Gastrocnemius Recessions in the Management of Chronic Recalcitrant Plantar Fasciopathy-A Systematic Review

Background: Chronic Recalcitrant Plantar Fasciopathy (CRPF) is resistant to conservative treatments and has historically been managed with Open Plantar Fasciotomy (OPF). This systematic review aims to evaluate the role of the Gastrocnemius Release Procedures (GRPs) in treating CRPF, focusing on its indications, surgical techniques and clinical outcomes. Methods: A systematic literature search was conducted following PRISMA guidelines using MEDLINE, Cochrane and Scopus. Studies pertinent to the topic were screened, and those that reported clinical outcomes of GRPs in patients with CRPF were retrieved. The quality assessment was carried out using the Newcastle-Ottawa Scale. Results: Eighteen studies met the inclusion criteria, analyzing a total of 901 patients with a mean follow-up of 27.8 months. Indications for performing GRPs subsisted if conservative treatment failed to relieve pain and if Isolated Gastrocnemius Contracture (IGC) was present. All GRPs significantly reduced pain, with Visual Analogue Scale (VAS) scores decreasing from a mean of 7.3 pre-operatively to 2.56 post-operatively (64.93% reduction). American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from 50.1 to 84.7 on average. Ankle dorsiflexion increased by an average of 7.75°. Patient satisfaction was high, with an average rate of 85% (range 61.6% to 100%). Minor complications were reported but resolved in most cases. Conclusions: Indications for performing GRPs still need to be clarified, and the best surgical technique remains to be defined. Nevertheless, the GRP seems to offer sustained pain relief and functional improvement in patients with CRPF.