Operative treatment of subcalcaneal pain

Twenty of 21 consecutive patients (21 heels) with subcalcaneal pain retractory to conservative treatment managed by resection of the proximal attachment of the plantar fascia and the heel spur, if present, were reviewed retrospectively. The results, at a mean followup of 40 months (range, 12-102 months), using a 100 point scoring system, rated excellent in 8 patients, good in 10, fair in 1, and poor in 1 (90% satisfactory outcome). Time to maximal improvement often was prolonged, yet once reached was maintained over time. The only complication encountered was 1 superficial wound infection. Radiographically it was noted that, despite complete excision, subcalcaneal exostoses often reformed and the fascial transection never did precipitate collapse of the longitudinal arch of the foot. A combination of mucoid and fibrinoid degeneration of the plantar fascia, an acceleration of an age related process, was the principal histopathologic finding. It was concluded that the subcalcaneal pain unresponsive to conservative modalities can be treated effectively by the index procedure. The radiographic and histologic findings of this study suggest that changes within the fascia, rather than the spur, are primarily responsible for the pathogenesis of the syndrome.