Cutting Down on the Size of the Cut for Heel Surgery
Pain in the back of the heel doesn't sound like such a serious problem. But it can be disabling. The pain is usually caused by stiff-backed shoes and repetitive motions such as running. Eventually a bursa in the heel becomes irritated and inflamed. A bursa is a fluid-filled sac that cushions bones and soft tissues where they rub against each other. The Achilles tendon may also degenerate and become tender where it enters the heel bone. This can make it hard for doctors to tell exactly where the pain is centered.

Most patients with severe heel pain get better with conservative treatments over time. But about 10 percent of people don't get better. These patients end up needing surgery. Surgery is done to remove the irritated tissue. The surgeon also shaves off the tip of the heel bone at an angle that will help prevent the pain from coming back.

In the past this surgery has always been done as an open procedure. This means it was done with one or more cuts in the skin and soft tissues. For this surgery, the open procedure has a somewhat high rate of complications, including infections and changed nerve sensations.

The endoscope has revolutionized surgery. An endoscope is a tube that can be placed through a very small incision. The endoscope allows surgeons to use tiny cameras to see the inside of the heel, rather than using large cuts. This study looked at how effective endoscopic heel surgery was compared to open surgery.

The authors looked at results in 50 heels, all at least two years after surgery. Results for both open and endoscopic surgery were mostly good. And both groups took about the same amount of time to recover from surgery. However, the endoscopic surgeries were done more quickly, and patients got out of the hospital sooner. More importantly, endoscopic surgeries had fewer complications. The endoscopic surgery also left a smaller scar.

The authors conclude that endoscopic surgery is a good option for this surgery. More study is needed on a bigger group of patients. The authors warn surgeons that the endoscopic technique takes some time to master. The authors also note that patients with calcium deposits and severe degeneration of the Achilles tendon probably do better with open surgery.
Zachary Leitze, MD, et al. Endoscopic Decompression of the Retrocalcaneal Space. In The Journal of Bone and Joint Surgery. August 2003. Vol. 85-A. No. 8. Pp. 1488-1496.