Background Information:

What are the other Names for the Procedure?

• Heel Spur Surgery
• Removal of Heel Spur

What is Heel Spur Removal surgical procedure?

• A heel spur is a protrusion on the underside of the heel bone, due to the deposition of calcium
• Sometimes, this can cause severe heel pain that does not respond to conservative treatments in which case, a surgery may be performed to remove the heel spur
• The heel pain caused is not due to the heel spur as such, but due to inflammation of the fibrous band of connective tissue (plantar fascia) that runs along the bottom of the foot, connecting the heel bone to the toes
• A Heel Spur Removal surgery is hence directed at releasing this fascia, with or without removal of the heel spur

What part of the Body does the Procedure involve?

A Heel Spur Removal surgical procedure involves the:

• Sole of foot
• Heel bone
• Ligaments and fascia attached to the heel bone

Why is the Heel Spur Removal surgical procedure Performed?

A Removal of Heel Spur procedure may be performed for the following reasons:

• Often, the heel spurs are painless; though sometimes, they can be associated with intermittent or chronic pain, if inflammation develops at the point of spur formation
• The pain may worsen, while walking, jogging, or running
• In most cases, a surgery is successful in treating the condition and relieving pain

What are some Alternative Choices for the Procedure?

• Heel Spur Removal surgery should be used only as a last resort, after conservative treatment methods have failed to produce successful results
• When a heel spur is identified and treated early, conservative methods usually prove to be very effective; particularly, the use of orthotic shoe inserts
• However, if left unchecked, heel spurs and their associated symptoms could become more serious, in which case Heel Spur Removal surgical procedures may be necessitated

Conservative treatments include:

• Stretching exercises
• Shoe-related recommendations
• Taping or strapping to rest stressed muscles and tendons
• Use of shoe inserts or orthotic devices
• Physical therapy
• Over-the-counter medications, such as acetaminophen, or anti-inflammatory medications, such as ibuprofen, to help relieve the pain
• In some patients, steroid injection may be used to relieve heel inflammations

What are the Recent Advances in the Procedure?

Endoscopic plantar fasciotomy is a recent advancement in Heel Spur Removal surgery.

What is the Cost of performing the Heel Spur Removal surgical procedure?

The cost of Heel Spur Removal surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Removal of Heel Spur procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.heel-that-pain.com/heel_spur/surgery/heel_spurs_surgery.php (accessed on May 16, 2014)

http://www.georgelianmd.com/cms/Procedures/SurgicalTreatment/tabid/64/Default.aspx (accessed on May 16, 2014)

http://heelspurs.com/_surgery.html (accessed on May 16, 2014)

http://www.mayoclinic.com/health/plantar-fasciitis/DS00508 (accessed on May 16, 2014)

Prior to Heel Spur Removal surgical procedure:

How is the Heel Spur Removal surgical procedure Performed?

• Treating the foot pain with a Heel Spur Removal surgery can be done in different ways.
• In most techniques, the plantar fascia is released from its attachment to the heel bone, which takes care of the pain
• In endoscopic plantar fasciotomy, two slits are made around the heel. Through these slits in the side of the heel, a small camera is inserted, which allows the surgeon to see the injured area. The surgeon then, detaches or cuts the plantar fascia ligament from the heel bone using a small knife, relieving the tension that created plantar fasciitis
• In other procedures, the entire plantar fascia may not be cut; instead, only a portion of the ligament is detached
• In addition to these procedures, the surgeon may also decide to remove the spur itself, during the operation. When this occurs, the surgeon, guided by a small camera, uses small instruments to completely remove the bony fragments of calcium
• Removal of Heel Spur can seriously diminish occurrences of pain in the heel, since it prevents the tissue around the heel from being damaged further by the bone fragment
• Regardless of the procedure, it is a good idea to talk to your orthopedic surgeon, in order to learn more about each individual procedure that is available for your condition, and to choose the one that is most appropriate for you.

Where is the Procedure Performed?

The Heel Spur Removal surgery is usually performed in an out-patient surgery center facility. Normally, the individual can go home, once the procedure is completed.

Who Performs the Procedure?

The Heel Spur Removal procedure is performed by an orthopedic surgeon and assisted by an anesthesiologist.

How long will the Procedure take?

It usually takes anywhere between 1-3 hours, to complete the Removal of Heel Spur surgery procedure.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Heel Spur Removal procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Heel Spur Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Heel Spur Removal surgical procedure?

• An X-ray of the foot will indicate the heel spur protrusion
• The physician may suggest further tests depending on the health of the individual and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Heel Spur Removal surgical procedure?
• Why is this procedure necessary? How will this procedure help?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• What are the risks while performing the procedure?
• What are the possible complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Heel Spur Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia is administered during a Heel Spur Removal surgery.

How much Blood will you lose, during the Procedure?

• Since the Heel Spur Removal procedure requires only a small incision, the amount of blood loss is minimal
• If complications arise during the procedure, it could lead to a further loss of blood

What are the possible Risks and Complications during the Heel Spur Removal surgical procedure?

There are general factors that increase the risk of getting complications during Heel Spur Removal surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Heel Spur Removal surgery are:

• Bleeding
• Injury to the neighboring structures
• Anesthetic complications
• Need for further procedures

What Post-Operative Care is needed at the Healthcare Facility after the Heel Spur Removal surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Heel Spur Removal surgical procedure:

What are the possible Risks and Complications after the Heel Spur Removal surgical procedure?

Post Heel Spur Removal procedure, the following complications may arise:

• Infection
• Bleeding from the surgical wound
• Pain and discomfort
• Permanent numbness

What is the Prognosis after the Surgery?

A Heel Spur Removal surgery is successful in treating the pain in most cases. The prognosis after Heel Spur Removal is generally good.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms after a Heel Spur Removal surgery:

• Pain around the surgical wound
• Swelling and redness
• Bleeding or fluid drainage around the spot
• Fever
• Dizziness
• Signs of infection

What Post-Operative Care is needed at Home after Heel Spur Removal surgical procedure?

At home, the following post-operative care is recommended, after a Heel Spur Removal surgery:

• At the end of the surgical procedure, the wound is covered and a short plaster splint applied. This dressing and splint gives support to the ankle, holding it securely. The dressing should be left intact, until seen by the surgeon (on subsequent visits)
• Do not walk on the splint; bearing weight on the affected foot, will delay the tissue healing in that area
• If the splint gets wet or there is a problem with it, please inform the doctor immediately
• In some cases, it may be necessary for patients to use bandages, casts, surgical shoes, crutches, or canes, for some period of time, after the surgery

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 6 weeks to 3 months, to fully recover from the Heel Spur Removal surgical procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The spur tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The spur tissue removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Heel Spur Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility
• An anesthesiologist
• The orthopedic surgeon
• A pathologist

Individuals are advised to inquire and confirm the type of billing, before the Heel Spur Removal surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA