Endoscopic Decompression of the First Branch of the Lateral Plantar Nerve and Release of the Plantar Aponeurosis for Chronic Heel Pain

Abstract

Entrapment of the first branch of the lateral plantar nerve is a commonly missed cause of recalcitrant plantar heel pain. The diagnosis is made on a clinical ground with maximal tenderness at the site of nerve entrapment. Treatment of the nerve entrapment is similar to that for plantar fasciitis, with rest, activity modification, nonsteroidal antiinflammatory drugs, stretching exercise, and local steroid injection. Surgical release of the deep abductor hallucis fascia is indicated when conservative treatment failed. Endoscopic release of the nerve through the dorsal and plantar portals, as well as endoscopic plantar aponeurosis release, is a feasible approach. P lantar heel pain is one of the most common problems faced by orthopaedic surgeons. Differential diagnoses include plantar fasciitis, entrapment of the first branch of the lateral plantar nerve, fat pad disorders, stress fracture of the calcaneal body, fatigue fracture of the medial calcaneal tuberosity, rupture of the plantar aponeurosis, tarsal tunnel syndrome, sciatica, painful piezogenic heel papules, glomus tumor of the heel pad, and bone and soft tissue tumor. 1The most common cause of plantar heel pain is plantar fasciitis, which is usually cured with conservative care. Entrapment of the first branch of the lateral plantar nerve, which can occur together with plantar fasciitis, is one of the most commonly overlooked causes of plantar heel pain. The nerve consists of sensory fibers for the calcaneal periosteum and the long plantar ligament as well as motor fibers for the quadratus plantae, flexor digitorum brevis, and abductor digiti quinti muscles.2 Nerve entrapment syndrome has previously been considered only in cases with intractable heel pain, but it may play a role in the early phases of painful heel syndrome. 3Diagnosis of the nerve entrapment is made on clinical grounds. Early morning pain is uncommon with isolated nerve entrapment. It tends to cause more pain at the end of the day or after prolonged activity. This may be related to the engorgement of a vessel accompanying the first branch of the lateral plantar nerve causing ischemia of the nerve rather than pure static compression of the nerve by the fascia. 4 The pathognomonic sign is maximal tenderness at the medial border of the plantar heel where the nerve entrapment occurs.1 The diagnosis can be confirmed by injection of lidocaine and bupivacaine into the region of the nerve, resulting in complete, albeit temporary, relief of the pain.

An Anatomical Basis for the Myofascial Trigger Points of the Abductor Hallucis Muscle

“…e muscle originates from flexor retinaculum, medial process of the calcaneus tuberosity, and intermuscular septum between itself and flexor hallucis brevis; the insertion is into the medial aspect of the proximal hallux phalanx, the collateral ligament of the proximal metatarsophalangeal joint, and the medial sesamoid bone [14,15]. e abductor hallucis muscle is innervated by a medial plantar nerve, which is a branch of the tibial nerve, and the vascular supply is made by a medial malleolar network, medial calcaneus branches of the lateral plantar artery, medial plantar artery, first plantar metatarsal artery, and perforations of the arterial plantar arch [16,17].…”

Partial Plantar Fasciotomy Using Endoscope with Inner Two-Channel Portals Produced Better Functional Outcomes Than Mini-Open Procedures for The Treatment of Refractory Plantar Fasciitis

“…After 12 months of follow-up, the AOFAS score increased from 46.00 to 91.67, and the postoperative functional satisfaction reached 89%. In MacInnes's study, [27] [28][29][30] After the treatment in this study, the patients in the arthroscopy group can walk normally and return to normal life on the second day after surgery, while the traditional incision surgery group needs a transition period (about 2 weeks for walking). Partial resection of the calcaneus fascia under two-channel arthroscope in plantar fasciitis patients is a new and innovative technique that has been reported and clinically applied in recent years.…”

Novel Investigation of the Deep Band of the Lateral Plantar Aponeurosis and Its Relationship With the Lateral Plantar Nerve

“…There is a vast amount of literature relating to Baxter nerve, the first branch of the lateral plantar nerve, and its relationship to nerve entrapment and plantar fasciitis. 2,13,17,23 However, literature is deficient when describing the portion of the lateral plantar nerve that passes deep to the fascial band we found. Sarrafian's Anatomy of the Foot and Ankle calls this part of the lateral plantar nerve the superficial Distance from the tuberosity of the base of the fifth metatarsal to point 1. b Distance from point 1 to the location where the fascial band crosses the lateral plantar nerve.…”