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bibliography * The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Santini 2003.

Drilling into calcaneous to treat heel pain is surprisingly effective

Santini S, Rebeccato A, Schiavon R, Nogarin L. Percutaneous drilling for chronic heel pain. J Foot Ankle Surg. 2003;42(5):296–301. PubMed #14566722.
Tags: plantar fasciitis, neat, surgery, good news, etiology, counter-intuitive, foot, leg, limbs, pain problems, overuse injury, injury, tendinosis, treatment, pro

PainSci summary of Santini 2003?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★☆☆?3-star ratings are for typical studies with no more (or less) than the usual common problems. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.

Bone can’t really “swell,” but they can get packed with fluid (“intraosseous congestion and bone-marrow edema,” along with other signs of irritation and fatigue). This was identified in 25 feet using a special medical scan (a bone scan). Three small holes were drilled in the calcaneus (heel) bone to relieve the pressure (particularly in the marrow, I imagine). The authors reported an 81% success rate, with a large drop in pain lasting at least 21 months: from an average of 8.8 on a pain scale, all the way down to 2.2.

~ Paul Ingraham

original abstractAbstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

The authors report a retrospective study involving 25 feet in 21 patients who underwent percutaneous drilling for chronic heel pain. Patients with increased activity of the heel were considered for surgical treatment if there was increased uptake on the delayed bone scans. The average follow-up was 21 months (range, 6 to 30 months). All patients were treated in day surgery with local anesthesia. Three small holes were bored in the medial cortex of the calcaneus. Clinical evaluation of the parameters of pain, walking distance, fascial tenderness, paresthesias, and ankle and subtalar joint motion were evaluated preoperatively and at final follow-up. In 7 patients, repeat bone scans were performed and 6 patients had resolution of the abnormal uptake. In 81% of feet treated, there was a favorable outcome based on a subjective scoring scale. Using a visual analog pain scale, the preoperative pain level was 8.8 (range, 4 to 10), and at latest follow-up, it was 2.4 (range, 0 to 10). These results are comparable to other available surgical methods for the treatment of recalcitrant heel pain. Less predictable results were seen in patients with rheumatic and systemic pathologies and in those diagnosed with Haglund deformity. This technique appears to be effective in the relief of intraosseous congestion and bone-marrow edema.

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One article on cites Santini 2003 as a source:

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