Nerve Entrapment in Painful Heel Syndrome

Öztuna, Volkan; Özge, Aynur; Eskandari, Metin Manouchehr; Çolak, Mehmet; Gölpinar, Alper; Kuyurtar, Fehmi

doi:10.1177/107110070202300304

Cited by 32 publications

(17 citation statements)

References 14 publications

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“…39 Many factors have been purported to cause plantar heel pain, including overuse, biomechanical derangements, inflammatory arthritis, stress fractures, nerve entrapment, and defective running shoe construction. 8,32,42 Amis et al 3 found that 78% of patients with painful heels had ankle dorsiflexion limitations of at least 5°. Kibler et al 26 noted that 90% of running athletes with plantar fasciitis had either a lack of 5°dorsiflexion beyond neutral on the affected side, or a lack of 10°or more dorsiflexion compared to the nonaffected side.…”

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A Combined Treatment Approach Emphasizing Impairment-Based Manual Physical Therapy for Plantar Heel Pain: A Case Series

Young¹,

Walker²,

Strunce³

et al. 2004

J Orthop Sports Phys Ther

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Study Design: Case series. Objective: To describe an impairment-based physical therapy treatment approach for 4 patients with plantar heel pain. Background: There is limited evidence from clinical trials on which to base treatment decision making for plantar heel pain. Methods and Measures: Four patients completed a course of physical therapy based on an impairment-based model. All patients received manual physical therapy and stretching. Two patients were also treated with custom orthoses, and 1 patient received an additional strengthening program. Outcome measures included a numeric pain rating scale (NPRS) and self-reported functional status. Results: Symptom duration ranged from 6 to 52 weeks (mean duration ± SD, 33 ± 19 weeks). Treatment duration ranged from 8 to 49 days (mean duration ± SD, 23 ± 18 days), with number of treatment sessions ranging from 2 to 7 (mode, 3). All 4 patients reported a decrease in NPRS scores from an average (±SD) of 5.8 ± 2.2 to 0 (out of 10) during previously painful activities. Additionally, all patients returned to prior activity levels. Conclusion: In this case series, patients with plantar heel pain treated with an impairment-based physical therapy approach emphasizing manual therapy demonstrated complete pain relief and full return to activities. Further research is necessary to determine the effectiveness of impairmentbased physical therapy interventions for patients with plantar heel pain/plantar fasciitis. J Orthop Sports Phys Ther 2004;34:725-733.

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A Combined Treatment Approach Emphasizing Impairment-Based Manual Physical Therapy for Plantar Heel Pain: A Case Series

Young¹,

Walker²,

Strunce³

et al. 2004

J Orthop Sports Phys Ther

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“…Postoperativ Anlegen einer Unterschenkelschiene oder Orthese in Neutralstellung. Hinweise auf ein Nervenengpasssyndrom sind über-wiegend belastungsabhängige Beschwerden an der medioplantaren Ferse und typischerweise verstärkte Beschwerden beim morgendlichen Aufstehen oder nach einer längeren Ruhepause [7,12]. Gelegentlich kann es auch zu Schmerzen im Ruhezustand kommen.…”

Section: Operationstechnikunclassified

“…Der erste Ast des Nervus plantaris lateralis hat rein motorische Qualitäten und versorgt den Musculus flexor digitorum brevis, den Musculus quadratus plantae und den Musculus abductor digiti quinti [10]. Typische Prädilektionsstellen für eine Nervenkompression sind der Rand der tiefen Faszie des Musculus abductor hallucis, die mediale Kalkaneusregion (Region des plantaren Fersensporns) sowie die Region zwischen dem Musculus abductor hallucis und dem medialen Kopf des Musculus quadratus plantae.Hinweise auf ein Nervenengpasssyndrom sind über-wiegend belastungsabhängige Beschwerden an der medioplantaren Ferse und typischerweise verstärkte Beschwerden beim morgendlichen Aufstehen oder nach einer längeren Ruhepause [7,12]. Gelegentlich kann es auch zu Schmerzen im Ruhezustand kommen.…”

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Neurolyse des Nervus plantaris lateralis zur Behandlung des Nervenengpasssyndroms am Rückfuß

