OBJECTIVE: To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain. METHODS: The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed, including 20 males and 30 females;aged from 40 to 68 years old with an average of (50.12±7.35)years old, the medical history ranged from 1 to 4 years. All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression, and were followed up, the duration ranged from 24 to 60 months with an average of(42.00±3.28) months. All patients had obvious heel pain before surgery, and X-ray examinations often showed the presence of calcaneal spurs. In addition to the routine foot examination, the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray, for the evaluation of clinical effect. The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain, voluntary movement, gait and stability. RESULTS: The VAS decreased from (8.75±1.24) before surgery to (5.15±2.35) at 3 months after surgery, (4.07±2.53) at 6 months after surgery, and (3.95±2.44) at the last fllow-up(P<0.05). The AOFAS score increased from (53.46±4.17) before surgery to(92.46±2.53) at 3 months after surgery, (96.33±2.46) at 6 months after surgery, and (97.05±2.37) at the last follow-up(P<0.05). The arch height was (41.54±1.15) mm before operation and (41.49±1.09) mm after the operation, the difference was not statistically significant(P>0.05). The internal arch angle of the foot arch was (121±6)° before operation and (122±7)° after operation. The difference was not statistically significant(P>0.05). CONCLUSION Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited great clinical effect for treating intractable heel.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Heel/surgery* ; Heel Spur/surgery* ; Retrospective Studies ; Calcaneus/surgery* ; Foot Diseases ; Pain ; Endoscopes ; Treatment Outcome

Flatfoot could be divided into flexible flatfoot and rigid flatfoot. Flatfoot with symptoms is called symptomatic flatfoot, surgical treatment is required if conservative treatment is not effective. Subtalar arthroereisis is a minimally invasive procedure which has been used for many years with good results in flexible flatfoot, however, still has many controversial points. Controversial points focus on indications and contraindications, optimal age, subtalar arthroereisis alone or not, efficacy and safety of absorbable material implants, and implant removal. The paper reviewed and summarized the use and controversies of subtalar arthroereisis in symptomatic flatfoot as follows:the best indication for subtalar arthroereisis was pediatric flexible flatfoot syndrome and aged from 10 to 12 years old was optimal age for treatment;tarsal coalitions with flatfoot and adult flatfoot were relative indications. Stiff flatfoot, joint laxity, and subtalar arthritis were contraindications;obesity and neurogenic flexible flatfoot were relative contraindications. The correction ability of subtalar arthroereisis alone was limited, and it's combined with other procedures depending on patient's situation. The safety and efficacy of absorbable material implants had been reported. Routine removal of the implant was not necessary, the main reason of which was tarsal sinus pain.
Adult ; Humans ; Child ; Flatfoot/surgery* ; Orthopedic Procedures/methods* ; Absorbable Implants ; Subtalar Joint/surgery* ; Heel/surgery* ; Pain/surgery*

OBJECTIVE: To compare clinical efficacy of minimally invasive locking plate and anatomic locking plate in treating intra-articular calcaneal fractures via sinus tarsi approach. METHODS: A retrospective analysis was conducted of 48 patients with intra-articular calcaneal fractures treated with surgery via sinus tarsi approach from July 2016 to June 2017. According to differernt methods of internal fixation, the patients were divided into minimally invasive locking plate group and anatomic locking plate group. In minimally invasive locking plate group, there were 14 males and 10 females, aged from 27 to 46 years old with an average age of (38.70±5.58) years old, 18 patients were typeⅡand 6 patients were type Ⅲ according to Sanders classification. In anatomic locking plate group, there were 17 males and 7 females, aged from 26 to 46 years old with an average age of (37.10±6.44) years old, 16 patients were typeⅡ and 8 patients were type Ⅲ according to Sanders classification. Operative time, visual analogue scale (VAS), postoperative complications between two groups were compared, and Böhler angle, Gissane angal, calcaneal width and height were recorded and compared between two groups at 1 week after operation and final follow up. The functional effect was assessed according to Maryland foot function score at final follow up. RESULTS: All patients were followed up for (14.10±1.94) months (ranged 12 to 18 months). All patients were obtained bone union from 8 to 16 weeks with an average of (10.60±2.25) weeks. Operation time, VAS score and complication rate in minimally invasive locking plate group were (69.50±7.51) min, (2.80±1.07) and 2 cases respectively, and (77.50±7.15) min, (3.80±1.09) and 8 cases in anatomic locking plate group respectively, there were statistical difference between two groups ( CONCLUSION Compare with anatomic locking plate, minimally invasive locking plate via sinus tarsi approach for Sanders typeⅡ and Ⅲ intra-articular calcaneal fractures could obtain similar reliable fixation and functional recovery with more simple operation, shorter operative time, lighter postoperative pain and less complications.
Adult ; Aged ; Bone Plates ; Calcaneus/surgery* ; Female ; Fracture Fixation, Internal ; Fractures, Bone/surgery* ; Heel ; Humans ; Intra-Articular Fractures/surgery* ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVET o summarize the clinical effects of the repairing methods for skin and soft tissue defection of heel.

