A multimodal endoscopic surgical strategy for refractory plantar fasciitis: Clinical outcomes of the DORR technique with adjunctive gastrocnemius recession.

Abstract

BackgroundPlantar fasciitis is a prevalent cause of heel pain, often managed nonoperatively. For patients who remain symptomatic despite nonoperative treatment, surgical options are considered. The debridement, ostectomy, release, and radiofrequency (DORR) procedure-a novel endoscopic suprafascial approach-aims to address multiple pathological components of chronic plantar fasciitis to achieve best outcomes.MethodsA retrospective review of 37 patients who underwent the DORR procedure with endoscopic gastrocnemius recession for chronic plantar fasciitis between 2023 and 2024 was performed. Patients had recalcitrant symptoms despite at least 6 months of nonoperative therapy. The procedures included a suprafascial arthroscopic debridement and calcaneal spur removal, medial plantar fascia release, radiofrequency microtenotomy and endoscopic gastrocnemius recession. Clinical outcomes included the European Foot and Ankle Society (EFAS) score, Visual Analogue Scale (VAS) for pain, patient satisfaction, and expectation fulfilment, assessed preoperatively and at 6 months.ResultsSignificant improvements were observed in EFAS scores (from 9.11 ± 2.62 to 19.19 ± 3.07, P < .001) and VAS pain scores (from 7.73 ± 1.10 to 2.43 ± 2.08, P < .001). Overall, 86.5% of patients reported satisfaction with the procedure, and 94.6% felt their expectations were met. Complication rates were low, with one case each (2.7%) of recurrent heel pain and transient toe abduction weakness. No cases of lateral foot numbness were observed.ConclusionThe DORR procedure with adjunctive endoscopic gastrocnemius recession appears to be a safe and effective surgical option for patients with recalcitrant plantar fasciitis. By addressing all postulated pathology, both structural and functional contributors to heel pain, this approach may offer a more comprehensive solution than conventional techniques. Further prospective studies are warranted.