Plantar Calcaneal Spurs: Is Surgery Necessary?
When Surgery Is Indicated
There remains a small subsection of patients who ultimately require surgical intervention when all else fails. Partial plantar fasciotomy has remained a mainstay with good long-term outcomes when such patients need a more aggressive treatment approach.
When considering surgery for recalcitrant heel pain, one must ensure a careful and comprehensive differential diagnosis in addition to a thorough history and physical exam. When heel pain is associated with radiographic presence of enthesopathy, the differential should include a history of trauma, degenerative disease, inflammatory joint disease, crystal deposition disease, endocrine disorders (including diabetes mellitus) and infection (such as Reiter’s).8
What The Literature Reveals
One may release a portion of the proximal plantar aponeurosis either openly, percutaneously or endoscopically. Regardless, controversy remains as to the necessity of concomitantly resecting the calcaneal heel spur. As it is technically challenging to resect the spur alone while leaving the plantar fascia inviolate, very few such studies have been reported. Steindler noted that less than half (7/16) of patients with isolated spur resection had good outcomes.15 Anderson found that 11 out of 72 patients had only fair or poor clinical results when the spur was resected alone.16
On the other hand, Ward and Clippinger found that seven out of eight patients had excellent results while one patient had 75 percent improvement with a partial fasciotomy without resecting the spur.17 Snider, et. al., reported that 10 of 11 such procedures among runners also yielded excellent results.18 Brekke and Green found those with minimal incision fasciotomy alone experienced greater pain reduction when they compared them to those who had open procedures with or without heel spur resection.19 In fact, many other studies have also confirmed good postoperative results while the calcaneal spur was left intact.20-26