Patient-reported outcomes following plantar incisions in foot surgery
Background: Plantar incisions may be used in a variety of surgical procedures. Despite numerous studies reporting on procedures which use plantar incisions and thus inadvertently demonstrating good results with plantar incisions, most surgeons still avoid this approach due to the fear of developing a painful plantar scar. There is a shortage of studies demonstrating a clear correlation between plantar scar formation and poor patient-reported outcomes. The aim of this study is to assess the clinical outcome of plantar incisions in various procedures.
Methods: In this retrospective study we identified all patients who underwent surgery using a plantar incision between January 2000 and December 2019. A total of 23 patients were available for assessment. Three common procedures were identified: lesser metatarsal head resection, plantar fibromatosis excision and lateral sesamoidectomy. Demographic data was collected, and clinical outcome was assessed using the Self-Reported Foot and Ankle Score (SEFAS) questionnaire. Twenty-one female (22 feet) and two male patients (two feet) were included. The mean follow-up was 124 (range 8–231) months in the plantar fibromatosis group, 111.5 (range 28–177) months in the lateral sesamoidectomy group and 106.3 (range 42–157) months in the lesser metatarsal head excision group. The study included 12 patients in the sesamoidectomy, nine patients in the plantar fibromatosis and two patients in the lesser metatarsal head excision groups. The mean age of the study population was 45 (range 20–71) years.
Result: The mean postoperative SEFAS score in our series was 44 (range 22–48). Nineteen (82%) patients scored as excellent, two (10%) patients as good, one (4%) patient as fair and one (4%) as poor. All wounds healed well with no symptomatic callosities on clinical examination requiring revision.
Conclusion: This study demonstrates that plantar incisions, irrespective of indication and orientation (21 longitudinal and three transverse), heal well and with good patient-reported outcomes. We believe that it would be erroneous to ‘avoid plantar incisions at all costs’ and that plantar incisions must be considered if deemed technically superior and with less risk than a dorsal approach.
Level of evidence: Level 4