Abstract：Objective To compare the clinical efficacy of arthroscopic resection of calcaneal spur, plantar fascia release, radiofrequency ablation and calcaneal decompression in the treatment of chronic heel pain. Methods Clinical data of 47 patients (47 feet) underwent surgery in Suining Central Hospital from May 2014 to December 2016 were retrospectively analyzed, of whom 21 patients (21 feet) were treated with traditional incision and plantar fascia (incision group), and 26 patients (26 feet) were treated with arthroscopic spur excision, plantar fascia release, radiofrequency ablation and calcaneal decompression (arthroscopic group). Then VAS scores and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used to assess pain and function before and 1 week, 1 month, 2 months, 3 months, and 6 months after surgery. The efficacy and perioperative complications were evaluated. Results The procedures in 47 patients were successfully performed, and the follow-up ranged from 6 months to 18 months, with an average of 11.2 months. There were 8 patients (38.1%) surffering from perioperative complications in the incision group, including 4 patients of cutaneous necrosis and delayed wound healing, as well as 4 patients of medial or lateral numbness in foot. Together 3 patients(11.5%) had complications in the arthroscopic group, and all had lateral numbness in the foot. There was no statistical significance between the groups (χ2=3.209, P＞0.05). The hospital stay and hospitalization cost were (15.0±4.9) days and (9 647.3±1039.7) yuan in the incision group, as well as (9.3±2.2) days and (11 557.6±1 099.6) yuan in the arthroscopic groups, respectively, and there were statistical differences (t=4.944, 6.066, all P values＜0.01). On the one hand, as for VAS scores, the pain in the incision group relieved significantly 1 month after surgery (P＜0.05), while the arthroscopic group also relieved significantly from the first postoperative week (P＜0.05), achieving stable state 3 months after surgery, and the level of pain relief in the arthroscopy group 1 week after procedures was equal to that in the incision group 1 month after surgery. On the other hand, for AOFAS ankle-hind foot scores, the incision group began to improve significantly 3 months after operation, while the arthroscopic group began to improve 1 month after surgery (P＜0.05), achieving stable state after 3 months, and the function improvement in the arthroscopic group 1 month after surgery was equal to that in the incision group 3 months after surgery. At the follow-up of 6 months, arthroscopic VAS score and AOFAS ankle-hind foot score were still better than those of the incision group; subjective satisfaction degree was 85.7%(18/21) in the incision group and 96.2%(25/26) in the arthroscopy group. There was no significant difference (Z= 0.542, P＞0.05). Conclusions Compared to traditional therapy, arthroscopic treatment has short hospital stay, rapid pain relief and functional recovery, which also can avoid skin complications. However, there are still numbness and poor satisfactory in a few cases, so it is necessary to further study of local nerve anatomy and innervation, to achieve better clinical outcomes.
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2018, Vol. 23 
