Annotated Bibliography
Results of Extracorporeal Shockwave Therapy Peer Reviewed Research

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Articles addressing Outcomes and Complications related to surgery for Plantar Fasciitis
Summary: A full or partial fasciotomy (3rd Party Payor covered procedures) require cutting a portion or all, of the fascia, which affects the biomechanics of the plantar fascia and its function in the foot. This can contribute to long term negative effects on the foot such as nerve entrapment, decrease in arch height, leg strain, stress fractures, lateral column syndrome due to loss of stability in the arch as well as dorsal strain, which can lead to metatarsalgia. Recovery from these procedures can be prolonged. Therefore, aggressive conservative treatment available should be attempted prior to surgical release.

Baxter, D, Thigpen, C.M. "Heel Pain—Operative Results." Foot and Ankle, 1984, vol. 5, No. 1, 16-25.
Study Type: Retrospective Study, no control
Inclusion Criteria: Treated Symptoms for > 6 months, failed NSAIDS, orthoses, > 2 steroid injections, heel spur presence, and nerve entrapment of the abductor digiti quinti freedom
Results: 12 months Success: 94%
Recovery: 2 weeks limited ambulation, Suture removal 2-3 weeks post procedure, normal mobility 4-6 weeks

Daly, P., et al. "Plantar Fasciotomy for Intractable Plantar Fasciitis: Clinical Results and Biomechanical Evaluation." Foot and Ankle. May 1992, Vol. 13, No. 4, 188-195.
Study Type: Retrospective Study, no control
Results: 4.5-15 years Success: 71% with prolonged recovery period, detrimental effect on function may occur requiring additional treatment. Persistence of abnormalities such as flattening of the longitudinal arch post fasciotomy.
Side Effects following surgery: 36% heel tenderness, 29% limp, 100% limited ankle and subtalar motion.
Additional Treatment required following surgery: 50%
Recovery Period: 10.5 months recovery (vs. 6 month recovery reported by others).

Kitaoka, Harold, et al. "Mechanical Behavior of the Foot and Ankle after Plantar Fascia Release in the Unstable Foot.& Foot and Ankle International, January 1997, Vol 18, No. 1, 8-15.
Study Type: Cadaver Study
Purpose: Fasciotomy has a greater effect in unstable feet. The change in position of the bones of the foot may lead to unstable or destabilized feet and further deformity.
Results: Joint rotation and arch displacement occurs in all feet to a measurable point. Deformity occurs in unstable feet with pre-existing arch instability.

Murphy, G. Andrew, et al. "Biomechanical Consequences of Sequential Plantar Fascia Release." Foot and Ankle International, March 1998, Vol 19, No 3, 149-152.
Study Type: Cadaver Study
Purpose: Determination of the extent of plantar fascia release that can be performed without seriously altering the biomechanics of the foot.
Results: The arch height drops 18% after the partial fascial release and 29% after complete release. Aggressive conservative treatment of plantar fasciitis should therefore be tried before surgical release is considered because of the adverse biomechanical changes in the foot after such surgery.

Sammarco, G. James, Idusuyi, Osaretin "Stress Fracture of the Base of the Third Metatarsal after an Endoscopic Plantar Fasciotomy: A Case Report" Foot and Ankle International, March 1998, Vol. 19, No 3, 157-159.
Study Type: Case Study
Purpose: Case report of side effects following endoscopic plantar fasciotomy
Results: Release of the plantar fascia results in excessive strain in the lateral side of the foot from loss of the stress relieving function of the plantar fascia. Fracture of the base of the third metatarsal was the result of increase forces produce by the endoscopic plantar fasciotomy.

Sharkey, Neil, et al. "Biomechanical Consequences of Plantar Fascial Release or Rupture During Gait: Part I – Disruptions in Longitudinal Arch Conformation." Foot and Ankle. December 1998, Vol. 19, No. 12, 812-820.
Study Type: Cadaver Study
Purpose: To determine the consequences of fasciotomy.
Results: Significant collapse of the arch in the sagittal plane post complete fasciotomy or plantar fascial rupture. A change occurs in arch, even with partial release of the plantar fascia and increases strain on the tibialis posterior muscle.
Side Effects following surgery: Plantar fascial division (possibly even division of only the central band) or rupture may lead to long-term complications elsewhere in the foot. The changes in conformation of the arch caused by partial fasciotomy are small, which perhaps accounts for the favorable outcomes reported in short-term studies. Surgically compromised plantar fascia my lead to progressive pes planus caused by the added stress placed upon the tibilias posterior muscle and secondary ligamentous restraints. Any change form normal may be sufficient to precipitate a cascade of events eventually leading to pes planus with accompanying pain.

Sharkey, Neil, et al. "Biomechanical Consequences of Plantar Fascial Release or Rupture During Gait: Part II – Alterations in Forefoot Loading." Foot and Ankle. February 1999, Vol. 20, No. 2, 86-96.
Study Type: Cadaver Study
Purpose: Delineation of the effects of plantar fasciotomy on forefoot or metatarsal loading.
Results: Complete fasciotomy or plantar fascia rupture increased the magnitude of strain in the dorsal aspect of the second metatarsal by more than 80%. Side Effects following surgery: Strains increase the rate of accumulation of damage in the bone, possibly leading to metatarsalgia. If damage caused by increased strain or increased frequency of loading accumulates faster than can be repaired by remodeling, it may escalate to stress fracture.


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