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Heel Spur Surgery/Endoscopic Heel Spur Surgery
Heel pain is caused by the excessive pull of
a ligament in the arch of the foot called the plantar fascia. Generally
the pain can be treated successfully without the need for surgery.
However there are instances where non-surgical treatment of heel pain
may fail and surgery may be necessary. Very often, the patient with
heel pain will demonstrate a heel spur on an x-ray. In the past, many
of the surgeries that were performed to relieve heel pain were designed
to remove the bone spur. An incision was made on the side of the heel
or the bottom of the heel, the spur identified and removed.
Unfortunately, the healing time was very protracted and continued pain
following the surgery was not uncommon. Now that the cause of heel pain
is better-understood (See heel pain) the surgery is much more successful and the recovery time greatly diminished. The Surgery Most
surgical procedures are aimed at detaching the plantar fascial ligament
from its attachment into the heel bone. This may be accomplished with a
small incision on the bottom of the heel or on the side of the heel.
The procedure is performed by "feel". The surgeon inserted the scalpel
blade and felt for the plantar fascia. Once they were confident that
they had identified the plantar fascia they would cut the ligament free
from the heel bone. In the mid 1990's a new
procedure was developed called the "Endoscopic Plantar Fascial
Release". This procedure developed by Dr. Steven Barrett DPM and Dr.
Steven Day DPM of Houston, Texas uses technology similar to that used
in arthroscopic surgery. A small incision is place on the side of the
heel where a small cannula is placed allowing the insertion of an
arthroscopic camera. The plantar fascial ligament is visualized and
then cut using a small surgical blade. This allows the surgeon greater
control during the surgery. The surgeon can control where and how much
of the ligament is freed from the heel bone. Some surgeons still perfer
to remove the spur at the time of surgery. This is the surgeon's choice
and based upon their training and experience. The
surgery is generally performed in an outpatient surgical center or
hospital operating room. It can be performed under a local anesthesia,
twilight anesthesia or a general anesthesia. At the completion of
surgery a gauze dressing is applied and the patient placed in a post
operative shoe or cast. Recovery Period
Most patients are allowed to walk on the foot immediately but they are
encouraged to limit their activities. The first week it is recommended
that they stay off their feet except to use the restroom or have
something to eat. After the first 3 to 7 days the bandage is removed
and Band-Aids placed over the incision site. At this point the patient
may attempt to wear a good supportive walking shoe if allowed to by
their surgeon. Some surgeons perfer to protect the foot with a cast or
have the patient use crutches. In 10 to 14 days the sutures are removed
and the patient is allowed to bath the foot. It generally takes a
minimum of three weeks before the patient is able to walk normally,
with minimal discomfort. The patient should return to wearing their
orthotics as soon as they are comfortable to wear in their shoes.
Because the surgery does not address the cause of the heel pain (See heel pain) it is a good idea to wear orthotics
following the surgery to reduce reoccurrence of the heel pain or other
foot problems that might arise from excessive pronation of the foot. The
amount of time needed to be off from work depends upon the demands of
the job and the type of shoes that must be worn. If a limited amount of
walking is required for the job and the patient is able to return to
work wearing a cast the patient may be able to return to work in one
week. If the job requires a lot of time standing, walking climbing or
kneeling the patient may be required to be off work for three weeks or
longer. These are general guidelines and it is important that the
patient follow their doctor's instructions and guidance. Each surgeon
has their own set of criteria to guide the patient through their
surgery based upon their experience. Possible Complications Overall
this surgery has a very high success rate, but as with any surgical
procedure there are possible complications. If the patient walks
excessively on the foot during the healing period following the
surgery, it may damage the weakened soft tissues in the area of the
heel. This can lead to continued pain in the heel or in other areas of
the foot, particularly on the top and outside of the foot. This is due
to jamming of a joint in the area. Infection is another possible
complication. The risk of infection will increase if the surgical site
gets wet while the sutures are in place. In some instances a
continuation of the pain may occur. This can be due to the ligament not
being cut all the way through at the time of surgery. Another cause of
continued pain might be the presence on a pinched or damaged nerve
called a calcaneal neuroma. A calcaneal neuroma is relatively
rare and not easily identified and may only be recognized with the
failure of the initial surgery. Some instances of failure of the
surgery cannot be identified. In these cases the initial cause of the
heel pain maybe due to something other than abnormal foot mechanics.
Unfortunately, there are no tests for identifying these other causes of
heel pain. They are generally diagnosed as a matter of exclusion,
rather than with direct diagnostic testing.
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