Proximal Medial Gastrocnemius Recession for Recalcitrant Plantar Fasciitis

Area of Science:

• Orthopedic Surgery
• Podiatric Medicine
• Sports Medicine

Background:

• Recalcitrant plantar fasciitis (RPF) presents a treatment challenge due to its resistance to conservative measures.
• Surgical options for RPF are debated, with limited large-scale, long-term outcome data.
• Gastrocnemius recession shows promise, but extensive follow-up studies are scarce.

Purpose of the Study:

• To evaluate the efficacy of proximal medial gastrocnemius recession (PMGR) for RPF.
• To compare patient-reported physical performance (FAAM-ADL) and pain (VAS) pre- and post-surgery.
• To assess mid- to long-term outcomes and patient satisfaction following PMGR.

Main Methods:

• Retrospective cohort study of 167 patients with RPF undergoing PMGR (2009-2021).
• Collected data on FAAM-ADL, VAS, and satisfaction scores at baseline, 1 year, and long-term follow-up.
• Recorded patient demographics, symptom duration, time to improvement, calf power, Silfverskiold test results, and complications.

Main Results:

• Pre-surgery: FAAM-ADL 22.5, VAS 8.6. Post-1-year: FAAM-ADL 89, VAS 1.33 (P < .01).
• Long-term follow-up (>12.5 years): Median FAAM-ADL 86.4, VAS 1.90, satisfaction score 1 (IQR 0-1).
• Low complication rate: 1 lateral gastrocnemius recession, 1 sural nerve neuritis.

Conclusions:

• PMGR is an effective surgical treatment for recalcitrant plantar fasciitis.
• The study provides robust evidence with a large sample size and mid- to long-term follow-up.
• Positive outcomes support PMGR as a valuable option for refractory RPF cases.