Safety and Feasibility of the Plantar Portal Technique in the Surgical Management of Plantar Fasciitis: A Cadaveric Study

Abstract

Introduction This study investigates the proximity of the portals and nearby motor and sensory nerves in endoscopic release of the plantar fascia and the safety and efficacy of the addition of a novel third (plantar) portal to improve access to the calcaneal spur.Methods Nine fresh-frozen lower extremity cadavers were examined in this study. In addition to the conventional medial and lateral portals for endoscopic plantar fascia release, a third (plantar) portal was utilized to debride the calcaneal spur area. The fascia was released with the use of an obturator cannula. Each cadaver was carefully dissected, the distance of the nerves to the portals and the obturator cannula was measured with a digital caliper, and the adequacy of the plantar fascial cut was evaluated. The nerves were examined along their course to check for any injuries.Result The closest distance between the lateral plantar nerve and the plantar portal was 15.3 +/- 1.47 mm, and the obturator cannula was 10.53 +/- 1.50 mm. The closest distance between the first branch of the lateral plantar nerve (Baxter's nerve) and the obturator cannula was 10.02 +/- 0.65 mm. The closest distance between Baxter's nerve and the calcaneal spur area was 8.21 +/- 1.12 mm. There was no evidence of nerve or muscle injury in the dissected cadavers.Conclusions Using the plantar portal in conjunction with conventional portals in endoscopic plantar fasciitis surgery can be advantageous, as it provides easier access to the calcaneal spur and is safe in terms of its distance from the nearby neural structures.