Calcaneal decompression as part of painful heel syndrome


Background: Many modalities of surgical treatment are available for painfulheel syndrome like: release of half of planter fascia, excision of spur, drillingof calcaneum, and calcaneal osteotomy, without agreement on the mosteffective one.Aim: to evaluate the effect of calcaneal bone drilling in addition to planterfascia release and calcaneal spur removal for patients with painful heelsyndrome.Patients and methods: between 2007‐2011 at Al‐Yarmouk Teaching hospital,a retrospective comparative study of (44) feet of (38) patients (M=11 andF=27) with persistent painful heel syndrome divided into 2 groups: first group(24) feet of (18) patients were treated by calcaneal drilling with thetraditional surgery (release of planter fascia + calcaneal spur excision), andthe second group (20) feet of (20) patients were treated with traditionalsurgery only (control group). Evaluation of patient's pain and satisfactionwas based on VAS (visual analogue pain scale) system for local pressuretenderness and rest pain.Results: The mean pre‐operative rest pain and local pressure tendernesswere 8.38±0.99 and 8.95±1.21 for group I respectively and 8.50±0.81and8.80±0.81for group II respectively.There was significant decrease in rest heelpain in group I in comparison with group II after 6 months (from 4.40±0.97for group II to 0.88±1.05 for group I), and after 2 years follow‐up (from2.25±1.47 for group II to 0.25±0.66 for group I) with p<0.05. There wassignificant decrease in local pressure tenderness in group I in comparisonwith group II after 6 months follow‐up (from 5.85±1.01 for group II to1.92±1.58 for group I), and after 2 years follow‐up (from 3.85±1.56 for groupII to 0.33±0.75 for group I) with p<0.05. Complications were post‐operativeinfection (9.1%), heel paresthesia (13.6%), and persistent pain (2.3%).Conclusions: calcaneal drilling is one of significantly effective modality oftreatment for recurrent heel pain syndrome when combined with ordinaryrelease of planter fascia and spur excision.