULT: Significant improvement was seen between the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score before surgery and at final follow-up (P < 0.0001). With regard to the radiographic parameters which evaluated longitudinal arch height, significant improvement was seen between the talar pitch (P = 0.0002), calcaneal plantar angle (P < 0.0001) and lateral talocalcaneal angle (P = 0.0251) before and at 2 years after surgery. One patient with severe pes planus before surgery showed poor clinical and radiographic results.

CONCLUSIONS: This procedure can bring about good results in patients who do not have severe pes planus.