Introduction: Plantar fasciitis is a common syndrome characterized by pain at the origin of the plantar fascia, most often on rising after a period of inactivity. It is usually self limited. Treatment includes: NSAIDs, physical therapy, orthotics, steroid injections, and lately shock wave therapy. Patients who fail to respond to non-operative treatment are often referred to one of a variety of surgical procedures.

We report our experience with one such procedure, percutaneous release via a medial approach.

Methods: At our institution, patients with plantar fasciitis who fail to improve despite first (NSAID, PT) and second (injection, orthotics) line therapy, are referred for percutaneuos plantar fasciotomy. We retrospectively reviewed 34 patients who underwent 38 procedures between 1999–2006. Mean patient age at surgery was 50 (30–65). 24 were evaluated by an uninvolved orthopedic surgeon at an outpatient clinic, and 10 responded to a mail or telephone questionnaire. Assessment included pain relief, functional improvement, complications, and willingness to re-undergo, or recommend the surgery.

Results: Average VAS score dropped from 8.9 to 2.1. Function improved in 93%. The surgery met or exceeded expectations in 76%, and 82% would have re-undergone or recommended the procedure. Injury to the lateral plantar nerve was encountered in 3 patients.

Conclusion: Percutaneous plantar release is an effective treatment for resistant plantar fasciitis. Care should be taken to prevent nerve injury by accurate technique.

Introduction: Pediatric ankle trauma is common, and mostly a self limiting condition, with most children recovering within a few days to one week. However, some children seem to be affected more than others and to recover more slowly, despite normal radiographs. We set out to determine the occurrence of radiographically occult fractures, using high-resolution ultrasound.

Material and Methods: Twenty consecutive, skeletally immature patients, aged from 5 to 13 years with acute ankle injury, and normal radiographs were referred for high resolution ultrasound during the first week after the injury. A follow-up radiograph, obtained 2–3 weeks after the injury, was assessed for periosteal reaction / callus formation.

Results: In 13 patients there was no ultrasonographic evidence of fracture, nor was a periosteal reaction / callus formation. Six patients had ultrasonographic evidence of small fractures of the lateral malleolus, and periosteal reaction / callus formation on the follow-up film. In one patient a subcortical compression was evident on ultrasound. In this patient, although no periosteal reaction was observed on the follow up X-ray, a small fracture line became evident.

Discussion: Small lateral malleolar fractures may be missed on standard ankle radiographs. In patients with a clinical presentation consistent with a fracture, high resolution ultra-sound is a highly sensitive and specific diagnostic tool.

Introduction Musculoskeletal injuries, especially fractures, cause reduced limb mobilization. The diminished limb activity promotes muscular atrophy, leading to a slower return to function. Attempts to prevent this atrophy using electrical stimulation have been described after knee reconstruction.

The Myospare percutaneous electrical stimulator has been developed to prevent immobilization related atrophy. We undertook this pilot study to assess feasibility, safety, and efficacy of applying electrical stimulation under a cast after ankle fractures.

Patients and Methods Between May and December 2004, patients who sustained closed ankle fractures requiring surgery, were recruited to participate in this study. 24 patients took part in the study, sixteen male and eight female. Age range was 18 to 62 years (average 40). All patients underwent open reduction and internal fixation using standard AO technique. A short walking cast was applied after surgery. Patients were randomized into a treatment and a control group. The experimental device was applied in the treatment group for 6 weeks. Patients were examined at 2, 6 and 12 weeks.

Evaluation included measurement of calf and ankle circumference, dorsiflexion and plantiflexion, and calculation of the ratio between the injured and uninjured side. At each visit pain intensity was assessed using a visual analog score, and patients filled out a function assessment questionnaire. Analysis was performed using chi square, t-test and repeated measures analysis.

Results All patients tolerated the stimulator well. No adverse effects were encountered. There is a trend toward improvement in calf diameter, dorsiflexion and plantarflexion. However, with the small number of patients in this study, no significant difference was apparent. Functional recovery and VAS scores were borderline higher in the treatment group at 12 weeks (p=0.043 and p=.049) when compared to baseline.

Discussion The use of the Myospare device under a cast in patients after surgical fixation of ankle fractures has been demonstrated as feasible and safe. In this pilot study a trend toward enhanced recovery was apparent in the treatment group.