A Novel Indigenous Endoscopic-Assisted Surgery for Intractable Plantar Fasciitis: A Case Series

Plantar fasciitis is the most common cause of heel pain in adults, and while most cases respond to conservative treatment, a subset of patients require surgical intervention. Endoscopic plantar fascia release (EPFR) is preferred for its minimally invasive nature and favorable outcomes. However, the cost of disposable instrumentation presents a barrier in low-resource settings.

Rajesh Simon et al conducted a study to evaluate the clinical effectiveness and safety of endoscopic plantar fascia release using reusable, affordable, autoclavable instruments developed as a cost-conscious alternative to disposable kits. The kit typically used for endoscopic plantar fasciotomy included a disposable trocar, disposable slotted cannula (pre-cut 15cm K-nail 7mm), and disposable blade (custom made).

This prospective case series included 24 patients with intractable plantar fasciitis who underwent EPFR using reusable instruments. Patients were assessed preoperatively and at 12 months postoperatively using the AOFAS Hindfoot Score and the VAS for pain. Data were analyzed using paired t tests with significance set at p < 0.05.

The key findings of the study were:

• Of the 24 patients included in the study, 17 (70.8%) were females and 7 (29.2%) were males.

• The mean age of participants was 46.9 ± 8.2 years, with a range of 30 to 63 years.

• The left foot was affected in 11 patients (45.8%), while the right foot was involved in 13 patients (54.2%).

• The mean plantar fascia width was 8.1 ± 1.1 mm, ranging from 7 to 11 mm.

• The mean follow-up period was 35.3 ± 14.2 months, ranging from 12.3 to 65.8 months.

• The mean preoperative AOFAS score improved from 59.2 ± 3.8 to 84.4 ± 6.0 postoperatively (p < .001), and the mean VAS score decreased from 8.1 ± 1.7 to 2.4 ± 0.5 (p < .001).

• Pain relief was reported by 91.7% of patients.

• No major complications were observed.

The authors concluded - “Endoscopic plantar fasciotomy using reusable instruments demonstrated significant improvements in both functional outcomes and pain relief, as reflected by the increase in AOFAS scores and the decrease in VAS scores postoperatively. The procedure was safe, effective, and the positive results were maintained over a substantial follow-up period. Although cost was not directly analyzed in this study, the use of reusable instruments offers a practical and potentially more economical alternative to disposable kits, particularly in resource-limited settings where affordability and sustainability are important considerations.”

Level of evidence: IV

For Further details on the article refer to:

A Novel Indigenous Endoscopic-Assisted Surgery for Intractable Plantar Fasciitis: A Case Series

Rajesh Simon et al

Indian Journal of Orthopaedics (2026) 60:199–205

https://doi.org/10.1007/s43465-025-01597-x