Endoscopic plantar fasciotomy versus open plantar fasciotomy for treatment of plantar fasciitis: a systematic review and meta-analysis

BACKGROUND: Plantar fasciitis is a degenerative pathology that most common causing heel pain in adults aged 40-60. Severe pain typically presents at morning or after prolonged activity. Treatment includes conservative measures, physical therapy, orthotics, and injections. Surgical intervention is considered for severe cases requiring prolonged treatment. OBJECTIVES: The primary objective is to compare functional outcomes between open and endoscopic plantar fasciotomy, while the secondary objective is to compare their respective complication rates. MATERIALS AND METHODS: A comprehensive search of the English-language literature was conducted using multiple databases, including PubMed, Cochrane, Scopus and Google Scholar in addition to a manual search. Studies regrading endoscopic plantar fasciotomy (EPF) and open plantar fasciotomy (OPF) were included in the meta-analysis. The methodological quality of the included studies was assessed using the appropriate tool. A sensitivity analysis was performed to evaluate the robustness of the findings. The analysis focused on outcomes such as pain relief (VAS scores), functional improvement (AOFAS scores), complications and operative time. A total of 19 articles met the inclusion criteria for this meta-analysis. RESULTS: This meta-analysis of 19 studies and 646 patients showed that both OPF and EPF resulted in excellent improvements in AOFAS and VAS scores. Comparative studies revealed a non-significant difference between the two groups, with Standardized Mean Difference (SMD) for VAS score {1.36 (95% CI (- 4.03, 6), p-value = 0.390} and {- 0.39 (95% CI (- 5.41, 4.63), p-value = 0.770} for AFOS score. Consistently and significantly shorter mean operative time for EPF (15.76 min) compared to OPF (36.78 min). EPF demonstrated a lower complication rate 5% (95% CI: 2%, 9%). Compared with OPF 11% (95% CI: 2%, 45%). However non-comparative studies demonstrated OPF slightly more pain relief (VAS score) and functional improvement (AOFAS score). CONCLUSION: This study showed that both EPF and EPF appear to be effective treatments. EPF was associated with shorter operative times and a lower complication rate.