Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Decompression drilling for heel pain

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

  1. podrick

    podrick Active Member


    Members do not see these Ads. Sign Up.
    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.

    rick
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    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.

    regards,

    rick
     
  7. nicpod1

    nicpod1 Active Member

    Rick,

    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

    nic,

    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.
    regards,

    rick
     
Loading...

Share This Page