Hai-En Peng, DPM - Podiatrist, Foot/Ankle Surgeon, Southern California, Thousand Oaks

Rearfoot Surgery

Many conditions can affect the back portion of the foot and ankle. Fortunately, many of these problems can be resolved through conservative treatments. However when pain persists or deformity occurs, surgical intervention can often help alleviate pain, reduce deformity, and/or restore the function of your foot or ankle.

Heel Surgery

Two common conditions that can cause pain to the bottom of the heel are plantar fasciitis and heel spur(s). Although there are many causes of heel pain in both children and adults, most can be effectively treated without surgery. When chronic heel pain fails to respond to conservative treatment, surgical care may be warranted.

Plantar Fasciitis is an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes. This tissue can become inflamed for many reasons, most commonly from irritation by placing too much stress (such as excess running and jumping) on the bottom of the foot.

Heel Spur(s) or heel spur syndrome are most often the result of stress on the muscles and fascia of the foot. This stress may form a spur on the bottom of the heel. While many spurs are painless, others may produce chronic pain.

Based on the condition and the chronic nature of the disease, heel surgery can provide relief of pain and restore mobility in many cases. The type of procedure is based on examination and usually consists of plantar fascia release, with or without heel spur excision. There have been various modifications and surgical enhancements regarding surgery of the heel. Dr. Peng will determine which method is best suited for you.

There are many other causes of heel pain, which has become one of the most common foot problems reported by patients of podiatric physicians. Many of them have a basis in heredity, as do a lot of other foot conditions. Among the causes are stress fractures and stress-fracture syndrome, entrapped nerves, bruises, bursitis, arthritis (including gout), deterioration of the fat pad on the heel, improper shoes, and obesity, just to name some. Most of these conditions will be treated nonsurgically, though surgery may be recommended in some instances.

Extracorporeal shock wave therapy (ESWT) is a noninvasive surgical procedure that uses sound waves to treat chronic heel pain. This outpatient procedure takes about 30 minutes and is usually performed under local and general anesthesia.

ESWT is not used to treat some types of heel pain (e.g., rheumatoid arthritis, infections, tarsal tunnel syndrome) and the procedure is contraindicated in patients who have a bleeding disorder and those who take blood-thinning medications (e.g., warfarin, heparin).

Most patients are able to resume normal activity the day after receiving extracorporeal shock wave therapy. Heavy lifting and strenuous exercise should be avoided for 4 weeks. Side effects include bruising, mild pain, numbness, tingling, and swelling.

Conventional surgery may be necessary to treat severe heel pain that does not resolve or that continues to worsen after 6 months of treatment. Surgery for heel pain may involve release of the plantar fascia, or surgical removal of a heel spur or bursa (fluid filled sac).

The procedure to release the plantar fascia is performed through a small incision in the side or bottom of the foot. The surgeon cuts the fascia, and possibly the flexor digitorum brevis muscle, so that it no longer pulls on the heel bone. If a heel spur is present, it is removed.

Following surgery, the structures that maintained the arch of the foot may no longer function properly, and the arch is weaker and may flatten. In this case, imbalances in the structure of the foot can develop, causing hammertoes or bunions. Orthotics should be used to provide extra support and keep the foot properly aligned.

Haglund's Deformity (pump bump)

This deformity is characterized by a bony enlargement on the back of the heel. Although not always painful, it may become so if bursitis develops near the Achilles tendon secondary to footwear irritation. If attempts at shoe modification and other medical treatments fail to improve this condition, surgical correction may be beneficial. Based on X-ray evaluation and other tests or examinations, Dr. Peng will select an operative treatment to alleviate the condition. Procedures that are included for this problem could as simple as removing the bump or surgically fracturing the heel bone to realign the bone so that the bump is not prominent.

Insertional Achilles Clarification/Spur

This deformity differs from Haglund's deformity, in that spur formation or calcification at the insertion of the achilles tendon is the cause of pain. Often associated with achilles tendinitis, this deformity can often be difficult to treat medically and therefore surgical treatment may be necessary in chronic cases. There are many causes of this condition, including arthritis, but the most common appears to be overuse syndrome, where trauma occurs where the achilles tendon attaches to the heel bone. Surgical treatment includes removal of the bone spur and/or calcification, along with repair of the achilles tendon. This will require the patient being off the foot for 6 weeks to allow the tendon to heal.