Calcaneal decompression as part of painful heel syndrome treatment
Background: Many modalities of surgical treatment are available for painful heel syndrome like: release of half of planter fascia, excision of spur, drilling of calcaneum, and calcaneal osteotomy, without agreement on the most effective one. Aim: to evaluate the effect of calcaneal bone drilling in addition to planter fascia release and calcaneal spur removal for patients with painful heel syndrome. Patients and methods: between 2007‐2011 at Al‐Yarmouk Teaching hospital, a retrospective comparative study of (44) feet of (38) patients (M=11 and F=27) with persistent painful heel syndrome divided into 2 groups: ﬁrst group (24) feet of (18) patients were treated by calcaneal drilling with the traditional surgery (release of planter fascia + calcaneal spur excision), and the second group (20) feet of (20) patients were treated with traditional surgery only (control group). Evaluation of patient's pain and satisfaction was based on VAS (visual analogue pain scale) system for local pressure tenderness and rest pain. Results: The mean pre‐operative rest pain and local pressure tenderness were 8.38±0.99 and 8.95±1.21 for group I respectively and 8.50±0.81and 8.80±0.81for group II respectively.There was signiﬁcant decrease in rest heel pain in group I in comparison with group II after 6 months (from 4.40±0.97 for group II to 0.88±1.05 for group I), and after 2 years follow‐up (from 2.25±1.47 for group II to 0.25±0.66 for group I) with p<0.05. There was significant decrease in local pressure tenderness in group I in comparison with group II after 6 months follow‐up (from 5.85±1.01 for group II to 1.92±1.58 for group I), and after 2 years follow‐up (from 3.85±1.56 for group II to 0.33±0.75 for group I) with p<0.05. Complications were post‐operative infection (9.1%), heel paresthesia (13.6%), and persistent pain (2.3%). Conclusions: calcaneal drilling is one of significantly effective modality of treatment for recurrent heel pain syndrome when combined with ordinary release of planter fascia and spur excision.