Comparison of efficacy between medial double-incision approach and medial-lateral double-incision approach in endoscopic surgery for refractory plantar fasciitis complicated with calcaneal spur.

Abstract

This study aims to compare the clinical efficacy of two endoscopic surgical approaches (medial double-incision and medial-lateral double-incision) in treating refractory plantar fasciitis complicated with calcaneal spur, to provide a reference for clinical surgical method selection. A total of 47 patients (54 feet) with refractory plantar fasciitis complicated with calcaneal spur who underwent CT-guided endoscopic surgery (Jan 2020-Mar 2024) were enrolled. They were divided into medial double-incision group (21 patients, 26 feet) and medial-lateral double-incision group (25 patients, 28 feet) by surgical approach. Clinical efficacy was evaluated with VAS scores, and operation time, calcaneal spur resection effect and postoperative functional recovery were compared between the two groups. The two groups had no significant differences in age, gender, BMI, or preoperative calcaneal spur length (P > 0.05). The medial-lateral double-incision approach had advantages: shorter operation time (54.29 ± 3.51 min vs 77.12 ± 4.95 min, P = 0.0004) and higher complete calcaneal spur resection rate (100% vs 84.62%, P = 0.031). No serious complications occurred in either group; 12-month follow-up showed both groups had significantly improved VAS scores vs preoperation, with no inter-group difference (P > 0.05). Both endoscopic approaches (medial double-incision and medial-lateral double-incision) have similar effects in improving pain and function in patients with refractory plantar fasciitis complicated with calcaneal spur. However, the medial-lateral double-incision approach-with shorter operation time and more thorough calcaneal spur resection-can be the preferred surgical method for this disease.