Comparative Outcomes of Percutaneous Plantar Fascia Release, Calcaneal Drilling, and Calcaneal Spur Removal versus ESWT in the Treatment of Plantar Fasciitis

Öz

This study aimed to compare the clinical outcomes of percutaneous plantar fascia release, calcaneal drilling, and calcaneal spur excision with extracorporeal shock wave therapy (ESWT) in patients with plantar fasciitis resistant to conservative treatment. A total of 52 patients diagnosed with plantar fasciitis and unresponsive to at least six months of conservative therapy between January 2021 and December 2024 were retrospectively analyzed. Patients were divided into two groups: minimally invasive surgery (n = 18) and extracorporeal shock wave therapy (ESWT) (n = 34). Demographic data, symptom duration, standing time at work, return-to-work time, complications, and clinical outcomes were compared using the Visual Analog Scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Roles & Maudsley (RM) score. There were no significant differences between the groups in terms of age, gender, body mass index (BMI), symptom duration, or standing time at work (p > 0.05). Return-to-work time was significantly longer in the minimally invasive surgery group (13.8 ± 4.5 vs. 4.3 ± 2.8 days, p = 0.001). While both groups showed comparable clinical improvement at the 6-month follow-up, VAS and AOFAS scores were better maintained in the surgical group at 12 months. In contrast, a decline was observed in the ESWT group (p = 0.001 and p = 0.012). Complication rates were similar between the groups (p = 0.99). Minimally invasive surgery provided more sustainable long-term clinical improvement. On the other hand, ESWT offered a predictable short-term cost advantage and enabled earlier return to work. Considering patient expectations and ease of application, ESWT appears to be an effective and practical treatment option that should be considered before proceeding with minimally invasive surgical interventions.

Anahtar Kelimeler

• ESWT
• Minimal İnvaziv Surgery
• Plantar Fasciitis

Perkütan Plantar Fasya Gevşetme , Kalkaneal Delik Açma ve Kalkaneal Spur Eksizyonu ile ESWT'nin Plantar Fasiit Tedavisindeki Karşılaştırmalı Sonuçları

Öz

Bu çalışma, konservatif tedaviye dirençli plantar fasiitli hastalarda, perkütan plantar fasya gevşetmesi, kalkaneal delik açma ve kalkaneal spur eksizyonu ile Ekstrakorporeal Şok Dalga Tedavisi (ESWT)’nin klinik sonuçlarını karşılaştırmayı amaçlamaktadır. Ocak 2021 ile Aralık 2024 tarihleri arasında plantar fasiit tanısı almış ve en az altı ay konservatif tedaviye yanıt vermemiş 52 hasta, retrospektif olarak analiz edilmiştir. Hastalar iki gruba ayrılmıştır: minimal invaziv cerrahi (n=18) ve ESWT (n=34). Demografik veriler, semptom süresi, işte ayakta durma süresi, işe dönüş süresi, komplikasyonlar ve klinik sonuçlar, Görsel Analog Skala (VAS), Amerikan Ortopedik Ayak ve Ayak Bileği Derneği Skoru (AOFAS) ve Roles & Maudsley Skoru (RM) ile karşılaştırılmıştır. Gruplar arasında yaş, cinsiyet, Vücut Kitle İndeksi (BMI), semptom süresi veya işte ayakta durma süresi açısından anlamlı bir fark bulunmamıştır (p > 0.05). İşe dönüş süresi, minimal invaziv cerrahi grubunda daha uzun bulunmuştur (13.8 ± 4.5 vs. 4.3 ± 2.8 gün, p = 0.001). Altıncı ayda her iki grup da benzer klinik iyileşme göstermiştir; ancak 12. ayda VAS ve AOFAS skorları cerrahi grupta daha iyi kalmış, ESWT grubunda ise gerileme gözlenmiştir (p = 0.001 ve p = 0.012). Komplikasyon oranları karşılaştırılabilir bulunmuştur (p = 0.99). Minimal invaziv cerrahi, uzun vadede daha sürdürülebilir klinik iyileşme sağlamaktadır. Buna karşın, ESWT erken dönemde öngörülebilir bir maliyet avantajı sunmakta ve hastaların daha kısa sürede iş yaşamına dönebilmesine olanak tanımaktadır. Hasta beklentileri ve uygulama kolaylığı gibi faktörler göz önünde bulundurulduğunda, ESWT’nin etkili ve pratik bir tedavi seçeneği olarak minimal invaziv cerrahi yöntemlere geçilmeden önce değerlendirilmesi önerilmektedir.

Anahtar Kelimeler

• eswt
• Plantar Fasiit
• Minimal İnvaziv Cerrahi

Kaynakça

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