Treatment of Chronic Heel Pain by Surgical Release of the First Branch of the Lateral Plantar Nerve

Baxter, Donald E.; Pfeffer, Glenn B.

doi:10.1097/00003086-199206000-00029

Cited by 151 publications

(88 citation statements)

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“…Although there was no significant difference in the grade of surgeon performing the surgery and the MOXFQ or VAS-FA scores, in general, the trends suggest that MOXFQ scores were lower if a consultant performed the procedure compared to a trainee surgeon (total MOXFQ score mean for consultants = 33.0 ± 4.4 and for trainee 36.2 ± 9.1, Wilks Lambda F [3,22] Correlation analyses were performed using percentage scores from questionnaires, bivariate correlation analysis, and 2-tailed Pearson correlations (Table 3). Age correlation analysis showed a generally weak negative correlation between patient age and the score they obtained in the MOXFQ questionnaire, indicating better outcomes in older patients.…”

Section: Resultsmentioning

confidence: 77%

Long-Term Outcome of Open Plantar Fascia Release

MacInnes

Roberts

Kimpton³

et al. 2015

Foot Ankle Int.

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Background: Plantar fasciitis is thought to be a self-limiting condition best treated by conservative measures, but despite this many patients have a prolonged duration of symptoms and surgery may be indicated. Partial plantar fascial release is reported to have a short-term success rate of up to 80%, but anecdotally this was not thought to represent our local experience. Methods: An audit of long-term patient-reported outcomes following open partial plantar fascia release was performed. A total of 30 patients (33 feet) were identified over a 10-year period and case notes were reviewed. Patients were contacted by letter and invited to complete 2 validated patient-reported outcome score questionnaires (Visual Analog Scale-Foot and Ankle [VAS-FA] and Manchester Oxford Foot Questionnaire [MOXFQ]). Responses were received from 24 patients (26 feet). The average ages were 42.4 (range 24-61) for male and 46.2 (range 33-60) for female patients, with a female/male ratio of 2.7:1. The average duration of treatment prior to operative intervention was 3.1 years (range 1-5). Preoperatively, our cohort underwent a range of conservative measures. All patients were reviewed postoperatively, and average time from surgery to completion of questionnaires was 80 months (range 14-130). Results: The outcomes were worse in patients who had received preoperative steroid injections and this was found to be statistically significant. The mean MOXFQ score was 33.6 ± 3.9 (0-64). Mean VAS-FA score was 57.8 ± 4.9 (24-100). Conclusion: This study found a negative correlation between duration of follow-up and outcome, in both MOXFQ and VAS-FA, showing that patients continued to improve many years postoperatively. The authors also found worse outcomes with preoperative steroid injections, better outcomes in older patients, and a weak gender bias, suggesting results in men were better than those in women. A prolonged recovery period and generally poor outcomes leads the authors to suggest that open plantar fascia release is of questionable clinical value and that patients may improve in the natural course of the disease, in spite of surgery. Level of Evidence: Level III, comparative study.

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Section: Resultsmentioning

confidence: 77%

Long-Term Outcome of Open Plantar Fascia Release

MacInnes

Roberts

Kimpton³

et al. 2015

Foot Ankle Int.

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“…In N paper the bifurcation of the tibial nerve into the medial and lateral plantar nerves mostly occurred within the flexor retinaculum and the medial calcaneal branch showed many anatomical variations, the neurovascular bundle was separated from other tendon sheaths, and enclosed in its own tunnel [5]. Hence accurate needle EMG is a cornerstone is diagnosis of this condition as simply relying on the single nerve conduction studies will fails to identify an entrapment due to an anomalous anatomy.…”

Section: Anatomymentioning

confidence: 99%

“…The association of posterior tibial nerve entrapment and athletic pursuit was first identified by Rask when he described it as Jogger's Foot in 1978 [5].…”

Section: Aetiologymentioning

confidence: 99%

Tarsal Tunnel Syndrome—A New Way to Diagnose an Old Problem

O’Brien¹,

Byrden²

2017

WJNS

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Tarsal Tunnel Syndrome [TTS] is the most common lower limb focal neuropathy but it has a poor pick up rate in most Electrodiagnostic (EXD) Laboratories. There is no gold standard for assessing TTS. The tibial nerve has a complex branching system with 4 main branches and 9 different patterns of division. This study evaluated potential TTS with a similar and extensive assessment of the tibial nerve. The protocol involved 2 tibial motor studies to the Adductor Hallucis Longus (AH) and Adductor Digiti Quinti (ADQ) muscles, assessing amplitudes and distal latencies; medial plantar, lateral plantar and calcaneal sensory studies assessing amplitudes and distal latencies. A needle EMG to the tibial innervated AH and ADQ muscles was also performed. This protocol evaluated 12 different parameters which significantly increased the diagnostic yield. TTS has a low pick up rate using current standard assessment methods accounting for between 0.5% and 0.6% of positive cases referred to electrodiagnostic laboratories. This study had a pick up rate of 3.3% with 40 positive cases identified out of a population of 1210 patients referred to an electrodiagnostic laboratory in a calendar year. A combination of positive findings was observed. There were on average 4.3 positive parameters. The calcaneal sensory study and the needle EMG to the distal AH and ADQ muscles were the most sensitive tests. These 3 tests are not routinely performed in most labs. Of the 40 cases of TTS over 80% had a history of either prior injury or surgery to affected lower limb. This study suggests that this 12 parameter assessment will increase diagnostic sensitivity.

