Endoscopic heel anatomy: analysis of 200 fresh frozen specimens

The authors radiographed and dissected 200 fresh frozen cadaveric specimens selected randomly from the general United States population. A 21% incidence of inferior calcaneal exostosis formation was identified. Of those specimens identified as having an inferior calcaneal exostosis, there was a 52.4% incidence of heel spurs that were in the plantar fascia and a 47.6% incidence of heel spurs that were identified superior to the plantar fascia. After dissection of the specimens, the mean width and thickness of the medial, central and lateral bands of the plantar fascia, and the width of the medial and lateral subcutaneous fat were calculated. The presence of an inferior calcaneal bursa was identified in one specimen, and the presence of a heel neuroma was identified in 0 specimens of the 200 examined. The results of this study will assist the practitioner in performing the endoscopic plantar fasciotomy by providing the surgeon with quantitative averages of fascial dimensions. By knowing these fascial measurements, the practitioner will be aided intraoperatively in determining what level of fasciotomy to perform. This could help obviate some of the postoperative biomechanical sequelae that can occur with total releases, and immediate postoperative excessive ambulation by the patient. This study may help to gain insight into the true etiology of heel spur syndrome/plantar fasciitis.