Case of the month: A case of chronic resistant heel pain successfully treated with minimally invasive surgery

By David Redfern

Heel pain is a common complaint and can become a chronic debilitating problem for affected patients. The most common cause is ‘plantar fasciitis’ (“policeman’s heel”) which is usually ‘insertional’ with typical tenderness on the plantar aspect of the heel at the attachment of the plantar fascia. The case we focus on here involved a policewoman! She suffered with chronic plantar fasciitis and was no longer able to work due to her continuing pain which had persisted  for 3 years despite various treatments including surgery.

She had quite literally exhausted conventional treatments. She was referred to me for assessment and further care and I arranged an MRI scan to confirm the diagnosis. This did indeed confirm plantar fasciitis but also inflammation (bone oedema) within a plantar calcaneal heel spur (see MRI image below).

MRI scan

Whilst an association between the presence of plantar calcaneal heel spurs and plantar fasciitis has been long understood, we also understand that such spurs are not the cause of plantar fasciitis. However, given that this lady had exhausted other treatment options and the MRI showed oedema of the spur I offered her percutaneous (minimally invasive) removal of this using a tiny burr under xray guidance.

The surgery was carried out under a short general anaesthetic through a 3mm incision on the back of the heel under image intensifier guidance (see below)

and she was allowed to take full weight through the foot immediately after surgery. She made excellent progress, and she returned to see me 8 weeks later with a dramatic resolution her pain and has now begun to return to work.

image2

Having suffered 3 years of continuous pain and disability this lady required an expert review to take stock of the situation and find a way forward. Whilst it is generally not routinely recommended to undertake surgery to these heel spurs, the key in this case was to recognise that this was an exception. The combination of a specialist approach and modern keyhole surgical techniques meant that this lady saw an end to her longstanding heel pain. LFAC offers an expert service to patients with heel pain and Mr Redfern is the most experienced surgeon in the UK for modern keyhole surgical techniques. He is an internationally recognised expert in this field, lecturing and training surgeons worldwide.

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