Entrapment neuropathy: The etiology of intractable chronic heel pain syndrome

Hendrix, Christopher L.; Jolly, Gary Peter; Garbalosa, Juan C.; Blume, Peter; Dosremedios, Edmund T.

doi:10.1016/s1067-2516(98)80062-8

Cited by 54 publications

(30 citation statements)

References 18 publications

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“…15,22 Many surgical approaches have been described in the literature. 8,9,16,19,22,[23][24][25][26][27] These include calcaneal spur resection, open fasciotomy, endoscopic plantar fasciotomy, calcaneal osteotomies, decompression of the calcaneus, excision of the infracalcaneal bursa, open release of the plantar neural structures, and percutaneous fasciotomy. The reported success rates range from 50% to 100% for these procedures.…”

Section: Levels Of Evidence: Therapeutic Level IVmentioning

confidence: 99%

A 12-Year Long-Term Retrospective Analysis of the Use of Radiofrequency Nerve Ablation for the Treatment of Neurogenic Heel Pain

Cozzarelli

Sollitto²,

Thapar³

et al. 2010

Foot & Ankle Specialist

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The authors discuss their rationale for the use of radiofrequency nerve ablation (RFNA) in the treatment of chronic neurogenic heel pain. Patients treated for plantar fasciitis who fail to improve after conservative and/ or surgical treatment should be reevaluated for a coexistent nerve entrapment. The results of a retrospective study of 82 patients who have undergone RFNA are presented. The patients were followed at 5, 10, and 12 years after the procedure. An evaluation of medical records was performed as a means of inclusion in this study. A standardized telephone interview was then done, and subjectively scored responses of the patients were recorded and analyzed. Of the patients, 89% reported no recurrence of pain after 5, 10, and 12 years postoperatively. The procedure is relatively easy to perform and involves inserting a 22-gauge cannula with an electrode into the areas of pain. This is done under general anesthesia. It takes approximately 15 to 20 minutes per heel to perform, depending on how many sites of tenderness have been identified. The patient is discharged with a minimal bandage and returns to shoe gear immediately following the procedure. The success rate with RFNA appears to be quite high with fewer associated risks and less post-operative morbidity.

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Section: Levels Of Evidence: Therapeutic Level IVmentioning

confidence: 99%

A 12-Year Long-Term Retrospective Analysis of the Use of Radiofrequency Nerve Ablation for the Treatment of Neurogenic Heel Pain

Cozzarelli

Sollitto²,

Thapar³

et al. 2010

Foot & Ankle Specialist

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“…The outcomes of TTR have varied, with failure rates of 4% to 56% reported (1,2,4,7), particularly in patients in whom a specific etiology could not be identified (10). We believe that these rates do not always reflect the "true" failure rate, because many studies have been of varieties of surgical release, including extensile release (11), the 4-medial ankle tunnel release (tibialis posterior, medial and lateral plantar nerves, and calcaneal nerve) (1,3,7,12,13), proximal-only TTR (2,3), distal-only TTR (6,14), selective nerve release (2,4,6,15), and shorter incisions (16). Again, only a few studies have been published and have included small numbers of patients with failed TTR, variable results, and a wide range of surgical procedures (4).…”

Section: Discussionmentioning

confidence: 99%

“…Throughout the published data, reports have been made of the variable outcomes of tarsal tunnel release (TTR) (2,4,5). The failure rate of TTR has ranged from 4% to 56% (1,2,6,7).…”

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confidence: 99%

Neurolysis for Failed Tarsal Tunnel Surgery

Yalçınkaya

Ozer²,

Yalçın³

et al. 2014

The Journal of Foot and Ankle Surgery

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“…Plantar fascia inflammation Plantar heel pain, gradual onset, worse in the morning, aggravated with weight bearing, palpation tenderness at plantar fascia insertion, pain with passive dorsiflexion of toes 27 Infection Fever, malaise, fatigue, weight loss 33 Heel spur Plantar heel pain, palpation tenderness at plantar fascia insertion 73 Degenerative heel pad Plantar heel pain, intensified by hard-heeled shoes, softened and thinned heel pad, irritated by compression 24 Stress fracture Diffuse heel pain, exacerbated by activity, swelling and redness of the overlying skin, calcaneal tenderness 27 Systemic disease Plantar heel pain, palpation tenderness at plantar fascia insertion, possible symptoms in other regions of the body 17,27 Avulsion of the plantar fascia Sudden onset, tearing or ripping pain in the midfoot or hindfoot, plantar ecchymoses, activity can be intolerable 1,2,5 Entrapment neuropathy Plantar heel pain, paraesthesia, burning and tingling sensation, tenderness along the course of the nerve, positive neural provocation tests 22,27,65 longus, and the tibialis posterior. The second is the tarsal canal, an osteofibrous structure, outlined by the grooved medial surface of the calcaneus and the superficial and deep sheaths of the retinaculum of the flexor digitorum longus tendon.…”

Section: Causes Of Subcalcaneal Heel Pain Signs and Symptomsmentioning

confidence: 99%

“…Subcalcaneal heel pain can be the result of a local entrapment neuropathy that involves the medial calcaneal branches of the tibial nerve or the nerve to the abductor digiti minimi muscle 5,7,22,57,63,64,65 ( Figure 1). Various authors have discussed the pathological processes that can lead to neural tissue compromise.…”

mentioning

confidence: 99%

Differential Diagnosis and Treatment of Subcalcaneal Heel Pain: A Case Report

Meyer¹,

Kulig²,

Landel³

2002

J Orthop Sports Phys Ther

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Objective: To describe the examination and intervention strategy utilized in the differential diagnosis and treatment of a patient with subcalcaneal heel pain. Background: The patient was a 44-year-old man with an 8-month history of left subcalcaneal heel pain. He presented with a chief complaint of limited standing and walking tolerance secondary to pain in the left heel. He had not responded to previous treatments of rest, anti-inflammatory medication, cortisone injections, and exercise prescription. Materials and Methods: The patient's subcalcaneal heel pain was reproduced utilizing the straight leg raise (SLR) in combination with ankle dorsiflexion and eversion to sensitize the tibial nerve. These findings suggested a neurogenic component to the dysfunction. Because restricted ankle dorsiflexion, excessive pronation, and posterior tibialis weakness were also found, mechanical dysfunctions also likely contributed to the etiology of heel pain. The patient was treated for 10 visits over a period of 1 month. Treatment consisted of active and passive motions aimed at restoring pain-free soft-tissue motion along the course of the tibial nerve. In addition, low-dye taping and therapeutic exercises were utilized to control excessive pronation and reduce stress on the plantar structures of the foot. Results: The patient's SLR increased from 42°to 54°and became pain-free. Dorsiflexion range of motion increased from 3°to 8°in the left ankle, and left posterior tibialis strength was normalized. Over a period of 1 month the patient's symptoms were resolved, and his standing and walking tolerance was fully restored. Conclusion: Assessment and potential contribution of neural dysfunction should be considered in patients with subcalcaneal heel pain.

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Entrapment neuropathy: The etiology of intractable chronic heel pain syndrome

Cited by 54 publications

References 18 publications

A 12-Year Long-Term Retrospective Analysis of the Use of Radiofrequency Nerve Ablation for the Treatment of Neurogenic Heel Pain

A 12-Year Long-Term Retrospective Analysis of the Use of Radiofrequency Nerve Ablation for the Treatment of Neurogenic Heel Pain

Neurolysis for Failed Tarsal Tunnel Surgery

Differential Diagnosis and Treatment of Subcalcaneal Heel Pain: A Case Report

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