Heel Pain—Operative Results

TLDR

Heel pain, often linked to pes planus or pes cavus, can cause significant disability and jeopardize employment or athletic careers. The authors propose that operative treatment targeting entrapment neuropathy can benefit patients with recalcitrant heel pain. Over six years, 34 operations were performed on 26 patients, involving isolated neurolysis of the mixed nerve to the abductor digiti quinti, release of the abductor hallucis fascia, and partial removal of impinging heel spurs or tight plantar fascia. The procedure yielded good results in 32 of 34 heels, with only two poor outcomes.

Abstract

In 6 years through 1982, the authors performed 34 operative cases in 26 patients with recalcitrant heel pain. The operative procedure involves an isolated neurolysis of the mixed nerve supplying the abductor digiti quinti muscle as it passes beneath the abductor hallucis muscle and beneath the medial ridge of the calcaneus. The deep fascia of the abductor hallucis muscle is released routinely, and an impinging heel spur or tight plantar fascia is partially removed or released if it is causing entrapment of the nerve. The biomechanical pathogenesis of heel pain in relation to pes planus and pes cavus predisposing to an entrapment neuropathy is described, and the anatomy of the heel in relation to the nerve distribution is clarified and well illustrated. Of the 34 operated heels, 32 had good results and two had poor results. Heel pain can cause total disability in the working population and may jeopardize one's employment or professional athletic career. The authors believe operative treatment has a place in the care of recalcitrant heel pain and that an entrapment neuropathy is an etiological factor in heel pain.