Endoscopic Versus Open Partial Plantar Fasciectomy for Solitary Plantar Fibromatosis: A Retrospective Cohort Study With Minimum 2-Year Follow-up
This retrospective cohort study demonstrates that endoscopic partial plantar fasciectomy offers faster mid-term functional recovery than open surgery for solitary plantar fibromatosis, while achieving comparable long-term clinical outcomes and recurrence rates at a minimum 2-year follow-up.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The bottom of the foot is a complex structure of tissue, bone, and ligaments designed to support the entire weight of the body while walking, running, and standing. Among these structures is the plantar fascia, a thick band of connective tissue that runs along the sole, acting like a natural shock absorber and maintaining the arch of the foot. Sometimes, this tissue develops a hard, painful lump known as solitary plantar fibromatosis. This condition, also called Ledderhose disease, involves the growth of a single, firm nodule within the fascia. It is not cancer, but it is locally aggressive, meaning it can grow and cause significant pain, making it difficult to walk or wear shoes. For decades, the standard way to remove these painful lumps was through open surgery, where a doctor makes a long cut on the bottom of the foot to reach the tissue. While effective, this approach often leaves a large scar on the weight-bearing surface of the foot, which can be tender and slow to heal. In recent years, surgeons have begun using endoscopic techniques for various foot problems, which involve making tiny cuts and using a small camera to guide the instruments. This method promises less damage to the skin and faster recovery, but until now, there was little solid evidence proving it worked as well as the traditional open method for removing these specific fibrous lumps.
A team of researchers at Soochow University in China set out to compare these two approaches directly. They looked back at the medical records of 25 patients who had undergone surgery for a single plantar fibroma between 2018 and 2022. The patients were split into two groups: 14 received the new endoscopic procedure, while 11 underwent the traditional open surgery. Before the operation, every patient had a detailed magnetic resonance imaging scan to confirm the size and location of the lump, ensuring that the growth was confined to the fascia and had not spread into deeper muscles. The surgeons then removed the growth along with a small border of healthy tissue to ensure the entire lesion was gone. In the open group, this meant a single incision directly over the lump. In the endoscopic group, the surgeons made two tiny portals on the side of the foot, away from the weight-bearing sole, and used a camera to visualize and cut out the tissue from the inside.
The results of this study, tracked over a period of more than two years, revealed a clear pattern in how patients recovered. Both groups saw their pain decrease and their foot function improve significantly compared to their condition before surgery. However, the speed of that recovery differed. Patients in the endoscopic group felt better much sooner. At the one-year mark, those who had the minimally invasive procedure reported less pain and higher scores for foot function and overall quality of life than those who had the open surgery. They were able to return to daily activities and sports faster, likely because their foot soles did not have a large, fresh scar to heal. The open surgery group eventually caught up; by the time the final follow-up occurred, roughly two years after the operation, the pain levels and functional scores of both groups were nearly identical.
Perhaps most importantly, the study found that the smaller incisions did not compromise the success of the operation. Neither group experienced a return of the lump, as confirmed by final MRI scans, and no one needed a second surgery. The researchers noted that while the open surgery allowed for a slightly wider margin of healthy tissue to be removed, the endoscopic technique was precise enough to remove the entire growth without leaving any behind. The study suggests that for patients with a single, well-defined lump on the bottom of the foot, the endoscopic approach is a safe and effective alternative. It offers the distinct advantage of a quicker return to normal life without sacrificing the long-term outcome, providing a less invasive option for a condition that has traditionally required a more aggressive surgical approach.
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