Clinical And Plantar Fascial Morphologic Changes After Proximal Medial Gastrocnemius Release Treatment of Recalcitrant Plantar Fasciitis

Abstract

Background: Magnetic resonance imaging (MRI) has been used as a diagnostic and prognostic instrument to evaluate the results of conservative treatment for plantar fasciitis. However, there are scarce data available relative to changes in the plantar fascia after operative treatment. The primary objective of this study is to evaluate the imaging changes in patients with recalcitrant plantar fasciitis treated operatively by means of proximal medial gastrocnemius release. Methods: Thirteen patients with recalcitrant plantar fasciitis were studied with MRI preoperatively and 1 year after operative treatment. Quantitative (plantar fascia thickness) and qualitative variables (hyperintensity in the plantar fascia, insertional calcaneus bone edema, a plantar fascia tear, and the presence of perifascial collections) were assessed by 2 musculoskeletal radiologists. Clinical results were also measured with American Orthopaedic Ankle & Society (AOFAS), visual analog scale (VAS) pain, and 36-Item Short Form Health Survey (SF-36) scales. Results: The mean plantar fascia thickness was 6.59 mm preoperatively and 6.37 mm postoperatively ( P = .972). No statistically significant differences were found in any of the qualitative variables on comparing the pre- and postoperative periods. Patients reported clinical improvements in pain VAS, AOFAS measurement, and the physical subdomains of the SF-36 scale. Conclusion: Quantitative and qualitative variables assessed for the plantar fascia on MRI did not show any significant change after medial gastrocnemius release despite clear clinical improvement. Level of Evidence: Level II, perspective cohort study.

Impacto da liberação proximal do gastrocnêmio medial na fascite plantar: “rapid review”

“…It was found, intraoperatively, that the PMGR achieves a satisfactory correction of the contracture, and, therefore, the release of both heads is not necessary (5) . More than half of the patients (41) 2020 I 6 Clinical and plantar fascial morphologic changes after proximal medial gastrocnemius release treatment of recalcitrant plantar fasciitis Ginés-Cespedosa et al (32) 2021 II 7 Ankle dorsiflexion after isolated medial versus complete proximal gastrocnemius recession: A cadaveric study Manzi et al (40) 2021 V 8 Proximal medial gastrocnemius release: surgical technique Gamba et al (47) improved within two weeks after surgery, even presenting a mean of three years of symptoms (5) .…”

“…Ginés-Cespedosa et al (32) evaluated plantar fascia thickness and clinical outcomes in 13 patients with PMGR, pre-and postoperatively, through MRI. The mean preoperative thickness was 6.59 mm and in the postoperative, 6.37 mm.…”