Gastrocnemius Recession in Recalcitrant Plantar Fasciitis: A Systematic Review and Meta-Analysis of Randomized...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Research

Background:

• Recalcitrant plantar fasciitis (RPF) affects up to 10% of patients with chronic heel pain, often resistant to conservative management.
• Isolated gastrocnemius contracture is biomechanically linked to increased plantar fascia tension, suggesting a role for surgical intervention.
• Gastrocnemius recession (GR) is a surgical technique designed to alleviate fascial strain and enhance functional recovery in RPF patients.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of gastrocnemius recession (GR) as a treatment for recalcitrant plantar fasciitis (RPF).
• To evaluate the impact of GR on foot function, pain levels, and ankle dorsiflexion in patients with RPF.
• To compare GR with other surgical interventions like plantar fasciotomy regarding recovery and structural preservation.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines, registered with PROSPERO (CRD420251028862).
• Inclusion of randomized controlled trials assessing GR efficacy in RPF patients, with searches across PubMed, Cochrane Library, and Web of Science.
• Risk of bias assessed using RoB 2 tool; certainty of evidence evaluated using GRADE approach. Primary outcomes: AOFAS, VAS, and FDTPA.

Main Results:

• Five studies with 150 patients showed statistically significant improvements in foot function (AOFAS, SMD = 0.81), pain reduction (VAS, SMD = -1.17), and ankle dorsiflexion (FDTPA, SMD = 0.74).
• GR demonstrated superior postoperative recovery and better preservation of fascial structure compared to plantar fasciotomy.
• No major complications were reported; sustained benefits observed up to six years postoperatively. Moderate to high heterogeneity noted due to surgical technique and follow-up variations.

Conclusions:

• Gastrocnemius recession is a safe and effective surgical treatment for RPF, especially in cases of isolated gastrocnemius contracture unresponsive to conservative care.
• GR significantly enhances foot function, alleviates pain, and improves ankle mobility, offering durable long-term results.
• The findings support GR as a valuable therapeutic option for recalcitrant plantar fasciitis, contributing to improved patient outcomes.