METHODSFrom June 1998 to June 2009,42 patients with skin and soft tissue defection of heel underwent the repairing treatment,including 23 males and 19 females, with an average age of 37 years old ranging from 18 to 65. The causes of injuries included mangled injury in 22 cases, high fall injury in 10 cases, cut injury in 5 cases,melanoma in 3 cases, decubital ulcer in 2 cases. Of the 42 cases, 27 were on left side and 15 on right side. The defect area of skin ranged from 3 cm x 2 cm to 18 cm x 16 cm. The time between the injury and surgery ranged from 8 hours to 10 years. The wounds were repaired separately by medial plantar flap in 13 cases, lesser saphenous sural nerve vascular island flap in 18 cases, saphenous neurocutaneous vascular flap in 11 cases. The patients' outcome were evaluated with appearance,blood supply, texture, resilience and two points discrimination of the flaps.

RESULTSAll of the 42 flaps were survived. The distal skin necrosis occurred in 2 flaps, but healing occurred after debridement and intermediate thickness skin grafting. Three patients with sinus formation healed after 5 to 12 months of dressing change. All patients were follow-up for 8 months to 6 years. The flaps of all patients gained a satisfied shape after operation. The patients had a normal gait, the flaps had a good sense and a resistance to wearing,and no ulcer occurred. The two point discrimination of the flap was 4 to 12 mm.

CONCLUSIONIt is convenient and effective to repair the heel skin and soft tissue defects using medial plantar island skin flap when the defects is less then 8 cmx6 cm. As reliable blood supply,major artery preservation and high survival, the lesser saphenous sural nerve vascular island flap and saphenous neurocutaneous vascular flap can be transferred to repair the large soft tissue defect of heel.

Adolescent ; Adult ; Aged ; Female ; Foot Injuries ; surgery ; Heel ; abnormalities ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Young Adult

OBJECTIVETo evaluate therapy effect of radiofrequency in the treatment of painful heel syndrome under arthroscopy.

METHODSFrom January 2006 to December 2011, 13 patients with painful heel syndrome being admitted into our hospital were studied. There were 5 males and 8 femals, ranging in age from 35 to 68 years. All these surgeries were performed under local anesthesia. After constructing a man-made lacouna in the subcutaneous tissue above plantar fascia, a medial and a lateral portal were established on both sides of plantar fascia and at the anterior edge of calcaneal tuberosity. Hyperplasia and torn fiber tissue of plantar fascia, and plantar calcaneal bursa were removed with radiofrequency probe under arthroscopy. Then penetration of the plantar fascia was carried out in a reticulation-shaped pattern with a special radiofrequency probe TOPAZ. Each patient was assessed with VAS pain evaluation criteria and AOFAS ankle-hindfoot score system (AOFAS-AH) before and after operation. All the patients were followed up, and the duration ranged from 6 to 12 months.

RESULTSAll the 13 patients got excellent recovery with their heel pain relieved significantly. VAS score was 8.71 +/- 1.64 before operation, 6.27 +/- 2.53 at the 1st month after operation, and 2.30 +/- 2.69 at the 6th month after operation. AOFAS-AH score was 56.43 +/- 3.72 preoperation, 68.15 +/- 7.38 at 1st month post operation, and 84.51 +/- 2.93 at 6th month after operation. There were no perioperative and postoperative complications related to the procedure, such as blood vessel and nerve injury, and infection.

