The Use of Low-Energy Radial Shockwave in the Treatment of Entrapment Neuropathy of the Medial Calcaneal Nerve: A Pilot Study

Abstract

Medial calcaneal nerve entrapment is a well-recognized cause of heel pain. In addition, the development of an amputation neuroma of the medial calcaneal nerve from prior heel surgery via an open incision on the medial aspect of the heel is a serious common postoperative complication and can be extremely difficult to treat. This preliminary pilot study demonstrates that the use of low-energy extracorporeal shockwave is safe and efficacious in the treatment of this disorder without the morbidity associated with denervation surgery, which would be one of the most common methods to treat this complicated situation. Four patients, 2 with bilateral affectation, for a total of 6 medial calcaneal nerves, had a series of treatments with low-energy radial shockwave with the Swiss DolorClast machine. All 4 patients had improvement in their pain scores, to the point that none elected surgical treatment, and there were no complications.

Variations in the branching pattern of tibial nerve in foot: a review of literature and relevant clinical anatomy

“…Variations in the origin of MCN have been reported, but the nerve commonly arises as a branch of the TN [11,20,25,28,77]. The proximity of the origin of the MCN to the TT determines the risk of entrapment and subsequent compression of the nerve [10,24,28]. In other words, the risk of compression of the MCN is greater in the trifurcation pattern of TN termination.…”

“…The condition presents as heel pain, exaggerated after running or standing for long periods, and mimics "Jogger's foot" to an extent [67,74]. Chronic heel pain due to compression of the MCN can present with symptoms overlapping those of plantar fasciitis and Jogger's foot [10,47]. It can present among runners/joggers with a prolonged history of ill-fitting shoes [2,43].…”

“…The patient presents with heel pain that radiates along the inner aspect of the calcaneus to the medial arch of foot [26,60]. The diagnosis is established by eliciting tenderness of the nerve on the inside of the heel and a positive Tinel's sign [10,39,64].…”