Percutaneous drilling for chronic heel pain.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Radiology

Background:

• Chronic heel pain, often linked to increased calcaneal activity, presents a significant challenge in orthopedic treatment.
• Recalcitrant cases may require surgical intervention when conservative methods fail and bone scans indicate increased metabolic activity.

Purpose of the Study:

• To evaluate the efficacy of percutaneous drilling of the calcaneus for chronic heel pain.
• To assess clinical outcomes, including pain levels and functional improvement, following the procedure.

Main Methods:

• A retrospective study of 25 feet in 21 patients with chronic heel pain and increased bone scan uptake.
• Minimally invasive surgical technique involving percutaneous drilling of the calcaneus under local anesthesia.
• Clinical evaluation of pain, walking distance, tenderness, and joint motion pre- and post-operatively, with repeat bone scans in a subset of patients.

Main Results:

• 81% of treated feet showed a favorable outcome based on a subjective scoring scale.
• Significant reduction in pain, with visual analog scale scores decreasing from 8.8 preoperatively to 2.4 postoperatively.
• Resolution of abnormal bone scan uptake in 6 out of 7 patients who underwent repeat scans.

Conclusions:

• Percutaneous drilling is an effective surgical option for recalcitrant heel pain, comparable to other surgical methods.
• The procedure appears beneficial for relieving intraosseous congestion and bone-marrow edema.
• Outcomes may be less predictable in patients with rheumatic conditions, systemic pathologies, or Haglund deformity.