Chronic heel pain: when is surgery indicated?

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Background:Chronic recalcitrant heel pain is a commonly observed painful condition that often frustrates both the patient and the treating physician.Methods:Twenty-four patients (14 men and 10 women) with chronic resistant heel pain were included in this study. All patients were locally injected by platelet rich plasma (PRP), and according to the results of injection, patients were divided into two groups: group A patients had significant improvement and group B had no specific progress. Group B patients underwent surgical decompression of the first branch of lateral planter nerve “Baxter’s nerve” with release of medial planter fascia and calcaneal drilling.Results:PRP injection showed 58.3% satisfactory results with improvement of the Plantar Fasciitis Pain/Disability Scale (PFPS) from 79.15 (range, 71.8 to 83.8) to 22.3 (range, 15.4 to 25.5) and improvement of the Foot Function Index (FFI) from 160.42 (range, 155 to 166) to 30.4 (range, 23 to 38). PRP injection failed to provide satisfactory results in 10 patients (41.7%). This group of patients showed 90% satisfactory outcome after surgical interference with improvement of the PFPS from 60.8 (range, 55.4 to 63.8) to 21.8 (range, 16.4 to 25.6) and improvement of the FFI from 143.4 (range, 122 to 155) to 38 (range, 31 to 52).Conclusions:Conservative methods can provide satisfactory outcome in up to 90% in the treatment of chronic heel pain. Resistant cases can be managed by a local injection of PRP; surgical management should be reserved for patients who do not respond to PRP injection. Surgical management requires release of Baxter’s nerve and medial planter fascia, and calcaneal drilling.

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