Fuhrmann

Fröber

2010

Orthop Traumatol

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From 2006 to 2008, twelve patients (ten women, two men) were treated with a neurolysis of the lateral plantar nerve. In nine patients, the diagnosis was confirmed neurologically; in three patients, the authors decided to perform the nerve decompression due to clinical findings. The patients were followed up clinically (mean follow-up 15 months) and were asked to estimate their pain level with the visual analog scale (VAS). There were no postoperative complications. One patient developed a complex regional pain syndrome. Pain level decreased significantly within 6 weeks (VAS preoperatively 7.9; VAS postoperatively 3.8) and showed a further pain reduction to VAS 2.1 after 9 months. Two patients complained of recurrent symptoms after a mean of 11 months. In these patients, the initial diagnosis could not be confirmed by electrophysiological measurements.

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“…2 Nerve entrapment syndrome has previously been considered only in cases with intractable heel pain, but it may play a role in the early phases of painful heel syndrome. 3 Diagnosis of the nerve entrapment is made on clinical grounds. Early morning pain is uncommon with isolated nerve entrapment.…”

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Endoscopic Decompression of the First Branch of the Lateral Plantar Nerve and Release of the Plantar Aponeurosis for Chronic Heel Pain

Lui¹

2016

Arthroscopy Techniques

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Entrapment of the first branch of the lateral plantar nerve is a commonly missed cause of recalcitrant plantar heel pain. The diagnosis is made on a clinical ground with maximal tenderness at the site of nerve entrapment. Treatment of the nerve entrapment is similar to that for plantar fasciitis, with rest, activity modification, nonsteroidal antiinflammatory drugs, stretching exercise, and local steroid injection. Surgical release of the deep abductor hallucis fascia is indicated when conservative treatment failed. Endoscopic release of the nerve through the dorsal and plantar portals, as well as endoscopic plantar aponeurosis release, is a feasible approach. P lantar heel pain is one of the most common problems faced by orthopaedic surgeons. Differential diagnoses include plantar fasciitis, entrapment of the first branch of the lateral plantar nerve, fat pad disorders, stress fracture of the calcaneal body, fatigue fracture of the medial calcaneal tuberosity, rupture of the plantar aponeurosis, tarsal tunnel syndrome, sciatica, painful piezogenic heel papules, glomus tumor of the heel pad, and bone and soft tissue tumor. 1The most common cause of plantar heel pain is plantar fasciitis, which is usually cured with conservative care. Entrapment of the first branch of the lateral plantar nerve, which can occur together with plantar fasciitis, is one of the most commonly overlooked causes of plantar heel pain. The nerve consists of sensory fibers for the calcaneal periosteum and the long plantar ligament as well as motor fibers for the quadratus plantae, flexor digitorum brevis, and abductor digiti quinti muscles.2 Nerve entrapment syndrome has previously been considered only in cases with intractable heel pain, but it may play a role in the early phases of painful heel syndrome. 3Diagnosis of the nerve entrapment is made on clinical grounds. Early morning pain is uncommon with isolated nerve entrapment. It tends to cause more pain at the end of the day or after prolonged activity. This may be related to the engorgement of a vessel accompanying the first branch of the lateral plantar nerve causing ischemia of the nerve rather than pure static compression of the nerve by the fascia. 4 The pathognomonic sign is maximal tenderness at the medial border of the plantar heel where the nerve entrapment occurs.1 The diagnosis can be confirmed by injection of lidocaine and bupivacaine into the region of the nerve, resulting in complete, albeit temporary, relief of the pain.

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Nerve Entrapment in Painful Heel Syndrome

Cited by 32 publications

References 14 publications

A Combined Treatment Approach Emphasizing Impairment-Based Manual Physical Therapy for Plantar Heel Pain: A Case Series

A Combined Treatment Approach Emphasizing Impairment-Based Manual Physical Therapy for Plantar Heel Pain: A Case Series

Neurolyse des Nervus plantaris lateralis zur Behandlung des Nervenengpasssyndroms am Rückfuß

Endoscopic Decompression of the First Branch of the Lateral Plantar Nerve and Release of the Plantar Aponeurosis for Chronic Heel Pain

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