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Foot Ankle Surg. 2018 Dec 23. pii: S1268-7731(18)30233-9. doi: 10.1016/j.fas.2018.12.006. [Epub ahead of print]

The clinical outcome of endoscopic plantar fascia release: A current concept review.

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International Center for Hip, Knee and Foot Surgery, ATOS Clinic, Heidelberg, Germany.
Sancheti institute of Orthopaedics and rehabilitation, Pune, India.
International Center for Hip, Knee and Foot Surgery, ATOS Clinic, Heidelberg, Germany. Electronic address:



To clarify whether endoscopic plantar fascia release is safe and effective in the treatment of chronic plantar fasciitis. Secondary goals were a. to compare the clinical outcome between EPFR and non-operative treatment and b. to describe the various EPFR surgical approaches and their outcomes.


Two reviewers (MM and EBC) independently conducted the search using the MEDLINE/PubMed database. This database was queried with the terms 'endoscopic plantar fascia release' and 'endoscopic plantar fasciotomy'. To maximize the search, backward chaining of reference lists from retrieved papers was also undertaken.


From the initial 63 studies we finally chose and assessed 15 studies which were eligible to our inclusion-exclusion criteria. A total number of 535 patients (576 feet) were reported, with a slightly higher female rate. The vast majority of the studies were case series (66.7% of all), while two papers were randomized controlled trials (13.3%), two were case control studies (13.3%), and one was cohort study (6.7%). The overall quality of the studies included in this review, as it was evaluated according to the GRADE Working Group guidelines, was low, while it ranged from very low to high. All studies showed that the postoperative clinical and functional subjective scores were significantly improved with the use of EPFR. Overall, the postoperative complications' rate was 11.0%. The most common complications which were recorded were persistent heel pain (5.6%), paresthesias or numbness (4.3%), soft tissue healing problems (1.7%), and superficial infection (0.4%).


There was weak evidence to support that endoscopic plantar fascia release was safe and effective for the treatment of chronic plantar fasciitis.


Endoscopic plantar fascia release; Literature review; Plantar aponeurositis; Plantar fasciitis


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