Distal Tarsal Tunnel Release with Partial Plantar Fasciotomy for Chronic Heel Pain: An Outcome Analysis

Abstract

This study evaluated the effectiveness of distal tarsal tunnel release with a partial plantar fasciotomy for chronic subcalcaneal pain syndrome in patients who failed nonoperative management through a retrospective review of all patients undergoing this procedure between 1994 and 1999. Distal tarsal tunnel release and a partial plantar fasciotomy were offered only to those patients with disabling heel pain and were performed under general anesthesia or ankle block. Seventy-five patients (80 heels), averaging 20 months of nonoperative treatment, were identified (group I). Postoperative outcome questionnaires (SF-36 and Foot Function Index [FFI]) were sent to these patients and 44 (46 heels) responded (group II). In group I, 88% of patients had a good to excellent result. Many continued with mild to moderate residual symptoms, which typically did not limit their activity. In group II, 91% of patients were somewhat to very satisfied with their outcome. Visual analogue scale scores for pain were reduced by a mean of 55. SF-36 scores, matched against a control group of patients receiving just nonoperative treatment, showed a statistically significant improvement in all pain and functioning subcategories. We conclude that a distal tarsal tunnel release with a partial plantar fasciotomy may successfully increase function and decrease pain in patients who fail nonoperative treatment.

Neurolysis for Failed Tarsal Tunnel Surgery

“…The outcomes of TTR have varied, with failure rates of 4% to 56% reported (1,2,4,7), particularly in patients in whom a specific etiology could not be identified (10). We believe that these rates do not always reflect the "true" failure rate, because many studies have been of varieties of surgical release, including extensile release (11), the 4-medial ankle tunnel release (tibialis posterior, medial and lateral plantar nerves, and calcaneal nerve) (1,3,7,12,13), proximal-only TTR (2,3), distal-only TTR (6,14), selective nerve release (2,4,6,15), and shorter incisions (16). Again, only a few studies have been published and have included small numbers of patients with failed TTR, variable results, and a wide range of surgical procedures (4).…”

Heel Pain in the Athlete

“…Open partial plantar fascia release with decompression of the first branch of the lateral plantar nerve 42 (Figure 8) has shown up to 93% satisfaction in multiple studies. 3,10,42 This is the standard approach for patients who are recalcitrant to nonoperative management for at least 6 months.…”

“…3,10,42 This is the standard approach for patients who are recalcitrant to nonoperative management for at least 6 months. Watson et al 42 reported good or excellent results in 88% of cases without removing a heel spur. Complications of plantar fascia release include lateral column instability, pain in the calcaneal cuboid joint, and calcaneus fracture after heel spur removal.…”

Highlights of the Sixteenth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society, Vail, Colorado, 13–15 July 2000

“…In 85 patients (92 heels) with chronic disabling heel pain, distal tarsal tunnel release and partial plantar fasciotomy was done, followed by postoperative immobilization [30]. Good to excellent results were noted in 84% of patients with follow‐up evaluation (SF‐36, Foot Function Index, visual analogue scale (VAS), and general custom questionnaire) [30].…”