What is the role of surgery in the treatment of plantar heel pain?

Updated: Oct 01, 2018
  • Author: Vinod K Panchbhavi, MD, FACS; Chief Editor: Thomas C Dowd, MD  more...
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Answer

Multiple clinical recommendations, including the clinical consensus statement by the American Orthopaedic Foot and Ankle Society on the diagnosis and treatment of adult acquired infracalcaneal heel pain, [48] are available and are widely accepted. [10]

Because 90% of patients with plantar fasciitis respond favorably to conservative care, conservative methods should be tried for at least 6, or preferably 12, months before surgery is considered. Furthermore, full counseling regarding the risks and benefits must be administered because complete satisfaction after surgery is observed in only 50% of patients.

The surgery can be performed by open or endoscopic methods. However, if plantar fasciitis is suspected to coexist with compression of the first branch of the lateral plantar nerve, then the endoscopic method is not recommended.

Electromyography and nerve conduction studies are not necessary to diagnose compressive neuropathy of the first branch of the lateral plantar nerve; rather, the diagnosis of entrapment of the first branch of the lateral plantar nerve is made on a clinical basis. Testing nerve conduction across the site of entrapment in the heel is technically demanding. Motor weakness in the abductor digiti quinti may not be detected because of the dynamic nature of the compression.

By either the open or the endoscopic method, only 50% of the plantar fascia is released because a complete release can lead to collapse of the medial and lateral longitudinal arches.

Excision of a plantar heel spur is performed only if it is significantly large and it is compressing the first branch of the lateral plantar nerve.

Surgery for tarsal tunnel syndrome or for decompression of the first branch of the lateral plantar nerve requires release of the tibial nerve and its branches and overlying fascia, including the deep fascia of the abductor hallucis.


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