Aim and objective: In this study, we evaluated functional outcomes in patients treated with gastrocnemius recession for chronic plantar fasciitis due to isolated gastrocnemius tightness.
Materials and methods: In this prospective study, 20 patients with chronic plantar fasciitis due to isolated gastrocnemius tightness were included. Non-conservative treatment was given to all patients for 9 months. After the trial of conservative treatment, 20 patients who did not respond well were operated for gastrocnemius (18 open and 2 endoscopic procedures). American Orthopaedic Foot and Ankle Score (AOFAS) was calculated at 6 weeks, 3 months, 6 months, and 9 months. Visual analog score (VAS) was recorded at 9 months. At final follow-up at 9 months, patients were asked to choose satisfaction level in terms of high/partial/low and would they recommend this surgery to their friends and if they would go for the same for the opposite limb.
Results: Visual analog score improved from 7.2 to 1.2 (p value < 0.0001). The difference of the AOFAS at final follow-up (9 months) was found to be highly significant with a pre-op score of 49.4 to a final score as high as 93.3 (p value < 0.0001). Patient satisfaction level was calculated with relation to the AOFAS. High satisfaction was observed in 18 patients and partial satisfaction in 2 patients.
Conclusion: Gastrocnemius recession done for isolated gastrocnemius tightness causing chronic plantar fasciitis provides statistically significant improvement without any major complications with a short recovery period.
Riddle DL, Pulisic M, Pidcoe P, et al. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am 2003;85-A(5):872–877. DOI: 10.2106/00004623-200305000-00015.
Patel A, DiGiovanni B. Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot Ankle Int 2011;32(1):5–8. DOI: 10.3113/FAI.2011.0005.
Maskill JD, Bohay DR, Anderson JG. Gastrocnemius recession to treat isolated foot pain. Foot Ankle Int 2010;31(1):19–23. DOI: 10.3113/FAI.2010.0019.
Ficke B, Elattar O, Naranje SM, et al. Gastrocnemius recession for recalcitrant plantar fasciitis in overweight and obese patients. Foot Ankle Surg 2018;24(6):471–473. DOI: 10.1016/j.fas.2017.05.008.
Carlson RE, Fleming LL, Hutton WC. The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle. Foot Ankle Int 2000;21(1):18–25. DOI: 10.1177/107110070002100104.
Chen YN, Chang CW, Li CT, et al. Finite element analysis of plantar fascia during walking: a quasi-static simulation. Foot Ankle Int 2015;36(1):90–97. DOI: 10.1177/1071100714549189.
Cheung JTM, Zhang M, An KN. Effect of Achilles tendon loading on plantar fascia tension in the standing foot. Clin Biomech 2006;21(2):194–203. DOI: 10.1016/j.clinbiomech.2005.09.016.
Lemont H, Ammirati KM, Usen N. Plantar fasciitis. A degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003;93(3):234–237. DOI: 10.7547/87507315-93-3-234.
League AC. Current concepts review: plantar fasciitis. Foot Ankle Int 2008;29(3):358–366. DOI: 10.3113/FAI.2008.0358.
Radford JA, Burns J, Buchbinder R, et al. Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med 2006;40(10):870–875. DOI: 10.1136/bjsm.2006.029348discussion 875.
Gefen A. Stress analysis of the standing foot following surgical plantar fascia release. J Biomech 2002;35(5):629–637. DOI: 10.1016/s0021-9290(01)00242-1.
Kim W, Voloshin AS. Role of plantar fascia in the load bearing capacity of the human foot. J Biomech 1995;28(9):1025–1033. DOI: 10.1016/0021-9290(94)00163-x.
Cheung JTM, An KN, Zhang M. Consequences of partial and total plantar fascia release: a finite element study. Foot Ankle Int 2006;27(2):125–132. DOI: 10.1177/107110070602700210.
Monteagudo M, Maceira E, Garcia-Virto V, et al. Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession. Int Orthoped 2013;37(9):1845–1850. DOI: 10.1007/s00264-013-2022-2.
Avila A, Monteagudo M, Martinez-Albornoz P, et al. Medial gastrocnemius proximal release in chronic plantar fasciitis. Prospective study of 75 cases. Foot Ankle Surg 2016;2(22):24–25. DOI: 10.1016/j.fas.2016.05.049.
Hoefnagels E, Weereheijm L, Louwerens JW, et al. Chronic therapy resistant plantar fasciitis, the effect of lengthening the gastrocnemius muscle. Foot Ankle Surg 2016;22(2):58. DOI: 10.1016/j.fas.2016.05.143.
Molund M, Paulsrud Ø, Ellingsen Husebye E, et al. Results after gastrocnemius recession in 73 patients. Foot Ankle Surg 2014;20(4):272–275. DOI: 10.1016/j.fas.2014.07.004.
Abbassian A, Kohls-Gatzoulis J, Solan MC. Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis. Foot Ankle Int 2012;33(1):14–19. DOI: 10.3113/FAI.2012.0014.