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ORTHO Supersite are reporting: Gastrocnemius slide found safe, effective as treatment for chronic plantar fasciitis
Investigators found that the technique provided significant symptom relief even in patients with a body mass index greater than 30.
Quote:
Gastrocnemius recession yielded a 93.6% cure rate in patients with isolated chronic plantar fasciitis, according to a study presented here.
"Increased forces on the Achilles tendon have been correlated with increased tension within the plantar aponeurosis, and because of this, we thought the gastrocnemius slide should be evaluated for treatment of plantar fasciitis," said Jeffrey J. Rocco, MD, at the American Orthopaedic Foot and Ankle Society 23rd Annual Summer Meeting, held here.
Rocco and colleagues evaluated the outcomes for 47 feet of 41 patients examined an average of 19 months after undergoing surgery.
Investigators found that most patients had an improvement in pain, measured using the Visual Analog Scale (VAS). At follow-up, 27 feet of 23 patients had a VAS pain score of 0 points, and 15 feet in 15 patients scored between 1 and 4 points on the VAS. "There were three patients at the time of follow-up who felt that they were not improved, but they were not worse either," Rocco said.
Of 18 patients with a body mass index greater than 30 points, 10 were cured by surgery and had a VAS score of 0. Another six of these 18 patients had an improvement in VAS-measured pain, and two patients reported no change in their symptoms, he said.
"We had no significant complications, [but] we did have some transient sural nerve paresthesia," Rocco said.
"Gastrocnemius recession is a safe alternative to conservative management for people with chronic plantar fasciitis and [it is] a good solution for a difficult problem," he said.
Re: Gastroc recession cured 93.6% of chronic plantar fasciitis
It does beg the question what would have happened had they just unzipped the skin behind the TA, sewn it back up and given the same post op instructions!
Anyone know what happens to heel pain if you stick the foot in a planterflexed cast for 6 weeks without doing any surgery?
Also begs the question how were the patients doing a year on! If the cause of the PF was not tight TA oriented i suspect that they'll be quite a few which recur (especially in the BMI>30 brackett)
As my learned colleague says, a very flawed study.
Re: Gastroc recession cured 93.6% of chronic plantar fasciitis
Hmmm.... This study, although flawed, supports what I have been saying for years. Compliant patients who stretch get better, those that don't stretch do not get better. Most fat patients, in my practice, are far less compliant with self management, especially anything that has to do with exercise. In a couple of years the newly scarred calf will tighten again, the patients will gain more weight, and the success rate will drop from 93.6% to .936%.
Re: Gastroc recession cured 93.6% of chronic plantar fasciitis
"Gastrocnemius slide found safe". --- Hooray!
A spokesman the Gasroc said "he was found safe and well and living in a shed beside Clapham rail junction." Young Gastroc was later transfered to Great Ormond St Hospital for observation after reporting feeling a little stiff from mild hypothermia and post static dyskinesia. :-)
Re: Gastroc recession cured 93.6% of chronic plantar fasciitis
Colleagues:
This study does make sense, even though I don't know I would consider it a first line alternative to conservative therapy. I have been very impressed with the clinical results that a few patients have achieved that have had chronic plantar fasciitis who have been otherwise unresponsive to all conservative measures. These patients did get good relief of symptoms with a gastrocnemius recession procedure. Even though I don't personally do this surgery, since plantar fascial tension is directly related to Achilles tendon, it makes sense that reducing the Achilles tendon tension during weightbearing activities has the potential to relieve the pain of plantar fasciitis.
This procedure could be the next big surgical alternative for plantar fasciitis treatment next to partial plantar fasciotomy..... we just don't know yet what the long term side effects are to gastrocnemius recession, even though the procedure is commonly done for flatfoot reconstructive surgery. Sural nerve injury is the biggest surgical complication so far, to my knowledge.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: Gastroc recession cured 93.6% of chronic plantar fasciitis
Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis.
Abbassian A, Kohls-Gatzoulis J, Solan MC. Foot Ankle Int. 2012 Jan;33(1):14-9.
Quote:
BACKGROUND:
Isolated gastrocnemius contracture has been implicated as the cause of a number of foot and ankle conditions. Plantar fasciitis (PF) is one such condition that can be secondary to altered foot biomechanics as a result of gastrocnemius contracture. In this paper, we report our results with an isolated release of the proximal medial head of gastrocnemius for recalcitrant PF.
METHODS:
We prospectively followed a consecutive series of 21 heels in 17 patients following a Proximal Medial Gastrocnemius Release (PMGR). PF was diagnosed clinically and confirmed radiologically in all cases. To be included, at least 1~year of conservative treatment must have been tried and an isolated gastrocnemius contracture confirmed clinically using Silfverskiold's test preoperatively. Outcome measures included a 5-point Likert scale as well as subjective and objective calf weakness assessments. Final followup was on average 24 (range, 8 to 36) months after the surgery.
RESULTS:
Seventeen of the 21 heels (81%) reported total or significant pain relief following the surgery and none reported worsening of their symptoms. The majority did not have subjective or objective evidence of calf weakness. There were no `major' complications and only one case that suffered a `minor' complication.
CONCLUSION:
We believe a PMGR is a simple way of treating a patient with PF who has failed to respond to conservative management. In our series, the results were favorable, the recovery fast and the morbidity low.
Gastroc recession cured 93.6% of chronic plantar fasciitis
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