Gastrocnemius release procedures in the treatment of mechanical metatarsalgia: a systematic review

Mechanical metatarsalgia (MM) is a condition marked by forefoot overload, causing pain and functional limitations. While conservative treatments like insoles are often effective, surgery is considered when these fail. Traditional approaches focus on the midfoot or forefoot; however, gastrocnemius release (GR) has emerged as an alternative due to the link between equinus contractures and forefoot overload. This systematic review examines the role of GR in MM treatment, analyzing five studies that met the inclusion criteria. These studies evaluated outcomes following either minimally invasive proximal gastrocnemius release or ultrasound-guided needle-based lengthening. Results showed significant pain reduction, improved American Orthopedic Foot and Ankle Society (AOFAS) scores, and greater ankle dorsiflexion. Patient satisfaction was also high. Despite encouraging outcomes, limitations such as small sample sizes, short follow-ups, and methodological differences highlight the need for further research. Nevertheless, GR appears to be a promising option for MM, particularly in cases of isolated gastrocnemius contracture.