The patient, we’ll call her “Mildred,” suffered for years with plantar fasciitis—a condition that causes pain on the bottom of the foot, especially near the heel. Despite extensive physical therapy and multiple surgeries, nothing had relieved her pain.
This led her to Dr. Christopher Winfree, from the Neurosurgical Pain Center at Columbia University Medical Center/NewYork-Presbyterian Hospital. Pain surgeons like Dr. Winfree will often attempt to block the kind of pain Mildred was experiencing by implanting an electrical nerve stimulation (ENS) device in the patient’s spine.
The brain and spinal cord make up what is called the central nervous system, and all the nerves once they exit the spine are called the peripheral nervous system. The central nervous system is more delicate, so surgeons prefer to work with peripheral nerves. The most common place to put an ENS device is in the patient’s back, right where the peripheral nerve associated with the pain originates.
These nerve stimulation devices work, essentially, by introducing vibration to mask pain. You may have made use of this natural phenomenon yourself if you have ever rubbed your shin vigorously after bumping it on a coffee table.
The problem for Mildred was that she had already had one of these devices implanted in her back four times, and each time it had failed because of an infection.
When Dr. Winfree evaluated her, he knew that the only hope was to find another location to implant the device, farther along the nerve pathway. The perfect location, he determined, was in the back of her knee. Typically, the surgical placement of an ENS device there involves opening up the back of the knee, dissecting through muscles, arteries and veins to find the nerve they are looking for.
But at this point in Mildred’s ordeal, Dr. Winfree wanted to limit the amount of trauma they had to put her through. So he employed an innovative technique using ultrasound technology as a guide in the placement of the ENS device. Dr. Winfree and his colleagues described this approach in a paper, published in the journal Neurosurgery.
Ultrasound images were used like a camera and required only a tiny incision and a hollow needle. Dr. Winfree then threaded the ENS unit through the needle and attached it right where he wanted it. It didn’t take Mildred long to recover, and she finally got the relief she needed.
Originally posted: October 31, 2009
Updated: October 5, 2016
Image Credit: © [zayacsk] /Adobe Stock
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