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“…9 Neuropathy affecting the FBPLN is an uncommon but well-documented cause of chronic heel pain. 2,3,[8][9][10][11][12] The diagnosis of FBLPN neuropathy can be challenging, as patients may present with generalized heel pain symptoms often overlapping with more common clinical entities such as plantar fasciitis. A sharp, radiating pain along the course of the FBLPN, a focal Tinel sign, and maximal tenderness at the point of nerve entrapment suggest FBLPN involvement, although the sensitivity and specificity of these clinical symptoms and signs have not been established.…”

mentioning

confidence: 99%

“…3,12,13 Consequently, clinicians may use ancillary diagnostic testing to confirm clinically suspected FBLPN neuropathy. 2,3,10,12 Although plain radiographs can identify plantar calcaneal spurs, they are unable to directly visualize nerve entrapment, and many patients with calcaneal spurs are asymptomatic. 14 Magnetic resonance imaging provides excellent soft tissue detail of the TN and its branches, but the sensitivity of magnetic resonance imaging to detect FBLPN neuropathy remains indeterminate.…”

mentioning

confidence: 99%

Sonographic Visualization of the First Branch of the Lateral Plantar Nerve (Baxter Nerve)

Presley

Maida

Pawlina

et al. 2013

J of Ultrasound Medicine

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Technique and Validation Using Perineural Injections in a Cadaveric Modellantar heel pain is one of the most common clinical conditions presenting to foot and ankle specialists, with an estimated lifetime prevalence of 10% among people in the United States. 1 The differential diagnosis of plantar heel pain is broad and includes plantar fasciitis, plantar fascia rupture, calcaneal stress fracture, and fat pad disorders such as fat pad atrophy. 2 James C. Presley, MD, Eugene Maida, MB, ChB, Wojciech Pawlina, MD, Naveen Murthy, MD, Daniel B. Ryssman, MD, Jay Smith, MD Received December 10, 2012, ORIGINAL RESEARCHObjectives-The primary purpose of this investigation was to document the ability of high-resolution sonography to accurately identify the first branch of the lateral plantar nerve (FBLPN) using sonographically guided perineural injections in an unembalmed cadaveric model.Methods-A single experienced operator completed sonographically guided perineural FBLPN injections in 12 unembalmed cadaveric specimens (6 right and 6 left) obtained from 10 donors (5 male and 5 female) aged 47 to 95 years (mean, 71 years) with an average body mass index of 24.2 kg/m 2 (range, 17.2-31.6 kg/m 2 ). All injections were completed using 22-gauge, 38-mm stainless steel needles to deliver 1 mL of 50% diluted colored latex adjacent to the FBLPN in the abductor hallucis-quadratus plantae (AH-QP) interval. Six injections were completed using a cart-based ultrasound (US) machine and a 17-5-MHz transducer, and 6 were completed using a portable US machine and a 12-3-MHz transducer. Nerve conspicuity was graded on a 4-point scale (1, poor; 4, excellent). After a minimum of 24 hours, study coinvestigators dissected each specimen to assess injectate placement.Results-All 12 injections accurately placed latex onto the FBLPN within the AH-QP interval, with 11 of 12 (91%) resulting in complete nerve coverage. Proximal latex overflow to the lateral plantar nerve occurred in 82% of cases (10 of 12). The average distance between the plantar fascia and injected latex was 1.2 cm (range, 1.0-1.75 cm).No vascular injury was seen in any specimen. The average nerve conspicuities were 3.7 (range, 3-4) using the cart-based US machine and 1.8 (range, 1-4) using the portable US machine.Conclusions-Sonographic visualization of the FBLPN in the AH-QP interval is feasible and should be considered for diagnostic and therapeutic purposes in patients presenting with chronic or atypical heel pain syndromes. Further clinical experience should refine the role of FBLPN sonography and explore the utility of sonographically guided diagnostic and therapeutic FBLPN perineural injections.Key Words-Baxter nerve; first branch of the lateral plantar nerve; perineural injectionsVideos online at www.jultrasoundmed.org

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Treatment of Chronic Heel Pain by Surgical Release of the First Branch of the Lateral Plantar Nerve

Cited by 151 publications

References 0 publications

Long-Term Outcome of Open Plantar Fascia Release

Long-Term Outcome of Open Plantar Fascia Release

Tarsal Tunnel Syndrome—A New Way to Diagnose an Old Problem

Sonographic Visualization of the First Branch of the Lateral Plantar Nerve (Baxter Nerve)

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