Surgical Treatment of Bone Marrow Lesion Associated with Recurrent Plantar Fasciitis: A Case Report Describing an Innovative Technique Using Subchondroplasty^®.

Abstract

Plantar fasciitis is one of the most common chief complaints seen in the foot and ankle clinic. With a relatively benign course, most cases are self-limiting or amendable to conservative therapy; ~90% of all plantar fasciitis cases will respond to these methods. When conservative treatment and time fail, surgical intervention can be necessary to improve outcomes. We present a novel method using Subchondroplasty^® (SCP^®; Zimmer Holdings, Inc.; Warsaw, IN) and revision fasciotomy in a case in which initial fasciotomy had failed. After the patient had failed to improve, a worsening underlying bone marrow lesion was identified at the origin of the plantar fascia; thus, SCP^® was used with repeat fasciotomy. SCP^® involves injecting calcium phosphate into bone marrow lesions to stimulate long-term bone repair. At 10 months after SCP^®, the patient remained pain free and had returned to running at the final follow-up examination. This surgical treatment should be considered as an adjunctive procedure for those patients with plantar fasciitis, identifiable bone marrow lesions on magnetic resonance imaging, and continued pain when other treatment modalities have failed.