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Gastrocnemius Recession in Recalcitrant Plantar Fasciitis: A Systematic Review

Published:November 01, 2021DOI:https://doi.org/10.1053/j.jfas.2021.10.029

      Abstract

      Plantar fasciitis is a common cause of heel pain. Recalcitrant plantar fasciitis can be difficult to manage. Medial gastrocnemius recession is increasingly being used to treat recalcitrant plantar fasciitis, with advocates describing fewer complications and quicker recovery time than other surgical options. This systematic review aimed to determine the effectiveness of gastrocnemius recession for the treatment of patients with recalcitrant plantar fasciitis. Multiple databases were searched using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The level of evidence of each study was assessed according to the American Academy of Orthopaedic Surgeons Levels of Evidence. The level of bias for each study was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Seven studies were retrieved: 3 retrospective case series, 1 retrospective study that compared gastrocnemius recession to open plantar fasciotomy, 1 prospective cohort study (pre-post study with no control group), and 2 randomized controlled trials. All 6 studies that assessed pre- and postoperative pain using the Visual Analogue Scale showed a large reduction in pain postoperatively. Four studies that assessed pain at 12 months postoperatively showed a weighted mean of 76.06 ± 10.65% reduction in pain. No major complications were reported. Minor complications included sural neuritis. This review found a consistent reduction in pain following gastrocnemius release in patients with recalcitrant plantar fasciitis, suggesting it is a very promising treatment. However, the included studies are limited by low quality study designs and inherent biases, limiting the strength of recommendation. Further definitive, well-designed trials are required.

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      References

        • Monteagudo M
        • de Albornoz PM
        • Gutierrez B
        • Tabuenca J
        • Álvarez I.
        Plantar fasciopathy: a current concepts review.
        EFORT Open Rev. 2018; 3: 485-493
        • Cheney N
        • Sharpe BD
        • Lauf J
        • Long J.
        Controversies in surgical treatment of recalcitrant plantar fasciitis.
        Tech Foot Ankle Surg. 2021; 20: 86-102
        • Latt LD
        • Jaffe DE
        • Tang Y
        • Taljanovic MS.
        Evaluation and treatment of chronic plantar fasciitis.
        Foot Ankle Orthop. 2020; 5: 1-11
        • Tweed JL
        • Barnes MR
        • Allen MJ
        • Campbell JA.
        Biomechanical consequences of total plantar fasciotomy.
        J Am Podiatr Med Assoc. 2009; 99: 422-430
        • Anderson JG
        • Bohay DR
        • Eller EB
        • Witt BL.
        Gastrocnemius recession.
        Foot Ankle Clin. 2014; 19: 767-786
        • Maskill JD
        • Bohay DR
        • Anderson JG.
        Gastrocnemius recession to treat isolated foot pain.
        Foot ankle Int. 2010; 31: 19-23
        • Patel A
        • DiGiovanni B
        Association between plantar fasciitis and isolated contracture of the gastrocnemius.
        Foot ankle Int. 2011; 32: 5-8
        • Barouk L
        • Barouk P
        • Toulec E.
        Resultats de la liberation proximale des gastrocnemiens. Etude prospective symposium ‘Brieveté des gastrocnemiens’, journées de Printemps SFMCP-AFCP, Toulouse.
        Med Chir Pied. 2006; 22: 151-156
        • Chimera NJ
        • Castro M
        • Manal K.
        Function and strength following gastrocnemius recession for isolated gastrocnemius contracture.
        Foot ankle Int. 2010; 31: 377-384
        • Liberati A
        • Altman DG
        • Tetzlaff J
        • Mulrow C
        • Gøtzsche PC
        • Ioannidis JPA
        • Clarke M
        • Devereaux PJ
        • Kleijnen J
        • Moher D.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        J Clin Epidemiol. 2009; 62: e1-e34
        • Wright JG.
        Levels of evidence and grades of recommendations - AAOS bulletin.
        AAOS Archives. 2005; (Available at:) (Accessed July 10, 2021)
      1. National Heart, Lung, and Blood Institute. Study quality assessment tools. Available at: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. 2019. Accessed July 10, 2021.

        • Abbassian A
        • Kohls-Gatzoulis J
        • Solan MC.
        Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis.
        Foot Ankle Int. 2012; 33: 14-19
        • Ficke B
        • Elattar O
        • Naranje SM
        • Araoye I
        • Shah AB
        Gastrocnemius recession for recalcitrant plantar fasciitis in overweight and obese patients.
        Foot Ankle Surg. 2018; 24: 471-473
        • Monteagudo M
        • Maceira E
        • Garcia-Virto V
        • Canosa R.
        Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession.
        Int Orthop. 2013; 37: 1845-1850
        • Hoefnagels EM
        • Weerheijm L
        • Witteveen AG
        • Louwerens J-WK
        • Keijsers N.
        The effect of lengthening the gastrocnemius muscle in chronic therapy resistant plantar fasciitis.
        Foot Ankle Surg. 2020; 27: 543-549
        • Molund M
        • Husebye EE
        • Hellesnes J
        • Nilsen F
        • Hvaal K.
        Proximal medial gastrocnemius recession and stretching versus stretching as treatment of chronic plantar heel pain.
        Foot Ankle Int. 2018; 39: 1423-1431
        • Gamba C
        • Serrano-Chinchilla P
        • Ares-Vidal J
        • Solano-Lopez A
        • Gonzalez-Lucena G
        • Ginés-Cespedosa A
        Proximal medial gastrocnemius release versus open plantar fasciotomy for the surgical treatment in recalcitrant plantar fasciitis.
        Foot Ankle Int. 2020; 41: 267-274
        • Sammarco GJ
        • Bagwe MR
        • Sammarco VJ
        • Magur EG.
        The effects of unilateral gastrocsoleus recession.
        Foot Ankle Int. 2006; 27: 508-511
        • DiGiovanni BF
        • Moore AM
        • Zlotnicki JP
        • Pinney SJ.
        Preferred management of recalcitrant plantar fasciitis among orthopaedic foot and ankle surgeons.
        Foot Ankle Int. 2012; 33: 507-512