Percutaneous fenestration of the anteromedial aspect of the calcaneus for resistant heel pain syndrome

Abstract 

Introduction

The failure of conservative treatment of chronic heel pain might cause prolonged disability from continued discomfort and pain, which mandates a further treatment modality.

Aim of study

The presentation of the results of percutaneous fenestration of the anteromedial aspect of the calcaneus for symptomatic relief of resistant heel pain syndrome.

Material and methods

Between September 2001 and August 2006, 34 patients (38 feet) with chronic heel pain syndrome reported an unacceptable level of pain despite intensive conservative treatment. There were 23 females and 11 males with an average age of 41 years (25–59 years). The average follow-up was 46 months (range, 14–84 months). Clinical evaluation of the intensity of pain (VAS score system), walking distance, standing duration, fascial tenderness, and ankle and subtalar joint motion were evaluated preoperatively and at regular follow-up.

Results

The preoperative pain score level was 8.4 (range, 6–10). The mean postoperative VAS for pain at 4 weeks was 5.89 (range, 3–9), at 8 weeks the value was 3.98 (range, 2–7), at 4 months 2.46 (range, 2–5), at 8 months 1.7 (range, 0–3) and at 12 months zero. A clinical improvement was seen in all patients irrespective of the duration of symptoms (p=0.0041). Three heels (7.9%) had partial relief of pain, but after 43 weeks had complete subsidence of pain. Complications include three transient paraesthesias at the distribution of the medial calcaneal nerve that resolved spontaneously after 8 weeks post-surgery.

Conclusion

The results suggest the technique of percutaneous fenestration is a significantly effective treatment modality for patients with recalcitrant heel pain syndrome after failed conservative treatment.

The described technique may provide a useful method for treating refractory heel spur syndrome without resorting to invasive surgical techniques and warrants further study.

Keywords: Foot, Heel pains, Fenestration, Calcaneal spur, Fasciitis