Plantar fasciitis is a common pathology and the most likely cause for heel pain. It is caused by the inflammation, degeneration and possible calcification of the plantar fascia insertion in the calcaneal bone, reason why it is frequently called of “heel spur”. This pathology is associated with obesity, inactivity, flatfoot and cavus foot.
Repetition microtrauma, due to prolonged walking or running, aggravate symptoms.
Treatment is usually conservative, being the surgical treatment reserved for the recalcitrant cases.
Sometimes, less frequent diagnosis may be the cause of pain.
The picture represents a case with pain for many years, resistant to all measures of conservative treatment, infiltration and extracorporeal shockwave therapy.
In the Magnetic Resonance, an expressive venous dilation (arrow) enrolling the tibial nerve branches (arrow head) is observed.
Surgical exploration has confirmed the imaging findings.
After careful dissection of the tibial vein and tributaries (image above), the dilated venous segment was removed. It is easily perceptible the decompression effect on the tibial nerve and its plantar branches enabling the relief of the symptoms.
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