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Calcaneal Nerve Compression

Posted by Mar on 12/06/02 at 08:38 (101951)

Docs-

I found this on the internet: Calcaneal Nerve Compression,

HEEL PAIN can be due to compression of the calcaneal nerve. If you still have pain in you heel after bone spur removal, or treatment of plantar fasciitis consider that your pain may be due to a nerve problem. This can be identified by Quantitative Sensory Testing, and can be treated by surgery to decompress the calcaneal nerve.

How common is this? What is involved in a Quantitative Sensory Test -- is that nerve testing where they put a monitor on you and prick you in different places?

Any other info appreciated. Mar

Re: Calcaneal Nerve Compression

Ed Davis, DPM on 12/06/02 at 15:19 (102003)

Mar:
This diagnosis is probably more common than we think. The medial calcaneal nerve is a purely sensory branch so one has the option of resecting the nerve, nerve decompression or injection of sclerosing agents around the nerve. In the old days, when larger incisions were used for plantar fascial release and heel spur surgery, the medial calcaneal nerve was often cut -- the resulting numbness on the bottom of the heel, I believe, was partially responsible for pain relief from the surgery.
Ed

Re: Calcaneal Nerve Compression

Mar on 12/07/02 at 07:01 (102049)

Are the symptoms of calcaneal neuroma different from PF pain? Mar

Re: Calcaneal Nerve Compression

Dr. David S. Wander on 12/07/02 at 10:44 (102073)

You don't need to have a calcaneal neuroma, you can have a nerve entrapment. The most noted recent literature on nerve entrapments in this area are by Dr. Baxter, a foot/ankle orthopedic surgeon from Texas, and A. Lee Dellon, MD a plastic surgeon from Baltimore, specializing in nerve decompression procedures for entrapment neuropathies and diabetic neuropathy.

The symptoms of nerve entrapment can mimic plantar fasciitis, though nerve entrapment usually presents with more shooting pain and burning pain, and less pain upon arising in the morning and following rest. Unfortunately, you can actually have both an entrapment neuropathy and plantar fasciitis. Check out some of the literature written by Dr. Dellon and Dr. Baxter.

Re: Calcaneal Nerve Compression

Ed Davis, DPM on 12/07/02 at 13:10 (102100)

David:

Baxter views the first branch off the lateral plantar nerve as the culprit in some cases of heel pain. One means of diagnosis this is to palpate the calcaneal tuberosity with the fascia relaxed -- some have termed this 'subcalcaneal' pain. Since his treatment does involve some limited resection of the plantar fascia, it is not clear if the partial fascial release effected the cure or if a decompression actually did occur. The verdict is is still out on this one. What do you think?

I think medial calcaneal neuropathy is easier to diagnose. Most patients I have seen demonstrate a positive tinel's sign over the medial aspect of the calcaneus. The pain is not necessarily increased with placing tension on the fascia/ windlass effect. Also, they may have pain at the tuberosity as well as more superficial pain as the medial calcaneal nerves provide cutaneouos innervation at the bottom of the heel.
Ed

Re: Calcaneal Nerve Compression

Ed Davis, DPM on 12/06/02 at 15:19 (102003)

Mar:
This diagnosis is probably more common than we think. The medial calcaneal nerve is a purely sensory branch so one has the option of resecting the nerve, nerve decompression or injection of sclerosing agents around the nerve. In the old days, when larger incisions were used for plantar fascial release and heel spur surgery, the medial calcaneal nerve was often cut -- the resulting numbness on the bottom of the heel, I believe, was partially responsible for pain relief from the surgery.
Ed

Re: Calcaneal Nerve Compression

Mar on 12/07/02 at 07:01 (102049)

Are the symptoms of calcaneal neuroma different from PF pain? Mar

Re: Calcaneal Nerve Compression

Dr. David S. Wander on 12/07/02 at 10:44 (102073)

You don't need to have a calcaneal neuroma, you can have a nerve entrapment. The most noted recent literature on nerve entrapments in this area are by Dr. Baxter, a foot/ankle orthopedic surgeon from Texas, and A. Lee Dellon, MD a plastic surgeon from Baltimore, specializing in nerve decompression procedures for entrapment neuropathies and diabetic neuropathy.

The symptoms of nerve entrapment can mimic plantar fasciitis, though nerve entrapment usually presents with more shooting pain and burning pain, and less pain upon arising in the morning and following rest. Unfortunately, you can actually have both an entrapment neuropathy and plantar fasciitis. Check out some of the literature written by Dr. Dellon and Dr. Baxter.

Re: Calcaneal Nerve Compression

Ed Davis, DPM on 12/07/02 at 13:10 (102100)

David:

Baxter views the first branch off the lateral plantar nerve as the culprit in some cases of heel pain. One means of diagnosis this is to palpate the calcaneal tuberosity with the fascia relaxed -- some have termed this 'subcalcaneal' pain. Since his treatment does involve some limited resection of the plantar fascia, it is not clear if the partial fascial release effected the cure or if a decompression actually did occur. The verdict is is still out on this one. What do you think?

I think medial calcaneal neuropathy is easier to diagnose. Most patients I have seen demonstrate a positive tinel's sign over the medial aspect of the calcaneus. The pain is not necessarily increased with placing tension on the fascia/ windlass effect. Also, they may have pain at the tuberosity as well as more superficial pain as the medial calcaneal nerves provide cutaneouos innervation at the bottom of the heel.
Ed