Endoscopic versus open partial plantar fasciectomy for solitary plantar fibromatosis: a retrospective cohort study with minimum 2-year follow-up

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Plantar fibromatosis is a rare fibroproliferative disorder of the plantar fascia, and evidence on endoscopic management remains limited. This study compared postoperative outcomes after endoscopic versus open partial plantar fasciectomy for solitary plantar fibromatosis with minimum 2-year follow-up. This retrospective cohort study included 25 patients treated between January 2018 and January 2022: 12 men and 13 women, with a mean age of 48.2 ± 7.2 years. All patients underwent preoperative foot magnetic resonance imaging and partial plantar fasciectomy (14 endoscopic and 11 open procedures). Treatment allocation was nonrandom and determined through shared decision-making based on lesion characteristics, patient preference, and surgeon experience. Outcomes were assessed using the VAS, AOFAS-AH, SF-36, and FAAM. Final follow-up magnetic resonance imaging was used to evaluate recurrence. The mean follow-up period was 25.3 ± 3.7 months (median, 24.0 months; range, 24.0–37.7 months). At 12 months, nominal between-group differences favored the endoscopic group for VAS (2.7 ± 0.4 vs. 3.1 ± 0.5, P = .043), AOFAS-AH (85.2 ± 5.7 vs. 77.4 ± 6.3, P = .004), SF-36 (81.7 ± 3.8 vs. 76.9 ± 4.2, P = .008), and FAAM-ADL (97.0 ± 11.2 vs. 85.0 ± 14.4, P = .028). Pathology-reported resection margins were narrower in the endoscopic group (8 ± 7.0 vs. 15 ± 6.0 mm, P = .013). Linear mixed-effects models identified significant group-by-time interactions for AOFAS-AH, SF-36, FAAM-ADL, and FAAM-Sport, but not VAS. At final follow-up, no statistically significant between-group differences were detected in VAS ( P = .499), AOFAS-AH ( P = .966), or SF-36 ( P = .093). No MRI-detected recurrence or reoperation was observed. Both procedures were followed by clinical improvement. The endoscopic approach was associated with different recovery trajectories and selected early or intermediate functional advantages, whereas no statistically significant between-group differences in VAS, AOFAS-AH, or SF-36 were detected at final follow-up. No MRI-detected recurrence was observed during the available follow-up. Endoscopic partial plantar fasciectomy may be considered a minimally invasive option for selected solitary lesions confined to the plantar fascia; larger studies with longer surveillance are required. Not applicable.