CONCLUSIONPlantar fasciitis and plantar calcaneal bursitis are main factors of painful heel syndrome. Due to advantages of being easy to operate, having definite effect and no use to do spur removal or plantar fasciotomy. Endoscopy assisted plantar calcaneal bursa removal and plantar fascia penetration by radiofrequency technique can be a satisfactory treatment method for painful heel syndrome.

Adult ; Aged ; Arthroscopy ; methods ; Bursa, Synovial ; pathology ; surgery ; Bursitis ; pathology ; surgery ; Female ; Foot Diseases ; surgery ; Heel ; pathology ; surgery ; Humans ; Male ; Metatarsalgia ; pathology ; surgery ; Middle Aged ; Radio Waves

OBJECTIVETo treat heel pain with small needle-knife according to its classification,so as to improve the therapeutic effects.

METHODSFrom August 2005 to December 2008, 200 patients with 266 heel pain were treated according to the author's classification standards. There were 83 males and 117 females, ranging in age from 26 to 72 years, with a mean age of 46 years; the course of the disease ranged from 3 to 36 months, averaged 6.8 months. According to the classification:67 heels with plantar fasciitis type, 61 heels with calcaneal bursitis type, 36 heels with plantar fat pad inflammation-based type, 6 heels with calcaneus high pressure-type, 21 heels with nerve compression type, 75 heels with mixed type. All the patients were treated with small needle-knife by using different methods according to its classification.

RESULTSAfter 1 month treatment, among the patients with plantar fasciitis-type, 31 heels got an excellent result,36 good;among the patients with calcaneal bursitis type, 32 heels got an excellent result, 29 good; among the patients with plantar fat pad inflammation-based type, 9 heels got an excellent result, 20 good, 4 poor and 3 bad; among the patients with calcaneus high pressure-type, 1 patient got an excellent result, 3 good and 2 poor; among the patients with nerve compression type, 11 heels got an excellent result, 8 good, 1 poor and 1 bad; among the patients with mixed type, 16 heels got an excellent result, 46 good, 5 poor and 8 bad. At the 6th month after treatment, among the patients with plantar fasciitis-type, 21 heels got an excellent result, 40 good,5 poor and 1 bad; among the patients with calcaneal bursitis type, 30 heels got an excellent result, 28 good and 3 poor; among the patients with plantar fat pad inflammation-based type, 15 heels got an excellent result, 18 good, 2 poor and 1 bad; among the patients with calcaneus high pressure-type, 0 patient got an excellent result, 3 good and 3 poor;among the patients with nerve compression type,7 heels got an excellent result, 11 good, 1 poor and 2 bad; among the patients with mixed type, 10 heels got an excellent result, 45 good, 11 poor and 9 bad.

CONCLUSIONThe causes of heel pain can't be explained by using single pathogenesy,and also can't be treated with one method. The patients with calcaneal pain should be treated with different methods according to classification of heel pain, and thus the therapeutic effects can be improved.

Adult ; Aged ; Bursitis ; surgery ; Fasciitis, Plantar ; surgery ; Female ; Foot Diseases ; classification ; surgery ; Heel ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Pain ; surgery

OBJECTIVETo investigate the clinical effect of the nervus cutaneus femoris posterior pedicle flap on repairing large soft tissue defects at the heel or inferior segment of the shank.

METHODSTotally 14 cases were followed up for 8-22 months (mean 15.5 months) to observe the clinical effects of nervus cutaneus femoris posterior pedicle flap on repairing large soft tissue defects of the heel or inferior segment of the shank. Among them, there were 3 patients afflicted with infection and cutaneous defects in the middle and inferior segment of the shank after internal fixation of open fracture, 4 patients with soft tissue defects of the ankle and uncovered tendo calcaneus, and 7 patients with soft tissue defects of the heel and exposed calcaneus.

RESULTSThe flaps survived well in 13 cases and partial necrosis occurred in 1 case that was thereafter cured with changing dressing. Various extents of pain and stiffness of the knee joints were present in all cases and disappeared through 1-8 weeks' (mean 3.2 weeks) functional exercises. The last follow-up showed that all the flaps kept good texture and satisfactory appearance.

