Hassan Freih Odeh Abu
Department of Orthopedics Surgery, Jordan University Hospital, P.O. Box 73, Jubaiha 11941, Amman, Jordan.
Foot Ankle Surg. 2009;15(2):90-5. doi: 10.1016/j.fas.2008.08.006. Epub 2008 Oct 1.
The failure of conservative treatment of chronic heel pain might cause prolonged disability from continued discomfort and pain, which mandates a further treatment modality.
The presentation of the results of percutaneous fenestration of the anteromedial aspect of the calcaneus for symptomatic relief of resistant heel pain syndrome.
Between September 2001 and August 2006, 34 patients (38 feet) with chronic heel pain syndrome reported an unacceptable level of pain despite intensive conservative treatment. There were 23 females and 11 males with an average age of 41 years (25-59 years). The average follow-up was 46 months (range, 14-84 months). Clinical evaluation of the intensity of pain (VAS score system), walking distance, standing duration, fascial tenderness, and ankle and subtalar joint motion were evaluated preoperatively and at regular follow-up.
The preoperative pain score level was 8.4 (range, 6-10). The mean postoperative VAS for pain at 4 weeks was 5.89 (range, 3-9), at 8 weeks the value was 3.98 (range, 2-7), at 4 months 2.46 (range, 2-5), at 8 months 1.7 (range, 0-3) and at 12 months zero. A clinical improvement was seen in all patients irrespective of the duration of symptoms (p=0.0041). Three heels (7.9%) had partial relief of pain, but after 43 weeks had complete subsidence of pain. Complications include three transient paraesthesias at the distribution of the medial calcaneal nerve that resolved spontaneously after 8 weeks post-surgery.
The results suggest the technique of percutaneous fenestration is a significantly effective treatment modality for patients with recalcitrant heel pain syndrome after failed conservative treatment. The described technique may provide a useful method for treating refractory heel spur syndrome without resorting to invasive surgical techniques and warrants further study.
慢性足跟痛保守治疗失败可能会因持续不适和疼痛导致长期残疾，这就需要进一步的治疗方式。
展示经皮跟骨内侧开窗术治疗顽固性足跟痛综合征以缓解症状的结果。
2001年9月至2006年8月期间，34例（38足）慢性足跟痛综合征患者尽管接受了强化保守治疗，但仍报告疼痛程度难以忍受。其中女性23例，男性11例，平均年龄41岁（25 - 59岁）。平均随访46个月（范围14 - 84个月）。术前及定期随访时评估疼痛强度（视觉模拟评分系统）、行走距离、站立时间、筋膜压痛以及踝关节和距下关节活动度。
术前疼痛评分水平为8.4（范围6 - 10）。术后4周疼痛的平均视觉模拟评分为5.89（范围3 - 9），8周时为3.98（范围2 - 7），4个月时为2.46（范围2 - 5），8个月时为1.7（范围0 - 3），12个月时为零。所有患者均有临床改善，与症状持续时间无关（p = 0.0041）。3只足跟（7.9%）疼痛部分缓解，但43周后疼痛完全消失。并发症包括3例跟骨内侧神经分布区域的短暂感觉异常，术后8周自发缓解。
结果表明，经皮开窗术是保守治疗失败后顽固性足跟痛综合征患者的一种显著有效的治疗方式。所描述的技术可能为治疗难治性足跟骨刺综合征提供一种有用的方法，无需采用侵入性手术技术，值得进一步研究。
