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REPOST a problem after the operation of heel pain

Posted by Dr. John Chu on 2/13/01 at 09:49 (038812)

Please help if you can Thanks again.

Dear Sir:

I am a Orthopaedic surgeon from Taiwan. I really have some experience about the operation of heel pain with arthroscopic assisted plantar release. Usually it's effective but I have one case that felt no improvement after the operation. There is no neurological sign. I can not totally exclude out the possibility of plantar nerve compression. I wonder if there is any useful intervention before the re-operation for nerve decompression. How about your experience and could you please recommend some methods about this kind of condition.

Best wishes
John

Re: REPOST a problem after the operation of heel pain

Dr. Zuckerman on 2/13/01 at 17:43 (038869)

I guess I am the only one willing to help you doctor. You could cast, physical therapy. local steriod injection. Sounds re-operation may be in order. So if you have ruled out other causes includiing just giving it time then re-operative. I have found that some patients take up to six months after any heel spur-pf operation

Re: REPOST a problem after the operation of heel pain

Dr. David S. Wander on 2/16/01 at 15:22 (039182)

Dr. Chu,

It is unfortunate that your patient is still experiencing pain following an endoscopic plantar fascia release. Is the post operative pain the same as the pre operative pain? If it's not, it may be that the plantar fascia was released too far laterally, causing lateral column instability. Additionally, there can be nerve damage when the cannula/endoscope are introduced into the foot. If the pain is similar to the pre operative pain, there can be a stress/occult fracture of the calcaneus which may be evident on MRI or CT scan. If the pain post operatively is the same as pre operatively it can also be from inadequate release of the medial most fibers of the plantar fascia. During a course several years ago, it was noted that after performing endoscopic plantar fasciotomies on cadavers, the most medial fibers were found to still be intact when the incision was opened and inspected. As you stated, there may be an entrapment neuropathy that requires surgical decompression. There is excellent literature written by a plastic surgeon from Baltimore, Maryland. His name is A. Lee Dellon, MD and his expertise involves nerve entrapments and decompression. You may want to read some of his studies or contact him.
Good luck.

Re: REPOST a problem after the operation of heel pain

Dr. Kosova on 2/16/01 at 22:25 (039225)

Dr. Wanders,

I was at the Hershey seminar in 1995 ,I think, and I was taking ankle arthroscopy course and about ten of us performed epf on the cadavers and then opened them up to find that the cannula could not possibly cut the medial pf band because of its curved nature, it was cutting the medial segement of the central band to the lateralband. Dr. Barret was lecturing on his follow up studies on this technique and had no answer to this. In his paper he reported it was the medial pf being cut.

Great point.

Dr. Kosova

Re: REPOST a problem after the operation of heel pain

Dr. Zuckerman on 2/13/01 at 17:43 (038869)

I guess I am the only one willing to help you doctor. You could cast, physical therapy. local steriod injection. Sounds re-operation may be in order. So if you have ruled out other causes includiing just giving it time then re-operative. I have found that some patients take up to six months after any heel spur-pf operation

Re: REPOST a problem after the operation of heel pain

Dr. David S. Wander on 2/16/01 at 15:22 (039182)

Dr. Chu,

It is unfortunate that your patient is still experiencing pain following an endoscopic plantar fascia release. Is the post operative pain the same as the pre operative pain? If it's not, it may be that the plantar fascia was released too far laterally, causing lateral column instability. Additionally, there can be nerve damage when the cannula/endoscope are introduced into the foot. If the pain is similar to the pre operative pain, there can be a stress/occult fracture of the calcaneus which may be evident on MRI or CT scan. If the pain post operatively is the same as pre operatively it can also be from inadequate release of the medial most fibers of the plantar fascia. During a course several years ago, it was noted that after performing endoscopic plantar fasciotomies on cadavers, the most medial fibers were found to still be intact when the incision was opened and inspected. As you stated, there may be an entrapment neuropathy that requires surgical decompression. There is excellent literature written by a plastic surgeon from Baltimore, Maryland. His name is A. Lee Dellon, MD and his expertise involves nerve entrapments and decompression. You may want to read some of his studies or contact him.
Good luck.

Re: REPOST a problem after the operation of heel pain

Dr. Kosova on 2/16/01 at 22:25 (039225)

Dr. Wanders,

I was at the Hershey seminar in 1995 ,I think, and I was taking ankle arthroscopy course and about ten of us performed epf on the cadavers and then opened them up to find that the cannula could not possibly cut the medial pf band because of its curved nature, it was cutting the medial segement of the central band to the lateralband. Dr. Barret was lecturing on his follow up studies on this technique and had no answer to this. In his paper he reported it was the medial pf being cut.

Great point.

Dr. Kosova