CONCLUSIONSThe nervus cutaneus femoris posterior pedicle flap, having the advantages of simple surgical procedures, anastomosing the nerves and restoring the sensation of recipient site, can be used for recovering large soft tissue defects of the shank and ankle.

Adolescent ; Adult ; Aged ; Female ; Heel ; surgery ; Humans ; Leg ; surgery ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Surgical Flaps

BACKGROUND: Soft tissue defects of the posterior heel of the foot present difficult reconstructive problems. This paper reports the authors' early experience of five patients treated with a lateral calcaneal artery adipofascial flap. METHODS: Between 2003 and 2007, five patients (3 males and 2 females) with soft-tissue defects over the posterior heel underwent a reconstruction using a lateral calcaneal artery adipofascial flap and a full-thickness skin graft. The flap sizes ranged from 3.5 x 2.5 cm to 5.5 x 4.0 cm. RESULTS: All five flaps survived completely with no subsequent breakdown of the grafted skin, even after regularly wearing normal shoes. The adipofascial flap donor sites were closed primarily in all patients. CONCLUSIONS: Lateral calcaneal artery adipofascial flaps should be included in the surgical armamentarium to cover difficult wounds of the posterior heel of the foot. These flaps do not require the sacrifice of a major artery to the leg or foot, they are relatively thin with minimal morbidity at the donor site, and leave a simple linear scar over the lateral aspect of the foot.
Adipose Tissue/surgery ; Adult ; Aged ; Child ; Child, Preschool ; Fascia/surgery ; Female ; Heel/*surgery ; Humans ; Male ; Skin/surgery ; Soft Tissue Injuries/*surgery ; *Surgical Flaps/blood supply

The coverage of large soft tissue defects in heel is a problem for surgical reconstruction. Various reconstructive materials are available depending on the location, size and depth of heel defect, but unique function of heel skin cannot be restored easily by means of reconstruction. We used prefabricated flap of the foot heel to cover heel defect in a child and obtained satisfactory clinical results.
Amputation ; Child ; Heel ; injuries ; surgery ; Humans ; Male ; Surgical Flaps

OBJECTIVETo study the anatomy of peroneal tendofascial flap combined with adipofascial flap for the repair of heel tissue defects.

METHODSThe lower extremities of five cadavers (10 sides) were perfused with red latex, the blood supply of peroneal tendofascial flap and vicinity adipofascial flap were observed. The diameter, course, branches and location of the blood vessels were measured. Eight fresh cadavers (16 sides) were perfused with lead oxide-gelatine mixture. The covering fascia tissues of the lower extremities was obtained and photographed by X-ray. The vascular anastomosis and association of nutrient vessel of peroneal tendofascial flap and vicinity adipofascial flap were observed. Two adult lower extremities specimens (4 sides) were used to construct vessel diagrams for observation of the course, distribution and anastomosis of the vessels. Eight cases were treated successfully with theses flaps.

RESULTSThe blood supply of the combined fascial flap is multi-originated. For the area within 4 cm below and above the lateral malleolus cusp, the blood supply includes 2-5 branches from heel lateral artery with an average diameter of (0.5 +/- 0.2) mm, 1-2 branches from posterior lateral malleolus artery with an average diameter of (0.6 +/- 0.2) mm and 2-3 branches from the descending part of perforating branches of peroneal artery with an average diameter of (0.5 +/- 0.2) mm. The blood supply of area 4 cm above lateral malleolus cusp is 1-3 branches from intermuscular septum perforating branches of peroneal artery with an average diameter of (1.0 +/- 0.2) mm. These above branches are anastomosed each other and also send off many smaller branches to form vascular net around tendon. The fascial flaps and free skin grafts in eight patients were completely survived. All patients were followed up for 3-24 months, the donor and recipient sites were healed very well. The functional and cosmetic results were satisfactory.

CONCLUSIONSPeroneal tendofascial flap combined with adipofascial flap, with proximal pedicle or reverse distal pedicle, can be used to repair the defect at the lower leg and refractory small- and medium-sized defects at the heel.

Adipose Tissue ; anatomy & histology ; transplantation ; Adult ; Aged ; Fascia ; anatomy & histology ; transplantation ; Female ; Fibula ; Heel ; injuries ; surgery ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; anatomy & histology ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; Surgical Flaps