Renée A Fuhrmann1, Rosemarie Fröber. 1. Lehrstuhl für Orthopädie der Friedrich-Schiller-Universität Jena am Rudolf-Elle-Krankenhaus, Eisenberg, Germany. r.fuhrmann@krankenhaus-eisenberg.de
Abstract
OBJECTIVE: Reduction of heel pain by neurolysis of the lateral plantar nerve. Indications Contraindications Surgical Technique Postoperative Management Results INDICATIONS: Heel pain due to an entrapment of the lateral plantar nerve. CONTRAINDICATIONS: Acute inflammatory alterations in the foot. Skin laceration at the medial hindfoot. Relative: heel pain, which could not be assigned to a distinct diagnosis. Relative: flatfoot deformity with hindfoot valgus. SURGICAL TECHNIQUE: Regional anesthesia. Supine position. Tourniquet. Curved skin incision behind the medial malleolus to the medioplantar aspect of the heel. Incision of the flexor retinaculum and careful dissection of the tibial nerve, until the medial and lateral plantar nerves can be clearly identified. Stepwise decompression of the lateral plantar nerve along its course to the medial aspect of the heel. Exposure of the first branch of the lateral plantar nerve (Baxter's nerve) by dissection of the fascia overlying the quadratus plantae muscle and the flexor digitorum brevis muscle. Release of the tourniquet and hemostasis. Wound closure in layers. Below-knee splint in neutral position of the ankle. POSTOPERATIVE MANAGEMENT: Elevation of the concerned leg. Mobilization without weight bearing during the first 5 days. Stepwise increased weight bearing according to the pain level. Soft insoles for 12 weeks. No running or jumping for 12 weeks. RESULTS: 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.
OBJECTIVE: Reduction of heel pain by neurolysis of the lateral plantar nerve. Indications Contraindications Surgical Technique Postoperative Management Results INDICATIONS: Heel pain due to an entrapment of the lateral plantar nerve. CONTRAINDICATIONS: Acute inflammatory alterations in the foot. Skin laceration at the medial hindfoot. Relative: heel pain, which could not be assigned to a distinct diagnosis. Relative: flatfoot deformity with hindfoot valgus. SURGICAL TECHNIQUE: Regional anesthesia. Supine position. Tourniquet. Curved skin incision behind the medial malleolus to the medioplantar aspect of the heel. Incision of the flexor retinaculum and careful dissection of the tibial nerve, until the medial and lateral plantar nerves can be clearly identified. Stepwise decompression of the lateral plantar nerve along its course to the medial aspect of the heel. Exposure of the first branch of the lateral plantar nerve (Baxter's nerve) by dissection of the fascia overlying the quadratus plantae muscle and the flexor digitorum brevis muscle. Release of the tourniquet and hemostasis. Wound closure in layers. Below-knee splint in neutral position of the ankle. POSTOPERATIVE MANAGEMENT: Elevation of the concerned leg. Mobilization without weight bearing during the first 5 days. Stepwise increased weight bearing according to the pain level. Soft insoles for 12 weeks. No running or jumping for 12 weeks. RESULTS: 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.