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Decompression drilling for heel pain

Discussion in 'Foot Surgery' started by podrick, Nov 20, 2004.

  1. podrick

    podrick Active Member

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    i recently ran across an article regarding what is termed as a decompression osteotomy of the heel in order to eliminate diffuse heel pain.whose etiology has been deemed not due to tarsal or sinus tarsi syndrome or heelspur syndrome.it consists of drilling a series of holes with a .062 k-wire in the medial central aspect of the calcaneus.the holes form a circle.the authors describe it as a diffusing of inflammation.is anyone familiar with this and its mechanism of efficacy,if there is any.

  2. Craig Payne

    Craig Payne Moderator

    I am not familiar with the technique, but I do recal recently seeing the same publication you mentioned. I also have another one on file somewhere from the Chinese Medical Journal describing the same technique.

    What intrigues me about this, is that there was a study in AJR a while back that did some detailed MRI's of insertional plantar facisiitis/heel spur syndrome - I can not remember the numbers but many of them had bone marrow oedema .... that suggests to me that we a dealing with different subpopulation of what we thought might have had insertional plantar fasciitis - ie what role does the bone marrow oedema play :confused: Does it have anything to do with ESWT or the above technique of drilling holes in the calcaneus :confused: (relieveing the oedema :confused: )
  3. admin

    admin Administrator Staff Member

    Percutaneous drilling for chronic heel pain.
    Santini S, Rebeccato A, Schiavon R, Nogarin L.
    J Foot Ankle Surg. 2003 Sep-Oct;42(5):296-301

    Drilling of os calcis in persistent painful heel. (no abstract available)
    Chen BX, Li ZM
    Chin Med J (Engl). 1981 May;94(5):288-90

    Extracorporeal shock wave application for chronic plantar fasciitis associated with heel spurs: prediction of outcome by magnetic resonance imaging.
    Maier M, Steinborn M, Schmitz C, Stabler A, Kohler S, Pfahler M, Durr HR, Refior HJ.
    J Rheumatol. 2000 Oct;27(10):2455-62.
    MR imaging of plantar fasciitis:edema, tears, and occult marrow abnormalities correlated with outcome
    RP Grasel, ME Schweitzer, AM Kovalovich, D Karasick, K Wapner, P Hecht and D Wander
    Am. J. Roentgenol., Sep 1999; 173: 699 - 701

    Last edited: Nov 20, 2004
  4. podrick

    podrick Active Member

    calcaneus decompression

    i am very grateful to the host for the references on the subject.however,i agree with craig,as to what exactly is the role of bone marrow edema in plantar fasciatus or diffuse heel pain for that matter?
    would one first evaluate the role of bone marrow edema of the calcaneus through a bone scan,both pre and post operatively?
    finally,does anyone have specifics on the technique itself?
  5. nicpod1

    nicpod1 Active Member

    I work with two Physiotherapists who are both advanced traditional Chinese and, also, Western Accupuncturists. They have a technique for heel pain which involves 'peppering' the periosteum of the calcaneus with accupuncture needles. This also elicits an inflammatory response and apparently promotes healing and, therofore, pain-relief, in the same way as 'hitting it with a hammer' (see ECSWT thread on General Forum) and actual osteal drilling.

    It is, as you can imagine, extremely painful to 'pepper' in this way and I have recently been carrying-out a tibial nerve block prior to 'needling'. Results are to be awaited, but, obviously, this technique has the advantage of being able to be performed in a clinical room, with little, or no, post-op infection risk.

    Phyisos will also use a technique called myofascial release, with some success.

  6. podrick

    podrick Active Member

    peppering acupuncture technique

    hi nic,
    i am curious,when you were describing the acupuncture technique in your memo.you mentioned that they place the needles to the level of the periostium.so are they basically taking it to the level of the bone?
    you also mentioned myofascial release,now are talking about release of plantar fascia via some kind of cross frictional therapy or do you mean actual fasciotomy procedure.
    in a way this is very similar to prolotherapy whereby you create injury in order to promote healing via inflammation(i am oversimplifying of course).
    i look forward to your thoughts on the matter.


  7. nicpod1

    nicpod1 Active Member


    Yes - to bone!

    No - not surgery to release fascia, but a process which involves stretching the myofascial system (of which the plantar fascia is but a small part). Apparently, if every other type of tissue and fuid was removed from the body, except myofascia, an exact replica of all anatomy would remain. So, bascially, the Physios will rest thier hands on the area requiring attention, wait until the heat of their hands causes some 'changes/reponse' in the localised area (ususally 90 seconds - 2 minutes) and then push their hands in opposite directions, along the line of the fascial structure concerned......it's a bizarre and wonderful world in physio-land.

    I have no success stories of my own to relay about this technique, but some physios swear by it. Heel pain is so difficult to erradicate sometimes though, it's worth giving most things a go......well........maybe not a hammer, but, then again........................ :D
  8. podrick

    podrick Active Member

    decompression drilling


    thanks so much for the ifo.and yes i agree with you in regards to heel pain.i wish there was a real flowchart we could follow.

  9. NewsBot

    NewsBot The Admin that posts the news.

    Calcaneal decompression as part of painful heel syndrome

    Saad Mubarak Rasheed
    Mustansiriya Medical Journal Volume 13 Issue 2 December 2014
  10. NewsBot

    NewsBot The Admin that posts the news.

    The Effectiveness of Calcaneal Drilling for Treatment of
    Resistance Cases of Plantar Heel Pain

    Mohammed SH et al
    Al-kindy College Medical Journal 2018:14 No.2
  11. NewsBot

    NewsBot The Admin that posts the news.

    Comparison of the Isolated Plantar Fascia Release versus Plantar Fascia Release Combined with Calcaneal Decompression in Management of the Patients with Resistant Heel Pain
    Kayahan KARAYTUĞ et al
    September 18, 2021
  12. NewsBot

    NewsBot The Admin that posts the news.

    Comparison of the Isolated Plantar Fascia Release Versus Plantar Fascia Release Combined With Calcaneal Decompression in Management of the Patients With Resistant Heel Pain
    Kayahan Karaytug et al
    J Foot Ankle Surg. 2021 Sep 20;S1067-2516(21)00345-8

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