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.

Percutaneous fenestration for resistant heel pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, May 4, 2009.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

    Members do not see these Ads. Sign Up.
    Percutaneous fenestration of the anteromedial aspect of the calcaneus for resistant heel pain syndrome
    Freih Odeh Abu Hassan
    Foot and Ankle Surgery Volume 15, Issue 2, June 2009, Pages 90-95
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. Frederick George

    Frederick George Active Member

    This doesn't work by causing inflammation, but by releasing congestion or bone marrow oedema. Reportedly originally done by some Egyptian doctors, when I taught surgery in China in 1983 they presented a study measuring preop and postop pressure in the calcaneus. There was a positive correlation with the pressure drop and symptomatic relief. No plantar fasciotomy or heel spur excision was done.

    Now, of course, we can detect bone marrow oedema with MRI.

    You can also squeeze the heel, like testing for Sever's disease. Just a slight compression of the calcaneus (how much can you compress a bone, anyway) will cause pain.

    This compression pain seems generally to follow after initial heel spur/plantar fasciitis symptoms. Probably the long term inflammation. I've noticed achilles tendonitis/calf pain seems to follow this, and then sometimes tarsal tunnel syndrome follows.

    Originally, a circle of six holes was percutaneously drilled into the lateral calcaneus. This caused a stress riser however, and there were some calcaneal fractures.

    I've drilled two holes obliquely diverging from the excision of heel spur site, back into the body of the calcaneus. I've had good results with this, but I also remove the heel spur and release the plantar fascia. I've done this for over 20 yrs now, with no ill effects, and very good results. From my experience, I think the decompression is actually more important than the heel spur excision, and indeed there has been some discussion that the actual causative effect of the heel spur excision is to make a break in the cortex so that the marrow can decompress.

    Perhaps some of the failures with the dead simple endoscopic plantar fascial release were a result of this failure to remove the spur/decompress the calcaneus.

    The recent fad of coblation is more akin to prolotherapy, increasing inflammation to cause the migration of multipotential mesenchymal cells to the site to reinforce the rupturing plantar fascia. This is nothing new. It's been used for at least a century on lame horses, by puncturing the affected tendon/ligament repeatedly with a heated needle to cause repair/strenghtening of the tendon/ligament.

    It's called "pin firing," but is no longer legal in New Zealand because it's considered cruel.

    Interesting that some are doing it on humans, eh?

    Cheers

    Frederick
     
  4. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis.
    Sadek AF, Fouly EH, Elian MM
    J Orthop Surg (Hong Kong). 2015 Aug;23(2):237-40.
     
Loading...

Share This Page